Background: It is important to communicate accurately in the emergency department. Due to COVID-19 pandemic, a mask is mandatory to protect medical staffs and patients from infectious diseases, and the mask is known to disturb speech intelligibility. The objective of this study is to find out if a transparent mask can affect communication. Methods: : We conducted a randomized pre- and post-test trial with 40 participants in a real emergency room environment. The reader puts on a mask and read aloud sentences which are frequently used between medical staffs and patients or among medical staffs. The type of mask was randomly assigned to the reader which was transparent or non-transparent. Frequently used 5 sentences between medical staffs and patients and 5 sentences among medical staffs from prepared 100 sentences were randomly selected and recited. Participants were told to write down the sentences they heard. Each sentence written down was graded 0 or 1. After writing down 10 sentences, reader puts on another type of mask and the same experiment was done. The order of transparenton-transparent mask was randomly allocated to each participant. Results: : In frequently used sentences between medical staffs and patient, average score with a transparent mask was 4.88, and with a non-transparent mask was 4.50(p=0.001). In frequently used sentences among medical staffs, average score with a transparent was 4.77, and with a non-transparent mask was 4.05(p<0.001). Conclusions This study showed the transparent mask improves speech intelligibility when communicating in an emergency room.

Objective: The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients. Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8°C at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason. Results: Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference. Conclusion This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

Objective: The number of elderly people visiting emergency rooms is rapidly increasing. Fever is one of the common complaints of patients who come to the emergency room, and it is often difficult to determine its cause in elderly patients only through basic examinations and tests. This study sought to verify the relationship between computed tomography and emergency department revisits of febrile elderly patients. Methods: This study is a retrospective medical record analysis study. Patients who came to our emergency room between September 2016 and September 2019, aged 65 years or more, and with body temperature higher than 37.8°C at the time of presentation or during their stay in the emergency room were enrolled. Patient age, sex, vital signs at triage, laboratory tests, whether computed tomography (CT) was conducted or not were analyzed. The primary outcome was set as revisits to the emergency department within 72 hours after discharge, due to any reason. Results: Three thousand two hundred and forty patients were enrolled and of these 289 patients revisited the emergency department (ED). In the revisit (-) group, CT was performed on 44.09% of patients and 54.67% of patients in the revisit (+) group thus showing a statically significant difference. Conclusion This study showed that in elderly patients with fever presenting to the ED, patients who underwent a CT had 1.558 higher odds of revisit to the ED compared to patients who did not undergo a CT. From this result, it should be considered that the decision to discharge the febrile elderly patients based on the results of CT examination may not be appropriate.

Phage display technology provides a powerful tool to screen a library for a binding molecule via an enrichment process. It has been adopted as a critical technology in the development of therapeutic antibodies. However, a major drawback of phage display technology is that because the degree of the enrichment cannot be controlled during the bio-panning process, it frequently results in a limited number of clones. In this study, we applied next-generation sequencing (NGS) to screen clones from a library and determine whether a greater number of clones can be identified using NGS than using conventional methods. Three chicken immune single-chain variable fragment (scFv) libraries were subjected to bio-panning on prostate-specific antigen (PSA). Phagemid DNA prepared from the original libraries as well as from the Escherichia coli pool after each round of bio-panning was analyzed using NGS, and the heavy chain complementarity-determining region 3 (HCDR3) sequences of the scFv clones were determined. Subsequently, through two-step linker PCR and cloning, the entire scFv gene was retrieved and analyzed for its reactivity to PSA in a phage enzyme immunoassay. After four rounds of bio-panning, the conventional colony screening method was performed for comparison. The scFv clones retrieved from NGS analysis included all clones identified by the conventional colony screening method as well as many additional clones. The enrichment of the HCDR3 sequence throughout the bio-panning process was a positive predictive factor for the selection of PSA-reactive scFv clones.
Antibodies ; Bacteriophages ; Chickens ; Clone Cells* ; Cloning, Organism ; Complementarity Determining Regions ; DNA ; Escherichia coli ; Immunoenzyme Techniques ; Mass Screening ; Methods ; Polymerase Chain Reaction ; Prostate-Specific Antigen ; Single-Chain Antibodies

