Objectives: Electrocardiography (ECG)-based diagnosis by experts cannot maintain uniform quality because individual differences may occur. Previous public databases can be used for clinical studies, but there is no common standard that would allow databases to be combined. For this reason, it is difficult to conduct research that derives results by combining databases. Recent commercial ECG machines offer diagnoses similar to those of a physician. Therefore, the purpose of this study was to construct a standardized ECG database using computerized diagnoses. Methods: The constructed database was standardized using Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) and Observational Medical Outcomes Partnership–common data model (OMOP-CDM), and data were then categorized into 10 groups based on the Minnesota classification. In addition, to extract high-quality waveforms, poor-quality ECGs were removed, and database bias was minimized by extracting at least 2,000 cases for each group. To check database quality, the difference in baseline displacement according to whether poor ECGs were removed was analyzed, and the usefulness of the database was verified with seven classification models using waveforms. Results: The standardized KURIAS-ECG database consists of high-quality ECGs from 13,862 patients, with about 20,000 data points, making it possible to obtain more than 2,000 for each Minnesota classification. An artificial intelligence classification model using the data extracted through SNOMED-CT showed an average accuracy of 88.03%. Conclusions The KURIAS-ECG database contains standardized ECG data extracted from various machines. The proposed protocol should promote cardiovascular disease research using big data and artificial intelligence.

Methods: Patients who completed a questionnaire on back-pain between October 2016 and October 2017 were enrolled in this study. Appendicular skeletal muscle index (ASMI), cross-sectional area (CSA) index, fatty infiltration (FI) rate of the paraspinal muscles, and lumbar extensor strength index (LESI) were measured and compared between no back-pain and back-pain group. Correlations between LESI and ASMI, CSA index, and FI rate were analyzed. The back-pain group was further divided according to ASMI into sarcopenia and non-sarcopenia subgroups and by our newly developed back muscle degeneration risk index based on correlation coefficients between LESI and CSA index, FI rate. Differences in ASMI, CSA index, FI rate, LESI, and Visual Analog Scale (VAS) score between subgroups were analyzed. Results: The ASMI, CSA index, FI rate, and LESI differed significantly between back-pain and pain-free groups. The LESI demonstrated the strongest correlation with FI rate. There were no significant differences in VAS score and back muscle degeneration index in the back-pain group when divided according to the presence of sarcopenia. However, there was a significant difference in VAS score between back-pain patients when classified according to high and low back muscle degeneration risk index. Conclusions We suggest that the degree of back pain is more strongly associated with back muscle degeneration than with sarcopenia. This back muscle degeneration risk index, reflecting both back muscle morphology and function, could be a useful parameter for evaluation of back pain and muscle degeneration.

PURPOSE: This study compared the oncologic impact of postoperative chemotherapy and chemoradiotherapy on patients with rectal cancer without preoperative chemoradiation. METHODS: This retrospective study analyzed 713 patients with a mean follow-up of 58 months who had undergone radical resection for stage II/III rectal cancer without preoperative treatment in nine hospitals from January 2004 to December 2009. The study population was categorized a chemotherapy group (CG, n = 460) and a chemoradiotherapy group (CRG, n = 253). Five-year overall survival (OS) and disease-free survival (DFS) were analyzed, and independent factors predicting survival were identified. RESULTS: The patients in the CRG were significantly younger (P < 0.001) and had greater incidences of low rectal cancer (P < 0.001) and stage III disease (P < 0.001). Five-year OS (P = 0.024) and DFS (P = 0.012) were significantly higher in the CG for stage II disease; however, they were not significantly different for stage III disease. In the multivariate analysis, independent predictive factors were male sex, low rectal cancer and stage III disease for OS and male sex, abdominoperineal resection, stage III disease and tumor-positive circumferential margin for DFS. However, adjuvant therapy type did not independently affect OS (hazard ratio [HR], 1.243; 95% confidence interval [CI], 0.794–1.945; P = 0.341) and DFS (HR, 1.091; 95% CI, 0.810–1.470; P = 0.566). CONCLUSION: Adjuvant therapy type did not affect survival of stage II/III rectal cancer patients without neoadjuvant chemoradiotherapy. These results suggest that adjuvant therapy can be chosen based on the patient’s condition and the policies of the surgeons and hospital facilities.
Chemoradiotherapy ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Incidence ; Male ; Multivariate Analysis ; Rectal Neoplasms* ; Retrospective Studies* ; Surgeons

