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The pharmacokinetic properties of transdermal nicotine patches (TNPs) are different from those of other routes of nicotine administration; further, acute nicotine poisoning by TNPs may present with different clinical features. In the present report, we describe the case of a 23-year-old woman who was admitted to emergency department (ED) at Jeju National University Hospital with loss of consciousness. Five hours before the ED visit, she used multiple TNPs to attempt suicide. Initially, nausea and vomiting occurred, and the symptoms worsened over time. We immediately removed the TNPs, and the application sites were gently washed with sterile water. The patient’s level of consciousness gradually improved, and she fully recovered an altered mental status 5 hours later. Her initial urinary cotinine level was 324 ng/mL. Physicians should be aware that acute nicotine poisoning by TNPs can cause various toxic symptoms.

Objective This study aimed to determine whether there is a difference in mortality and medical resource utilization between geriatric (aged ≥65 years) and super-geriatric patients (aged ≥80 years) with traumatic brain injury (TBI). Methods We obtained comprehensive data (demographics, injury characteristics, injury severities, and outcomes) of geriatric and super-geriatric TBI patients from an emergency department-based injury surveillance system database from 2011 to 2016. Multivariate logistic regression analysis was performed to compare the mortality and nonroutine discharge (NRDC) status between both groups. Results Among 442,533 TBI patients, 48,624 were older than 65 years. A total of 48,446 patients (37,140 geriatric and 11,306 super-geriatric) without exclusion criteria were included in the final analysis. Both overall in-hospital mortality (adjusted odds ratio, 1.88; 95% confidence interval [CI], 1.28 to 2.74; P=0.001) and NRDC (adjusted odds ratio, 1.35; 95% CI, 1.07 to 1.71; P=0.011) were significantly higher in the super-geriatric group. In the stratified analysis, there were no significant differences in NRDC rate for all stratifications of treatment timing (emergency department vs. ward admission), but mortality remained to be significant for all stratifications. Conclusion Super-geriatric TBI patients showed a significantly higher risk-adjusted overall mortality and more inadequate medical resource utilization than did geriatric TBI patients. However, super-geriatric patients were more likely to undergo NRDC after admission; thus, further research about age-related health inequalities is needed in the treatment of super-geriatric patients.

Background We aimed to investigate the prevalence of low back pain (LBP) and its associated agricultural work-related, biomechanical factors among this population. Methods We analyzed initial survey data from the Safety for Agricultural Injury of Farmers cohort study involving adult farmers in Jeju Island. The prevalence of LBP was calculated with associated factors. Results In total, 1,209 participants were included in the analysis. The overall prevalence of LBP was 23.7%. Significant associations for LBP were the type of farming activity, length of farming career, prior agricultural injury within 1 year, and stress levels. Multivariate logistic regression analysis revealed three biomechanical factors significantly related to LBP: repetitive use of particular body parts; the inappropriate posture of the lower back and neck. Conclusions Some occupational, and biomechanical risk factors contribute to LBP. Therefore, postural education, injury prevention education, and psychological support will be needed to prevent LBP.

Purpose: To evaluate the severity of trauma, many scoring systems and predictive models have been presented. The quick Sequential Organ Failure Assessment (qSOFA) is a simple scoring system based on vital signs, and we expect it to be easier to apply to trauma patients than other trauma assessment tools. Methods: This study was a cross-sectional study of trauma patients who visited the emergency department of Jeju National University Hospital. We excluded patients under the age of 18 years and unknown outcomes. We calculated the qSOFA, the Modified Early Warning Score (mEWS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) based on patients’ initial vital signs and assessments performed in the emergency department (ED). The primary outcome was mortality within 14 days of trauma. We analyzed qSOFA scores using multivariate logistic regression analysis and compared the predictive accuracy of these scoring systems using the area under the receiver operating characteristic curve (AUROC). Results: In total, 27,764 patients were analyzed. In the multivariate logistic regression analysis of the qSOFA, the adjusted odds ratios with 95% confidence interval (CI) for mortality relative to a qSOFA score of 0 were 27.82 (13.63-56.79) for a qSOFA score of 1, 373.31 (183.47-759.57) for a qSOFA score of 2, and 494.07 (143.75-1698.15) for a qSOFA score of 3. In the receiver operating characteristic (ROC) curve analysis for the qSOFA, mEWS, ISS, and RTS in predicting the outcomes, for mortality, the AUROC for the qSOFA (AUROC [95% CI]; 0.912 [0.871-0.952]) was significantly greater than those for the ISS (0.700 [0.608-0.793]) and RTS (0.160 [0.108-0.211]). Conclusions: The qSOFA was useful for predicting the prognosis of trauma patients evaluated in the ED.