OBJECTIVE: It is difficult for emergency residents to attend all the lectures that are required because of the limited labor time. The Google Hangouts program for has been used as a remote videoconference to overcome the limit to provide equal opportunities and reduce the time and costs since 2015. This article reports the authors' experiences of running a residency education program using Google Hangouts. METHODS: From 2015, topics on the emergency radiology were lectured to emergency residents in three different hospitals connected by Google Hangouts. From 2017, electrocardiography analysis, emergency radiology, ventilator application, and journal review were selected for the remote videoconference. The residents' self-assessment score, and a posteducation satisfaction questionnaire were surveyed. RESULTS: Twenty-nine emergency residents responded to the questionnaire after using the Google Hangouts. The number of participants before and after Hangout increased significantly in other two hospitals. All the residents answered that the score on achieving the learning goal increased before and after the videoconference lectures. All the residents answered that the training program is more satisfactory after using the Google Hangouts than before. CONCLUSION: All emergency residents were satisfied and were more confident after the remote videoconference education using the Google Hangouts than before.
Education ; Electrocardiography ; Emergencies ; Emergency Medicine ; Internship and Residency ; Learning ; Lectures ; Running ; Self-Assessment ; Ventilators, Mechanical ; Videoconferencing

Background: Dental diseases are common in dogs and cats, and accurate measurements of dentoalveolar structure are important for planning of treatment. The information that the comparison computed tomography (CT) with dental radiography (DTR) is not yet reported in veterinary medicine. Objectives: The purpose of this study was to compare the DTR with CT of dentoalveolar structures in healthy dogs and cats, and to evaluate the CT images of 2 different slice thicknesses (0.5 and 1.0 mm). Methods: We included 6 dogs (2 Maltese and 1 Spitz, Beagle, Pomeranian, mixed, 1 to 8 years, 4 castrated males, and 2 spayed female) and 6 cats (6 domestic short hair, 8 months to 3 years, 4 castrated male, and 2 spayed female) in this study. We measured the pulp cavity to tooth width ratio (P/T ratio) and periodontal space of maxillary and mandibular canine teeth, maxillary fourth premolar, mandibular first molar, maxillary third premolar and mandibular fourth premolar. Results: P/T ratio and periodontal space in the overall dentition of both dogs and cats were smaller in DTR compared to CT. In addition, CT images at 1.0 mm slice thickness was generally measured to be greater than the images at 0.5 mm slice thickness. Conclusions The results indicate that CT with thin slice thickness provides more accurate information on the dentoalveolar structures. Additional DTR, therefore, may not be required for evaluating dental structure in small-sized dogs and cats.

Background/Aims: Small rectal neuroendocrine tumors (NETs) are often managed with local resection (endoscopic or transanal excision) owing to their low risk of metastasis and recurrence. However, the clinical significance of lymphovascular invasion in resected specimens remains controversial. In this study, we aimed to analyze the frequency of and risk factors for lymph node metastasis proven by histopathologic examination after radical resection. Methods: We retrospectively reviewed the records of 750 patients diagnosed with a rectal NET at four academic medical centers in South Korea between 2001 and 2019. The frequency of histopathologically proven lymph node metastasis and the associated risk factors were analyzed for small tumors (≤1.5 cm) with lymphovascular invasion. Results: Among 750 patients, 75 had a small tumor (≤1.5 cm) with lymphovascular invasion, of whom 31 patients underwent endoscopic resection only and 44 patients underwent additional radical surgery. Among the 41 patients who underwent surgery and had available data, the rate of regional lymph node metastasis was 48.8% (20/41). In multivariate analysis, the Ki-67 index (odds ratio, 6.279; 95% confidence interval, 1.212 to 32.528; p=0.029) was an independent risk factor for lymph node metastasis. During the mean follow-up period of 37.7 months, only one case of recurrence was detected in the surgery group. The overall survival was not significantly different between radical resection and local resection (p=0.332). Conclusions Rectal NETs with lymphovascular invasion showed a significantly high rate of regional lymph node metastasis despite their small size (≤1.5 cm).

