PURPOSE: The bedside lung ultrasound in emergency (BLUE) protocol is an excellent diagnostic tool for acute respiratory failures requiring admission to the intensive care unit. We incorporated cardiac ultrasound in the BLUE algorithm because cardiac origin is also necessary to examine in an emergency setting. We studied the usefulness of the emergency department (ED)-BLUE protocol for patients complaining of dyspnea in an emergency department. METHODS: At first, we assessed lung sliding, artifacts (Alines and B-lines), alveolar consolidation and pleural effusion on stage I and II evaluation. Then, we checked heart to detect 3Es (Effusion, Equality, and Ejection fractions). We divided all the possible conditions into 10 categories. We compared it with final diagnosis and examined the agreements using kappa statistics. We compared the physician's level of confidence for the first impression. The 10 categories were: 1) normal or inconclusive, 2) pulmonary embolism, 3) airway disease (chronic obstructive pulmonary disease or asthma), 4) pneumothorax, 5) large pleural effusion, 6) alveolar consolidation, 7) acute pulmonary edema due to systolic congestive heart failure, 8) acute respiratory distress syndrome, 9) chronic interstitial lung disease with exacerbation, and 10) pericardial effusion with/without tamponade. RESULTS: This prospective study was performed for 172 patients over 18-years-of-age with dyspnea during a 25-month period. Kappa value between the diagnosis after ED-BLUE and final diagnosis was 0.812(p<0.001). The mean of physician's full term for LOC for the first impression before and after ED-BLUE was 3.09+/-0.83 and 4.36+/-0.70 (paired t-test, p<0.001). CONCLUSION: ED-BLUE protocol could help the emergency physician make an accurate diagnosis in patients with dyspnea in the emergent setting.
Artifacts ; Dyspnea ; Emergencies ; Heart ; Heart Failure ; Humans ; Intensive Care Units ; Lung ; Lung Diseases, Interstitial ; Lung Diseases, Obstructive ; Pericardial Effusion ; Pleural Effusion ; Pneumothorax ; Prospective Studies ; Pulmonary Edema ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult

Objectives: Assessing the risks of youth suicide in educational and clinical settings is crucial.Therefore, this study developed a machine learning model to predict suicide attempts using the Korean Youth Risk Behavior Web-based Survey (KYRBWS). Methods: KYRBWS is conducted annually on Korean middle and high school students to assess their health-related behaviors. The KYRBWS data for 2021, which showed 1206 adolescents reporting suicide attempts out of 54848, was split into the training (n=43878) and test (n=10970) datasets. Thirty-nine features were selected from the KYRBWS questionnaire. The balanced accuracy of the model was employed as a metric to select the best model. Independent validations were conducted with the test dataset of 2021 KYRBWS (n=10970) and the external dataset of 2020 KYRBWS (n=54948). The clinical implication of the prediction by the selected model was measured for sensitivity, specificity, true prediction rate (TPR), and false prediction rate (FPR). Results: Balanced bag of histogram gradient boosting model has shown the best performance (balanced accuracy=0.803). This model shows 76.23% sensitivity, 83.08% specificity, 10.03% TPR, and 99.30% FPR for the test dataset as well as 77.25% sensitivity, 84.62% specificity, 9.31% TPR, and 99.45% FPR for the external dataset, respectively. Conclusion These results suggest that a specific machine learning model can predict suicide attempts among adolescents with high accuracy.

Objectives: Suicide is the leading cause of death among adolescents in South Korea, and depression and personality profiles have been identified as significant risk factors for self-injurious behavior. This study examined the influence of depressive mood and temperament/ character on self-injury in adolescents. Methods: A total of 116 adolescents (aged 12–18 years) with a primary diagnosis of major depressive disorder (MDD) and their parents were enrolled in this study. The participants were divided into three groups based on adolescent’s self-injury frequency, and their Children’s Depression Inventory (CDI), Youth Self-Report (YSR), and Temperament and Character Inventory (TCI) scores were compared. Finally, mediation analysis was conducted to investigate the relationship between suicidal ideation and self-injury. Results: Of study participants, 75.9% answered that they had suicidal ideation, and 55.2% answered that they had engaged in self-injurious behavior in the last six months. There were significant differences in CDI and suicidal ideation among the groups. After adjusting for age and sex, mediation analysis indicated that depressive mood mediated the relationship between suicidal ideation and self-injury. Conclusion This study emphasizes the importance of evaluating and managing depressive mood severity in adolescents with MDD as these factors partially mediate the transition from suicidal ideation to self-injury.