Glufosinate ammonium (GLA) is widely used as a commercial herbicide in many countries. Neurotoxicity of GLA has been associated with serious neurological complications such as loss of consciousness, convulsions, and memory impairment. Late-onset memory impairment due to GLA-induced hippocampal lesions is the most distinct clinical feature in GLA poisoning. However, the lesion of the splenium of the corpus callosum (SCC) is a rare condition in GLA poisoning, so the clinical features are not well known. We report the case of a 57-year-old male patient who developed SCC damage after GLA poisoning. The patient had various late-onset neurotoxic symptoms, including prolonged overall cognitive dysfunction and psychosis-like symptoms. Emergency physicians should be aware that GLA-induced SCC lesions may be associated with various late-onset neurotoxic symptoms.

Mondini-like dysplasia is a rare congenital inner ear malformation (IEM) and the most common anomaly associated with recurrent bacterial meningitis in children. Early diagnosis of Mondinilike dysplasia is crucial for preventing recurrent bacterial meningitis. We report a case of a 15-year-old girl with unrecognized Mondini-like dysplasia that was early diagnosed in the Emergency Department at the first episode of bacterial meningitis. Assessing hearing function in children who have their first episode of meningitis is crucial. Abnormal hearing test results are critical diagnostic findings that help to suspect an IEM. In addition, high-resolution computed tomography of the temporal bones is an excellent diagnostic tool for IEM.

Farmers' injuries are more frequent and severe than those in the other job groups. To identify the characteristics of agricultural injuries in Jeju, 119 first aid records and emergency department based injury surveillance system data for four years were analyzed retrospectively. Farmers' injuries in 119 first aid records were 1,947 cases, and mean age of injured patients was 63.9±11.8 years. The proportion of major trauma was 27.4%. The more frequent months of farmers' injuries were from August to October. In comparison between farmers' and non-farmers' injuries, farmers' injuries showed more male proportion (70%), mean age (54.0±17.0 years), and old age proportion (29%) than non-farmers' injuries did, with significance(p

Proper transportation of patients within the golden time is essential in emergency medical service system. Awareness of transportation in 178 paramedics was surveyed with questionnaire. The subjects included 155 men (87.1%), and the mean age was 37.1±6.1 years. In comparison according to gender, women paramedics showed significantly higher scores in decision of destination depending on patients' severity (p=0.018), whereas men paramedics in going to the nearest hospital under emergent situation (p=0.014). In comparison according to qualification licenses, first responders revealed significantly lower scores in decision of destination on patients' claim (p=0.033) and going to the nearest hospital under emergent situation (p=0.023), whereas significantly higher in decision of destination depending on patients' severity (p

Here, we describe a popliteal mass that was initially misdiagnosed as a simple popliteal cyst, which finally turned out to be osteochondrolipoma. A 63-year-old housewife presented with sustained knee pain in association with a palpable mass on the popliteal fossa. The mass was in the posteromedial area and soft, non-tender, non-movable in the posteromedial area. Using plain radiography, the mass appeared as a round, soft tissue density lesion containing bony fragments. We performed an ultrasound-guided needle biopsy in conjunction with magnetic resonance imaging, followed by an open excisional biopsy. Microscopically, histological sections showed a lipoma with cartilaginous and osseous differentiation, finally diagnosed as osteochondrolipoma. In conclusion, popliteal masses are not always simple cysts, and the evaluation of masses in the popliteal fossa is always necessary.

