Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.
Cardiopulmonary Bypass ; Critical Care ; Emergencies ; Heart Atria* ; Heart Injuries ; Heart Rupture* ; Humans ; Pericardiocentesis ; Thoracostomy ; Vena Cava, Superior*

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BACKGROUND: Totally implantable access port (TIAP) provides reliable, long term vascular access with minimal risk of infection and allows patients normal physical activity. With wide use of ports, new complications have been encountered. We analyzed TIAP related complications and evaluated the outcomes of two different percutaneous routes of access to superior vena cava. METHODS: All 172 patients who underwent port insertion with internal jugular approach (Group 1, n = 92) and subclavian approach (Group 2, n = 79) between August 2011 and May 2013 in a single center were analyzed, retrospectively. Medical records were analyzed to compare the outcomes and the occurrence of port related complications between two different percutaneous routes of access to superior vena cava. RESULTS: Median follow-up for TIAP was 278 days (range, 1-1868). Twenty four complications were occurred (14.0%), including pneumothorax (n = 1, 0.6%), migration/malposition (n = 4, 2.3%), pinch-off syndrome (n = 4, 2.3%), malfunction (n = 2, 1.1%), infection (n = 8, 4.7%), and venous thrombosis (n = 5, 2.9%). The overall incidence was 8.7% and 20.3% in each group (p = 0.030). Mechanical complications except infectious and thrombotic complications were more often occurred in group 2 (p = 0.033). The mechanical complication free probability is significantly higher in group 1 (p = 0.040). CONCLUSIONS: We suggest that the jugular access should be chosen in patients who need long term catheterization because of high incidence of mechanical complication, such as pinch-off syndrome.
Catheterization ; Catheters ; Follow-Up Studies ; Humans ; Incidence ; Jugular Veins ; Medical Records ; Motor Activity ; Pneumothorax ; Retrospective Studies ; Subclavian Vein ; Vascular Access Devices ; Vena Cava, Superior ; Venous Thrombosis

The pleurobiliary fistula was not common but sometimes it could occur after percutaneous transhepatic gallbladder drainage. This report describes the case of an 83-year-old Korean male diagnosed with a pleurobiliary fistula after percutaneous transhepatic gallbladder drainage. The patient was treated with endoscopic transpapillary gallbladder drainage under the guidance of the peroral cholangioscopy with SpyGlass DS system. It can decompress pressure within the gallbladder. Leakage from the gallbladder into the pleura was reduced. Finally, his condition got better and he recovered.

Recently, neuromelanin and nigrosome imaging techniques have been developed to evaluate the substantia nigra in Parkinson’s disease. Previous studies have shown potential benefits of quantitative analysis of neuromelanin and nigrosome images in the substantia nigra, although visual assessments have been performed to evaluate structures in most studies. In this study, we investigate the potential of using deep learning based automatic region segmentation techniques for quantitative analysis of the substantia nigra. The deep convolutional neural network was trained to automatically segment substantia nigra regions on 3D nigrosome and neuromelanin sensitive MR images obtained from 30 subjects. With a 5-fold cross-validation, the mean calculated dice similarity coefficient between manual and deep learning was 0.70 ± 0.11. Although calculated dice similarity coefficients were relatively low due to empirically drawn margins, selected slices were overlapped for more than two slices of all subjects. Our results demonstrate that deep convolutional neural network-based method could provide reliable localization of substantia nigra regions on neuromelanin and nigrosome sensitive MR images.

Recently, neuromelanin and nigrosome imaging techniques have been developed to evaluate the substantia nigra in Parkinson’s disease. Previous studies have shown potential benefits of quantitative analysis of neuromelanin and nigrosome images in the substantia nigra, although visual assessments have been performed to evaluate structures in most studies. In this study, we investigate the potential of using deep learning based automatic region segmentation techniques for quantitative analysis of the substantia nigra. The deep convolutional neural network was trained to automatically segment substantia nigra regions on 3D nigrosome and neuromelanin sensitive MR images obtained from 30 subjects. With a 5-fold cross-validation, the mean calculated dice similarity coefficient between manual and deep learning was 0.70 ± 0.11. Although calculated dice similarity coefficients were relatively low due to empirically drawn margins, selected slices were overlapped for more than two slices of all subjects. Our results demonstrate that deep convolutional neural network-based method could provide reliable localization of substantia nigra regions on neuromelanin and nigrosome sensitive MR images.