PURPOSE: This study examined the effect of indirect medical oversight on the quality of prehospital emergency care by emergency medical technicians. METHODS: Indirect medical oversight was applied for a year and 119 rescue run sheets were retrospectively analyzed before and after the program to study the effect of an indirect medical oversight program in one city. The general characteristics of patients who visited hospitals before and after the program were analyzed, along with patient evaluation records, personal data, outbreak patterns, transfer information, direct medical oversight, and emergency medical services (EMS) mobilization reports. In addition, by comparing medical records and the 119 rescue run sheets, changes in the accuracy of 119 rescue run reports, the adequacy of patient classification, and the adequacy of medical direction were analyzed. After gathering these data, statistical analysis was performed and the level of significance was defined as p<0.05. RESULTS: After executing the indirect medical oversight, there was significant improvement in the accuracy of 119 rescue run sheets (p<0.001) and in the consistency of severity classification in 119 rescue run sheets compared with medical records (p=0.016). The adequacy of direct medical oversight request also showed improvement after the indirect medical oversight took effect (p<0.001). However, there was no statistical significance in prehospital procedures. CONCLUSION: Indirect medical oversight significantly improved the quality of emergency medical service by emergency medical technicians. However, the further application and improvement of indirect medical oversight programs are required for the development of prehospital emergency medical care.
Classification ; Emergencies* ; Emergency Medical Services* ; Emergency Medical Technicians* ; Humans ; Medical Records ; Retrospective Studies

PURPOSE: Ureteral calculi are commonly encountered in the emergency department. Ureteral calculi influence the quality of life of patients, causing pain and economic burden. The optimal management of ureteral calculi remains a challenge for practicing physicians; therefore, this study was designed to determine which factors are related to the failure of their spontaneous passage. METHODS: This study was a retrospective review of the medical records of one hundred ninety-five patients who visited the emergency department complaining of renal colic from February 2012 to December 2012. Bivariate analyses were conducted relating physical, laboratory, and radiological methods to predict the failure of spontaneous passage. A multivariate logistic regression model was then derived, with all variables in the final model significant at p<0.05. RESULTS: One hundred twenty-eight stones were spontaneously expelled and sixty-seven were not. The mean stone size was significantly larger in the non-passage group than the passage group (p<0.001). When the stones were located in the upper ureter, or on the right side, the spontaneous passage rate was lower (p<0.001, p=0.035). Increased neutrophils and positive tests for urinary protein and bilirubin were also associated with the decreased likelihood of spontaneous passage (p=0.046, p=0.029, and p=0.048, respectively). In addition, the longer duration of symptoms and a previous history of ureteral calculi were related to a lower chance of spontaneous passage (p=0.005, p=0.019). CONCLUSION: Prognostic factors of failure, after the initial expectant management of ureteral calculi, included: calculi size, location (e.g., side), the duration of symptoms, the previous history, neutrophil levels, urinary bilirubin levels, and urinary protein levels. Therefore, emergency physicians need to cautiously decide between watchful waiting and interventions in these patients.
Bilirubin ; Calculi ; Emergencies ; Humans ; Logistic Models ; Medical Records ; Neutrophils ; Quality of Life ; Renal Colic ; Retrospective Studies ; Ureter ; Ureteral Calculi ; Watchful Waiting

PURPOSE: Osteoma is one of the common benign tumors of the skull vault and facial skeleton. Although most of the osteomas cause no symptoms, forehead osteomas may lead to facial disfigurement. Osteoma usually happens in solitary lesion and multiple osteomas which don't combine with syndrome are very rare. We report an experience of treatment of non-syndromic multiple osteomas in the skull. METHODS: A 54-year-old female patient visited due to the multiple palpable hard masses on her forehead in 2010. In 2002 of her first visit, masses started to appear on her forehead and she was diagnosed as the osteoma by excisional biopsy. She visited again because the mass size and number increased. In preoperative CT scanning, there were above 160 of osteomas, so surgery was planned. Enterogastroduodenoscopy and colonoscopy was conducted to rule out Gardener's syndrome, however there was no abnormality such as multiple polyposis. RESULTS: Under general anesthesia, coronal approach was conducted. There were numerous osteomas in frontal and parietal bone. The multiple osteomas were removed by burring and the patient recovered without any postoperative complications. CONCLUSION: Multiple osteomas in the skull were rarely reported, although it can accompanied with Gardener's syndrome. We report a case of non-syndromic multiple osteomas in skull vault.
Anesthesia, General ; Biopsy ; Colonoscopy ; Female ; Forehead ; Humans ; Middle Aged ; Osteoma ; Parietal Bone ; Skeleton ; Skull