Patient-physician interaction in clinical performance examination is one of essential components and assessed by standardized patients on the basis of five checklists. In this paper, medical students self-assessment was compared to standardized patients assessment on patient-physician interaction in clinical performance examination of one university. There were no significant correlations between them in two scenarios including breast pain and acute abdomen. However, there were tendencies that students underestimated their patient-physician interaction and orders of higher scores were regular independent of scenarios.

We report a case of a postinfarction ventricular septal defect caused by an acute recurrent occlusion after the implantation of a covered stent, which was performed as a rescue procedure for the ruptured left anterior descending artery during a percutaneous coronary intervention. Although the emergent implantation of a covered stent for the ruptured coronary arteries such as the left main coronary artery or the origins of the left anterior descending artery can be performed during a percutaneous coronary intervention, and a coronary bypass surgery should be considered in order to decrease the risk of complete occlusion, thus providing a superior long term patency.

PURPOSE: The clinical and radiographic outcomes of the internal fixation, which were executed on patients over the age of 65 with proximal humerus fracture by using a polyaxial angular stable locking compression plate (Non-Contact-Bridging proximal humerus plate, Zimmer, Switzerland, NCB), were evaluated.MATERIALS AND METHODS: Thirty two patients over the age of 65 among the proximal humerus fracture treated with NCB plate, between August 2007 and January 2011, were chosen as the subjects. The average age of patients was 71 years, and the average postoperative follow-up period was 11.5 months. The fractures included 14 two-part and 18 three-part fractures. The clinical results were evaluated, using the visual analog scale (VAS) score and the Constant score. The radiological results were evaluated by time to union and Paavolainen method, which measures the neck shaft angle.RESULTS: At the last follow-up examination, the mean VAS score was 3 points and the mean Constant score was 64.5 points, with bone union achieved after the average of 16.2 weeks following the surgery in all the cases. The mean neck shaft angle was 125.9 and 24 cases had good results, while 8 cases had fair results by Paavolainen method, at the last follow-up. There were 1 case of delayed union and cerclage wire failure, and 3 cases of subacromial impingement. There were no complications, such as loss of reduction, nonunion, screw loosening, or avascular necrosis of the humeral head.CONCLUSION: Internal fixation, using a NCB plate, was considered to be an effective surgical method in treating proximal humerus fracture in the elderly patients, on whom the fixation of the fracture and maintenance of reduction are difficult.

5% . 질소산화물을 저감하였으며 배기가스재순환율이 높을수록 질소산화물의 저감율도 증가하였다. Abstract: To meet the requirements of the Tier 4 interim regulations for off%road vehicles, emissions of particulate matter (PM) and nitrogen oxides (NOx) must be reduced by 95% and 30%, respectively, compared to current regulations. In this research, both the DPF and HPL EGR systems were investigated, with the aim of decreasing the PM and NOx emissions of a 56%kW off%road vehicle. The results of the experiments show that the DOC%DPF system is very useful for reducing PM emissions. It is also found that the back pressure is acceptable, and the rate of power loss is less than 5%. By applying the HPL EGR system to the diesel engine, the NOx emissions under low%and middle%load conditions are reduced effectively because of the high differential pressure between the turbocharger inlet and the intake manifold. The NOx emissions can be decreased by increasing the EGR rate, but total hydrocarbon (THC) emission increases because of the increased fuel consumption needed to compensate for the power loss caused by EGR and DPF.