Purpose: The purpose of this study was to investigate the cause of acute fatal poisoning and the time of death by analyzing the National Emergency Department Information System (NEDIS) of South Korea. Methods: The NEDIS data from 2014 to 2018 excluding non-medical visits were used for this study. The patients with acute poisoning were extracted using diagnostic codes. The toxic substances were classified into pharmaceuticals, pesticides, gases, artificial poisonous substances, and natural toxic substances. Patients were classified according to the time of death, place of death, and region. In each case, the most causative substances of poisoning were identified. Results: There were 380,531 patients including poisoning-related diagnoses, of which 4,148 (1.1%) died, and the WHO age-standardized mortality rate was 4.8 per 100,000. Analysis of 2,702 death patients whose primary diagnosis was acute poisoning, the most common cause of poisoning death was pesticides (62%), followed by therapeutic drugs, gas, and artificial toxic substances. Herbicides were the most common pesticides at 64.5%. The proportion of mortality by time, hyperacute (<6 h) 27.9%, acute (6-24 h) 32.6%, subacute (1-7 d) 29.7%, and delayed period (>7 d) were 9.8%. Conclusion This study suggests that the most common cause of poisoning death was pesticides, and 60% of deaths occurred within 24 hours. The 71% of mortality from pesticides occurred within 6-24 hours, but mortality from gas was mostly within 6 hours. According to the geographic region, the primary cause of poisoning death was varied to pesticides or pharmaceuticals.

Purpose: We report an atypical case of ischemic oculomotor palsy occurring sequentially in both eyes and then improving, followed by a new abducens palsy in a diabetic patient with poor blood sugar control.Case summary: A 51-year-old woman presented with diplopia, dizziness, and pain in the right eye and was diagnosed with oculomotor palsy in the right eye. Magnetic resonance imaging of her brain was normal but glycated hemoglobin concentration was 13.4%. After 2 months, the third nerve palsy in the right eye had recovered completely but a new third nerve palsy occurred in the left eye. 1 month later, the symptoms had improved, and the patient did not return to our clinic until 18 months later, when she returned with new diplopia. This time, she was diagnosed with a sixth nerve palsy in the left eye and was observed while controlling her blood sugar. She recovered after 4 months. Conclusions Generally, cranial nerve palsies occur unilaterally in situations that can cause ischemia, such as diabetes, high blood pressure, and hyperlipidemia. Rarely, they occur bilaterally, or two or more cranial nerve palsies occur simultaneously. However, it is very rare that cranial nerve palsy occurs sequentially in both eyes under the same systemic blood sugar control. Diabetic patients with poor blood sugar control require long-term monitoring, considering the possibility of symptoms developing in both eyes with a time lag or other forms of ischemic cranial nerve palsy.

Purpose: This study investigated the characteristics and treatment outcomes of patients who visited the emergency department due to intoxication and analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on their visits. Methods: A retrospective study was conducted using data from the National Emergency Department Information System (NEDIS) on patients who visited the emergency department due to intoxication between January 2014 and December 2020. In total, 277,791 patients were included in the study, and their demographic and clinical data were analyzed. A model was created from 2014 to 2019 and applied to 2020 (i.e., during the COVID-19 pandemic) to conduct a time series analysis distinguishing between unexpected accidents and suicide/self-harm among patients who visited the emergency department. Results: The most common reason for visiting the emergency department was unintentional accidents (48.5%), followed by self-harm/suicide attempts (43.8%). Unexpected accident patients and self-harm/suicide patients showed statistically significant differences in terms of sex, age group, hospitalization rate, and mortality rate. The time series analysis showed a decrease in patients with unexpected accidents during the COVID-19 pandemic, but no change in patients with suicide/self-harm. Conclusion Depending on the intentionality of the intoxication, significant differences were found in the age group, the substance of intoxication, and the mortality rate. Therefore, future analyses of patients with intoxication should be stratified according to intentionality. In addition, the time series analysis of intentional self-harm/suicide did not show a decrease in 2010 in the number of patients, whereas a decrease was found for unintentional accidents.