Objective: Ultrasound is widely used in the clinical field. However, training on use of ultrasound is insufficient. Newer models and techniques cannot be introduced for use by doctors without training and knowledge of its clinical utility. We produced a unique ultrasound education model and investigated if the use of the model could enhance the ability of clinicians to use ultrasound. Methods: A gelatin ultrasound practice model that can be transformed into various shapes was created using a cubeshaped plastic trainer. Residents and interns working in tertiary hospitals were surveyed for their awareness of the use of ultrasound through a questionnaire. Subsequently, ultrasound education was conducted, and a test was administered using a cube-shaped ultrasound education model. After the education and testing, awareness of the use of ultrasound was investigated through a questionnaire once again, and the test results were evaluated. Results: A total of 20 people participated in the evaluation and survey using the practice model. Of these, 11 people (55%) had procedural experience of using ultrasound. The Spearman’s correlation test was performed to compare previous ultrasound procedural experience with the number of correct answers, time spent on the test, and the number of attempts, and the results were 0.278 (P=0.235), -0.513 (P=0.021), and -0.369 (P=0.110), respectively. The correlation coefficients between the previous ultrasound knowledge level and changes in the knowledge level, preference, and confidence about ultrasound examination before and after practice were 0.261 (P=0.281), 0.638 (P=0.003), and 0.705 (P< 0.001), respectively. Conclusion Our cube-shaped ultrasound educational model can spark interest in the use of ultrasound, improve knowledge levels, and increase procedural skills in using ultrasound.

Objective: Traumatic brain injury (TBI) is one of the major causes of death and disability in children. Understanding the epidemiologic characteristics of TBI in children is the first step for developing preventative strategies, optimizing care systems, and rehabilitating the injury. Methods: This is a cross-sessional study based on the Emergency Department-based Injury In-depth Surveillance (EDIIS) in Korea. We identified children (aged 0 to 18 years) who presented with TBI in emergency departments between January 2011 and December 2018. Subjects were classified into four groups according to age and development: infant and toddler group (0-2 years), pre-school group (3-5 years), school-aged group (6-11 years), and adolescent group (12-18 years). Epidemiologic characteristics and outcomes were compared according to age groups, and temporal variability in incidence was evaluated. Results: During the 8-year study period, 45,734 children with TBI were included in the analysis. A higher incidence of TBI was observed in males, road accidents, and school/educational facilities as compared to the lesser-aged group (all P<0.01). Motor vehicle collisions were more common in the older group, but falls were more common in the younger group. Compared to the infant/toddler group, the adolescent group had higher intracranial injuries (8.1% vs. 16.8%; adjusted odds ratio [AOR], 1.8; 95% confidence interval [CI], 1.6-2.0) and mortality rate (0.2% vs. 1.3%; AOR, 2.0; 95% CI, 1.3-3.0). Conclusion The epidemiological characteristics of TBI in children are different for each group. It is necessary to develop differentiated preventative strategies and treatment systems based on the age groups of children.

Objective: Cardiac tamponade with hemodynamic collapse requires immediate treatment, and ultrasound-guided pericardiocentesis is the treatment of choice. Although an essential skill for emergency physicians, there is a lack of training. We created a phantom that could practice ultrasound-guided pericardiocentesis using readily available materials. The pros and cons of the materials used were then compared. Methods: Cardiac tamponade phantoms were made from gelatin, and included a heart, liver, and rib cage. We conducted a model-specific satisfaction questionnaire targeting 15 emergency physicians. The questionnaire was designed to be answered on a Likert 5-point scale. Results: Creating the gelatin model took 6 hours. At room temperature, the gelatin model was able to retain its shape for 3 days. Fifteen physicians participated in the questionnaire, comprising five subjects having actual pericardiocentesis experience. In the questionnaire, our model achieved high satisfaction with all questions. Conclusion In our study, the pericardiocentesis phantom made from gelatin could maintain its shape for a long time, there was better recognition of the needle tip, and the model was more similar to the actual cardiac tamponade situation. Considering these positive characteristics, we recommend the phantom as a model for pericardiocentesis training.

Background: Blepharoplasty has both aesthetic and functional benefits in patients with pseudoptosis; however, previous studies could not demonstrate its beneficial effects quantitatively and objectively. The authors objectively analyzed the visual field before and after surgery and investigated whether measurements of the visual field can be applied as a suitable predictor of surgical outcomes. Methods: In total, 18 eyelids in nine patients with pseudoptosis who had undergone simple skin excision blepharoplasty were evaluated prospectively from February to May 2016. The visual fields were analyzed preoperatively and 3 months postoperatively using the Goldmann kinetic perimetry test. The visual field test area was assessed using Adobe Photoshop. Results: Blepharoplasty had an average 4.99-fold beneficial effect on the superior visual field. In particular, more improvement was seen in the superior temporal quadrant than in the nasal quadrant. No correlation was found between the preoperative margin-to-reflex distance 1 (MRD1) and the surgical outcome (P=0.119). However, there was a strong correlation between the preoperative superior visual field and the surgical outcome (P=0.001). Conclusions Using the Goldmann kinetic perimetry test, we objectively and quantitatively proved the beneficial effect of blepharoplasty on patients with pseudoptosis. Furthermore, we demonstrated that the preoperative visual field is a better preoperative surgical outcome predictive factor than the preoperative MRD1.