Acquired bronchoesophageal fistula rare. Conservative treatment such as endoscopy is widely used. The recurrence rate after endoscopic treatment, however, is not well known. We report here on a case of a 54-year-old female who presented with recurrent bronchoesophageal fistula after endoscopic treatment that filled the fistula tract with Histoacryl ⓡ .

In this paper, firstly, we propose a generating method of the 3-D obstacle map using ultrasonic sensors. Secondly, we try to find the necessary stimulation conditions of compact tactile display device for effective transfer of obstacle information. The final goal of this research is the development of a walking guide system for the blind to walk safely. The walking guide system consists of a guide vehicle for the obstacle detection and a tactile display device for the transfer of the obstacle information. The guide vehicle, located in front of the walking blind, detects the obstacle using ultrasonic sensors. The processed information makes an obstacle map and transmits safe path and emergency situation to the blind by the tactile display. The tactile display device, located in the handle which is connected with the guide vehicle by cane, offers the processed obstacle information such as position, size, moving, shape of obstacle and safe path, etc. The concept of a walking guide system with tactile display is introduced, and experiments of 3-D obstacle detection and tactile perception are carried out and analyzed.

For safe walking of the people who are blind, walking assistance robot which can detecting and avoiding the obstacle was investigated. The implemented prototype walking assistance robot consists of a obstacle detecting module, a user interface using acoustic signal and a driving module. The obstacle detecting module uses 6 ultrasonic sensors those located at the front part of the robot can perceive the obstacle which is in 3 meter distances and degrees. It calculates the distance and degree from the obstacle using TOF (time of flight) method and decides the 3-dimensional location of the obstacle. The obstacle information is delivered to the user using acoustic alarm and guide sound. The robot is designed to avoid by itself when the obstacle is detecting and the user only follows it to safe walking. After the designed robot was implemented, driving and obstacle detecting experiments were carried out. The result showed that the designed walking assistance robot will help the people who are blind to walk around safe.

Pectus excavatum is rare, but it is the most common type of sternal congenital disorder. There are many surgical methods to correct pectus excavatum such as the Ravitch method, Wada method, Silastic mold method, and the Nuss operation. We report a case of minimal invasive surgery for pectus excavatum using a polyvinyl alcohol sponge.

This research is about a comfort sensing system for human environmental monitoring using a one-bodied humidity and temperature sensor and an air flow sensor. The thermal comfort that a human being feels in indoor environment has been known to be influenced mostly by six parameters, i.e. air temperature, radiation, air flow, humidity, activity level and clothing thermal resistance. Considering an environmental monitoring, we have designed and fabricated a one-bodied humidity and temperature sensor and an air flow sensor that detect air relative humidity, temperature and air flow in human environment using surface micromachining technologies. Micro-controller calculates a PMV (predicted mean vote) and CSV (comfort sensing vote) with sensing signals and display a PMV on LCD (liquid crystal display) for human comfort on indoor climate. Our work has demonstrated that a comfort sensing system can provide an effective means of measuring and monitoring the indoor comfort sensing index of a human being. Experimental results with simulated environment clearly suggest that our comfort sensing system can be used in many applications such as air conditioning system, feedback controlling in automobile, home and hospital etc..

The percutaneous transcatheter closure of secundum atrial septal defect has recently become an increasingly widespread alternative to surgical closure in many centers. Although immediate, short, and intermediate term results of percutaneous transcatheter septal closure are promising, the procedure is not free from inherent complications that could be lethal. We report a case of device embolization necessitating emergent surgical retrieval.