The aim of this study was to examine the feasibility of the Smart dynamometer as a rehabilitation exercise device in a daily care by comparing with the existing medical devices. We used and analyzed clinical and measurement data of breast cancer survivors who have used Smart dynamometer during their rehabilitation after breast cancer surgery. The Smart dynamometer was compared with the two existing devices of Takei dynamometer and surface electromyography (sEMG) that were used in routine care, respectively. Three key components of the rehabilitation exercise devices were analyzed to validate the feasibility of the Smart dynamometer: grip strength, reaction time, and grip endurance time. Pearson's correlation analysis was performed to compare the statistical significance between the devices. The data of 12 and 15 female breast cancer patients were analyzed for comparing the Smart dynamometer with Takei dynamometer and sEMG, respectively. There was a very weak correlation between the maximum values from the Takei and the Smart dynamometers in the affected and non-affected arms of breast cancer patients (r = 0.5321, 0.4733). Comparisons of 3 features between the Smart dynamometer and sEMG showed that there were strong positive correlations for both reaction time and endurance time in the affected and non-affected arms (r > 0.9). The feasibility of the Smart dynamometer for the possible use in a daily rehabilitation exercise was partially verified. Moreover, since the Smart dynamometer was highly correlated with time-related variables, it was important and significant to measure both grip strength and time-related information.
Arm ; Breast Neoplasms ; Breast ; Electromyography ; Feasibility Studies ; Female ; Hand Strength ; Humans ; Reaction Time ; Rehabilitation ; Self Care ; Survivors

BACKGROUND: Atherosclerotic plaques in the carotid artery have been considered a potential source of cerebrovas- cular events. Carotid plaques are associated with an increased risk of ischemic stroke. We performed this study to evaluate the relationship between atherosclerotic carotid plaques and cardiac function measured by echocardiography in elderly patients with ischemic stroke. METHODS: A total of 415 patients aged >60 yrs with acute ischemic stroke were divided into two groups according to the presence(groups I, n=195, 140 males) or absence(group II, n=220, 112 males) of carotid plaques. We evaluated the asso ciation of the presence of plaques with age, sex, potential vascular risk factors, other carotid images, and cardiac function by echocardiography. RESULTS: Of the 415 patients, carotid plaques were found in 195 cases. Mean plaque size was 2.44+/-0.7mm on the right side and 2.32+/-0.75mm on the left. Plaques were located more frequently in the carotid bulb(68%) than in the common carotid artery(32%). 57% were calcified plaques and 72%, multiple plaques. Group I(with carotid plaques) had a significantly higher percentage of males(73.6%, p<0.001), hypertension(68.5%, p=0.043), diabetes(28.7%, p=0.029), and dyslipidemia(60.1%, p=0.008). In addition, group I had thicker carotid IMT than group II(Right: 0.86 vs. 0.70mm, p<0.001, Left: 0.90 vs. 0.73mm, p<0.001), lower common carotid artery end diastolic flow velocity(Right: 13.37 vs. 15.73m/s, p=0.002, Left: 14.46 vs.17.24m/s, p=0.004), and higher E/E'level(11.57 vs. 9.36, p=0.001). Old age, dyslipidemia, and diastolic dysfunction were independently associated with carotid plaques. CONCLUSION: Our results indicated that old age, male gender, diabetes, hypertension, and dyslipidemia are more com- mon in patients with carotid plaques than in those without. Old age, male gender, dyslipidemia, and diastolic dysfunc- tion are independent risk factors of carotid plaques in elderly patients with ischemic stroke. We further concluded that though left ventricle systolic function is not associated with carotid plaques in elderly patients with ischemic stroke, left ventricle diastolic dysfunction is.
Aged ; Carotid Arteries ; Carotid Artery, Common ; Dyslipidemias ; Echocardiography ; Heart Ventricles ; Humans ; Hypertension ; Male ; Plaque, Atherosclerotic ; Risk Factors ; Stroke