PURPOSE: The present study investigated the therapeutic effects of periocular triamcinolone acetonide injections to treat inflammatory signs in patients with severe acute thyroid-associated ophthalmopathy. METHODS: Twenty-two patients with symptoms of severe acute thyroid ophthalmopathy were enrolled in the present study. The patients received four doses of 20 mg of triamcinolone acetonide via periocular injection into the inferotemporal orbital quadrant every 2 weeks. The changes in visual acuity, intraocular pressure, eye ball motility, exophthalmos, thickness of extraocular muscles, clinical activity score and NOSPECS score were measured. RESULTS: Eighteen of 22 patients (81.8%) showed improvement in soft tissue swelling, ten patients (45.5%) showed improvement in conjunctival hyperemia and one patient showed improvement of ocular motility. Clinical activity score and NOSPECS score had significant improvements. No patient had changes in visual acuity, intraocular pressure, diplopia, proptosis or thickness of extraocular muscles. An ocular adverse effect was found in one patient, who had subcutaneous fat atrophy at the injection site. CONCLUSIONS: In patients with severe acute thyroid ophthalmopathy, periocular triamcinolone acetonide injection can be effective to improve acute inflammatory symptoms, without significant adverse effects.
Atrophy ; Diplopia ; Exophthalmos ; Eye ; Graves Ophthalmopathy ; Humans ; Hyperemia ; Injections, Intraocular ; Intraocular Pressure ; Muscles ; Orbit ; Subcutaneous Fat ; Thyroid Gland ; Triamcinolone ; Triamcinolone Acetonide ; Visual Acuity

To better understand the anatomic location of scalp nerves involved in various neurosurgical procedures, including awake surgery and neuropathic pain control, a total of 30 anterolateral scalp cutaneous nerves were examined in Korean adult cadavers. The dissection was performed from the distal to the proximal aspects of the nerve. Considering the external bony landmarks, each reference point was defined for all measurements. The supraorbital nerve arose from the supraorbital notch or supraorbital foramen 29 mm lateral to the midline (range, 25-33 mm) and 5 mm below the supraorbital upper margin (range, 4-6 mm). The supratrochlear nerve exited from the orbital rim 16 mm lateral to the midline (range, 12-21 mm) and 7 mm below the supraorbital upper margin (range, 6-9 mm). The zygomaticotemporal nerve pierced the deep temporalis fascia 10 mm posterior to the frontozygomatic suture (range, 7-13 mm) and 22 mm above the upper margin of the zygomatic arch (range, 15-27 mm). In addition, three types of zygomaticotemporal nerve branches were found. Considering the superficial temporal artery, the auriculotemporal nerve was mostly located superficial or posterior to the artery (80%). There were no significant differences between the right and left sides or based on gender (P>0.05). These data can be applied to many neurosurgical diagnostic or therapeutic procedures related to anterolateral scalp cutaneous nerve.
Adult ; Aged ; Aged, 80 and over ; *Cadaver ; Female ; Frontal Bone/anatomy & histology ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; Orbit/anatomy & histology ; Peripheral Nerves/*anatomy & histology ; Scalp/*innervation ; Zygoma/anatomy & histology

PURPOSE: The present study was performed to evaluate the changes in tear film and ocular surface parameters after using sodium hyaluronate (SH) 0.1% alone or in combination with cyclosporine A (CsA) 0.05% in patients with thyroid-associated ophthalmopathy accompanied by dry eye. METHODS: A total of 72 eyes from 36 patients were divided into two groups; 36 eyes of 18 patients were treated with 0.1% SH alone (group 1), and 36 eyes of 18 patients were treated with SH 0.1% and CsA 0.05% (group 2). Tear break-up time (BUT), basal tear secretion test (BST), tear clearance rate (TCR), fluorescein staining (FS) and corneal sensitivity test (CST) were evaluated at pre-treatment and one, three and six months post-treatment. Conjunctival impression cytology was performed and tear CXCL11 (Chemokine (C-X-C motif) ligand) levels were measured pre-treatment and three months post-treatment. RESULTS: BUT, BST, TCR, KEP and CST were significantly improved at six months in group 1 (p < 0.05) and at three months in group 2 (p < 0.05). The degree of conjunctival squamous cell metaplasia, goblet cell density and tear CXCL11 levels were significantly changed at three months in group 2 (p < 0.05). However, there were no significant changes in group 1 after 3 months. CONCLUSIONS: Combined use of topical 0.1% SH and 0.05% CsA can result in early improvement in tear films and ocular surface parameters in patients with thyroid-associated ophthalmopathy accompanied by dry eye.
Cyclosporine ; Dry Eye Syndromes ; Eye ; Fluorescein ; Goblet Cells ; Graves Ophthalmopathy ; Humans ; Hyaluronic Acid ; Metaplasia ; Tears ; Thyroid Gland