Background We aimed to evaluate the efficacy and safety of early surgical ligation (within 15 days of age) over late surgical ligation (after 15 days of age) by a comparative analysis of very low birth weight (VLBW) infants undergoing surgical correction for symptomatic patent ductus arteriosus (PDA) over the course of 6 years in our hospital. Methods We retrospectively reviewed all the medical records in the neonatal intensive care unit at Hanyang University Seoul Hospital, from March 2007 to May 2013, to identify VLBW infants (< 1,500 g) who underwent surgical PDA ligation. Results The gestational age (GA) in the late ligation (LL) group was significantly younger than in the early ligation (EL) group (p=0.010). The other baseline characteristics and preoperative conditions did not differ significantly between the two groups. The intubation period before surgery (p < 0.001) and the age at surgery (p < 0.001) were significantly different. The postoperative clinical outcomes of the study patients, including major morbidity and mortality, are summarized. There were no significant differences in bronchopulmonary dysplasia, sepsis, or mortality between the EL and the LL groups. However, the LL group was significantly associated with an increased risk of necrotizing enterocolitis (p=0.037) and with a prolonged duration of the total parenteral nutrition (p=0.046) after adjusting for GA. Conclusion Early surgical ligation for the treatment of PDA that failed to close after medical treatment or in cases contraindicated for medical treatment might be desirable to reduce the incidence of necrotizing enterocolitis and to alleviate feeding intolerance in preterm infants.

Many robotic applications have been developed for rescue operations during disasters; these applications involve the use of different types of robots such as fire-fighting robots, rescue robots, and surveillance robots. In this paper, we propose two novel wireless remote controllers that not only offer a user-friendly operating interface but also enable easy control of a robot. The handheld controller can be easily carried by firefighters and the joystick-based controller allows more accurate and rapid control for specific tasks in emergency situations. Both controllers are designed to gather situational information such as video feed and temperature and gas concentration data. We analyze the efficiency of the two controllers by carrying out a performance evaluation. To determine the usefulness of these controllers to firefighters, a questionnaire survey was conducted. Based on the opinions of firefighters, we suggest scenarios in which both controllers may be applicable at expected fire sites.

A prototype of a walking guide robot with tactile display was introduced, and the psychophysical experiment of the tactile recognition for a tactile display was carried out and analyzed. The objective of this research is the development of a walking guide robot for the blind to walk safely. The walking guide robot consists of a guide vehicle for the obstacle detection and a tactile display device for the transfer of the obstacle information. The guide vehicle, located in the front of the walking blind, detects the obstacle using ultrasonic and infrared ray sensors. The processed information makes a obstacle map and transmits safe path and emergency situation to the blind by the tactile display. The guide vehicle offers the information of position and walking direction acquired from GPS module to the walking blind by voice. The tactile display device, located in the handle which is connected with the guide vehicle by cane, offers the processed obstacle information such as position, size, moving, shape of obstacle and safe path, etc.. The psychophysical experiments for the threshold of perception and recognition ability of tactile stimulation were carried out by the estimation of the subject group. As a result, the appropriate tactile stimulus intensity and frequency to recognize tactile stimulation effectively were discussed and derived.

Preoperative prediction of patellar tendon length is important during anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autograft. Three methods of imaging analysis to predict patellar tendon length were compared in this study. One hundred and twenty-three patients who underwent ACL reconstruction using BPTB autograft by single surgeon during October 2002 through April 2011 were included. We measured the patellar tendon length from true and oblique lateral simple radiographs (classified according to degree of rotation) and magnetic resonance image (MRI). These values were compared with actual length measured during operation and assessed accuracy by calculating the coefficient of determination. The mean length of patellar tendon measured during operation and by true lateral and oblique lateral radiographs and MRI were 42.4±0.45 mm (range, 32.0–54.0 mm), 41.7±0.61 mm (range, 24.2–55.3 mm), 40.7±0.57 mm (range, 24.8–51.5 mm), and 41.7±0.52 mm (range, 28.7– 56.0 mm), respectively. The correlation of patellar tendon length was the most strong between actual length and value from true lateral radiograph (coefficient of determination, r=0.660) according to simple linear regression analysis. R values were 0.361 and 0.332 for oblique lateral radiograph and MRI compared to actual value, respectively. In conclusion, Patellar tendon length measured on true lateral radiograph was the best method to coincide with actual patellar tendon length among various preoperative prediction methods.