Orbital emphysema with pneumocephalus is an unusual condition encountered in non-fracture craniofacial trauma. We report a case of orbital emphysema with disseminated pneumocephalus without any fracture, due to an orbital trauma caused by compressed air.

Orbital emphysema with pneumocephalus is an unusual condition encountered in non-fracture craniofacial trauma. We report a case of orbital emphysema with disseminated pneumocephalus without any fracture, due to an orbital trauma caused by compressed air.

Objective: This study was undertaken to establish a radiologic report monitoring system (RRMS) for missed and incidental findings (MIFs) in computed tomography (CT) and magnetic resonance imaging (MRI) reports, to help determine the clinical significance of MIFs in the emergency department (ED). Methods: Patients presenting to our ED in 2017 were subjected to RRMS. Preliminary reports and final reports were subsequently compared based on the clinical significance of the MIFs. If required, the patient was contacted and instructed to revisit the ED. Results: Totally, 12,132 CT and MRI exams were performed during the study period, and 321 cases (2.6%) encompassed MIFs. We attempted to contact 228 cases (1.9%) who had clinically significant MIF findings; 9 patients were instructed to return to the ED, whereas 105 cases were instructed to report to the outpatient department. Hospitalization was required for 12 patients: 2 cases required surgical intervention, 2 cases had an additional procedure, and 8 cases required medical hospitalization. Conclusion This study applied RRMS for a timely assessment of MIFs, determine rearrangements required, and present an active response to the MIFs determined in the ED. To improve patient care and safety, we hereby propose monitoring MIFs using the RRMS or similar methods.

Various methods for reconstructing partial upper lip defects have been reported, some of which, such as the Abbe and Estlander flaps, involve using the lower lip. However, determining the appropriate reconstruction method for large upper lip and oral commissure defects is particularly difficult because of the need to preserve the function and sensory ability of the lips and oral sphincter while achieving a satisfactory appearance. We describe our successful experience of using an extended Estlander flap to reconstruct a large defect caused by the excision of basal cell carcinoma on the upper lip and oral commissure.

As in other domains, artificial intelligence is becoming increasingly important in medicine. In particular, deep learning-based pattern recognition methods can advance the field of pathology by incorporating clinical, radiologic, and genomic data to accurately diagnose diseases and predict patient prognoses. In this review, we present an overview of artificial intelligence, the brief history of artificial intelligence in the medical domain, recent advances in artificial intelligence applied to pathology, and future prospects of pathology driven by artificial intelligence.
Artificial Intelligence ; Humans ; Pathology ; Prognosis

OBJECTIVE: This study examined the epidemiological characteristics of bicycle injuries and the wearing of a helmet. METHODS: A cross-sectional observational study was conducted using the emergency department-based Injury In-depth Surveillance data from 2013 to 2016. The study population consisted of patients related to bicycles of all ages. The variables associated with helmet wearing were sex, age, type of location, activity at injury, alcohol use at injury, and time of injury. Multivariable logistic regression analysis was conducted to estimate the risks of nonuse of helmets. RESULTS: Among the 31,923 eligible patients, 3,304 patients (10.3%) were wearing helmets at the time of the injury. The adjusted logistic regression model showed that females (adjusted odds ratio [aOR], 0.675; 95% confidence interval [CI], 0.614–0.742), teenagers (aOR, 0.265; 95% CI, 0.232–0.302), old age (aOR, 0.378; 95% CI, 0.326–0.438), road except for bicycle lanes (aOR, 0.510; 95% CI, 0.467-0.557), leisure (aOR, 0.290; 95% CI, 0.252–0.334) or vital activity (aOR, 0.188; 95% CI, 0.162–0.218) at injury, alcohol use at injury (aOR, 0.329; 95% CI, 0.253–0.427), night time (aOR, 0.609; 95% CI, 0.560–0.663), and winter (aOR 0.734; 95% CI 0.619–0.872) were significantly associated with the nonuse of helmets. CONCLUSION: This study identified the factors associated with helmet use during bicycle riding. Strategies aimed at increasing the use of bicycle helmets targeting the risk population are needed.
Adolescent ; Bicycling ; Emergencies ; Female ; Head Protective Devices ; Humans ; Leisure Activities ; Logistic Models ; Morinda ; Observational Study ; Odds Ratio