Cardiac rupture following blunt thoracic trauma is rarely encountered, since it commonly causes death at the scene. With advances in critical care, blunt cardiac rupture has been successfully treated with well-organized team approach including an emergency physician, anesthesiologist, and cardiac surgeon. We encountered a patient with blunt cardiac rupture of the junction of the superior vena cava and right atrium that extended 7 cm to the right ventricular junction. The patient was successfully resuscitated after a closed thoracostomy and pericardiocentesis with fluid loading. Cardiac injury was repaired via mid-sternotomy without cardiopulmonary bypass. The patient recovered without complications and was discharged on the 7th day after surgery.
Cardiopulmonary Bypass ; Critical Care ; Emergencies ; Heart Atria ; Heart Injuries ; Heart Rupture ; Humans ; Pericardiocentesis ; Thoracostomy ; Vena Cava, Superior

PURPOSE: There is an increasing incidence of mortality among trauma patients; therefore, it is important to analyze the trauma epidemiology in order to prevent trauma death. The authors reviewed the trauma epidemiology retrospectively at a regional emergency center of Korea and evaluated the main factors that led to trauma-related deaths. MATERIALS AND METHODS: A total of 17007 trauma patients were registered to the trauma registry of the regional emergency center at Wonju Severance Christian Hospital in Korea from January 2010 to December 2012. RESULTS: The mean age of patients was 35.2 years old. The most frequent trauma mechanism was blunt injury (90.8%), as well as slip-and-fall down injury, motor vehicle accidents, and others. Aside from 142 early trauma deaths, a total of 4673 patients were admitted for further treatment. The most common major trauma sites of admitted patients were on the extremities (38.4%), followed by craniocerebral, abdominopelvis, and thorax. With deaths of 126 patients during in-hospital treatment, the overall mortality (142 early and 126 late deaths) was 5.6% for admitted patients. Ages > or =55, injury severity score > or =16, major craniocerebral injury, cardiopulmonary resuscitation at arrival, probability of survival <25% calculated from the trauma and injury severity score were independent predictors of trauma mortality in multivariate analysis. CONCLUSION: The epidemiology of the trauma patients studied was found to be mainly blunt trauma. This finding is similar to previous papers in terms of demographics and mechanism. Trauma patients who have risk factors of mortality require careful management in order to prevent trauma-related deaths.
Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Cause of Death ; Child ; Child, Preschool ; Emergency Service, Hospital ; Female ; *Hospital Mortality ; Hospitalization ; Humans ; Infant ; Infant, Newborn ; Injury Severity Score ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Risk Factors ; Survivors ; Wounds and Injuries/*epidemiology/*mortality ; Young Adult

Alzheimer’s disease (AD) is a progressive and most frequently diagnosed neurodegenerative disorder. However, there is still no drug preventing the progress of this disorder. β-Amyrin, an ingredient of the surface wax of tomato fruit and dandelion coffee, is previously reported to ameliorate memory impairment induced by cholinergic dysfunction. Therefore, we tested whether β-amyrin can prevent AD-like pathology. β-Amyrin blocked amyloid β (Aβ)-induced long-term potentiation (LTP) impairment in the hippocampal slices. Moreover, β-amyrin improved Aβ-induced suppression of phosphatidylinositol-3-kinase (PI3K)/Akt signaling.LY294002, a PI3K inhibitor, blocked the effect of β-amyrin on Aβ-induced LTP impairment. In in vivo experiments, we observed that β-amyrin ameliorated object recognition memory deficit in Aβ-injected AD mice model. Moreover, neurogenesis impairments induced by Aβ was improved by β-amyrin treatment. Taken together, β-amyrin might be a good candidate of treatment or supplement for AD patients.

Purpose: Patient handovers are critical for patient safety. Studies have shown that nurses are often interrupted during handovers, and standardized guidelines are lacking. This study aimed to develop and evaluate the effectiveness of a new handover method for emergency nurses. Methods: This quasi-experimental study implemented a new handover method from August 1, 2022, at the emergency department of a university hospital. Pre- (34 responses) and post-(16 responses, six months later) surveys and post-interviews (six participants) were conducted. In the pre-survey, data were collected regarding handover-related characteristics, cause of handover error, handover perception and handover error experience. Data regarding handover perception and handover error experience were obtained again at the post-survey. Wilcoxon’s signed rank test was used to compare handover perception and handover error experience. The interview results were analyzed using inductive content analysis. Results: There were no significant differences in information quality or interaction and support, but the new handover method was more efficient, and handover errors decreased. Four themes were identified from interview responses. Conclusion By providing a quiet place and allowing emergency nurses to independently review patient records during handovers, we expect to maintain nursing continuity, increase efficiency, and ultimately ensure patient safety and nurses’ job satisfaction.