Background: To analyze the factors associated with women's vasomotor symptoms (VMS) using machine learning. Methods: Data on 3,298 women, aged 40–80 years, who attended their general health check-up from January 2010 to December 2012 were obtained from Korea University Anam Hospital in Seoul, Korea. Five machine learning methods were applied and compared for the prediction of VMS, measured by the Menopause Rating Scale. Variable importance, the effect of a variable on model performance, was used for identifying the major factors associated with VMS. Results: In terms of the mean squared error, the random forest (0.9326) was much better than linear regression (12.4856) and artificial neural networks with one, two, and three hidden layers (1.5576, 1.5184, and 1.5833, respectively). Based on the variable importance from the random forest, the most important factors associated with VMS were age, menopause age, thyroid-stimulating hormone, and monocyte, triglyceride, gamma glutamyl transferase, blood urea nitrogen, cancer antigen 19-9, C-reactive protein, and low-density lipoprotein cholesterol levels. Indeed, the following variables were ranked within the top 20 in terms of variable importance: cancer antigen 125, total cholesterol, insulin, free thyroxine, forced vital capacity, alanine aminotransferase, forced expired volume in 1 second, height, homeostatic model assessment for insulin resistance, and carcinoembryonic antigen. Conclusion Machine learning provides an invaluable decision support system for the prediction of VMS. For managing VMS, comprehensive consideration is needed regarding thyroid function, lipid profile, liver function, inflammation markers, insulin resistance, monocyte count, cancer antigens, and lung function.

Background: To analyze the factors associated with women's vasomotor symptoms (VMS) using machine learning. Methods: Data on 3,298 women, aged 40–80 years, who attended their general health check-up from January 2010 to December 2012 were obtained from Korea University Anam Hospital in Seoul, Korea. Five machine learning methods were applied and compared for the prediction of VMS, measured by the Menopause Rating Scale. Variable importance, the effect of a variable on model performance, was used for identifying the major factors associated with VMS. Results: In terms of the mean squared error, the random forest (0.9326) was much better than linear regression (12.4856) and artificial neural networks with one, two, and three hidden layers (1.5576, 1.5184, and 1.5833, respectively). Based on the variable importance from the random forest, the most important factors associated with VMS were age, menopause age, thyroid-stimulating hormone, and monocyte, triglyceride, gamma glutamyl transferase, blood urea nitrogen, cancer antigen 19-9, C-reactive protein, and low-density lipoprotein cholesterol levels. Indeed, the following variables were ranked within the top 20 in terms of variable importance: cancer antigen 125, total cholesterol, insulin, free thyroxine, forced vital capacity, alanine aminotransferase, forced expired volume in 1 second, height, homeostatic model assessment for insulin resistance, and carcinoembryonic antigen. Conclusion Machine learning provides an invaluable decision support system for the prediction of VMS. For managing VMS, comprehensive consideration is needed regarding thyroid function, lipid profile, liver function, inflammation markers, insulin resistance, monocyte count, cancer antigens, and lung function.

PURPOSE: This study was designed to determine the characteristics of patients who suffered from an injury associated with a maritime accident. METHODS: Using reviews of medical records, we retrospectively investigated the characteristics of maritime accident related injured patients that visited the emergency center of Inha University hospital. Variables analyzed were age, sex, sailor or passenger, type of accident, time required to arrive at the hospital, type of injury, site of injury, submersion or not, level of submersion, severity of injury, disposition of injury, type of ship, gross tonnage of ship, and distance from shore. RESULTS: Between January 1999 and December 2009, a total of 85 patients who were injured because of a maritime accident visited the emergency center of InHa Univ. hospital. The mean age of patients was 45.7+/-15.1 years old. Fifty four were male and 31 were female. The most common types of injury were submersion (40.0%) and contusion (38.8%). Submersed patients as a group had a higher injury severity and higher mortality than those not submersed. The most frequent sites of injury were the extremities (62.9%) and the head and neck (35.5%). The mean injury severity scale were 4.63+/-13.05 units?. Almost all patients (85.9%) had a mild degree of injury. The mortality rate was 10.6%; the most common cause of death was drowning. CONCLUSION: Submerged patients have a higher injury severity and mortality than non-submerged patients. Capsizing and sinking is associated with a higher severity of injury and mortality according to the type of accident, because submersion confers high risk for injury and mortality. Prevention of submersion is important for reducing injury severity and mortality in patients who have maritime accidents.
Cause of Death ; Contusions ; Emergencies ; Extremities ; Female ; Head ; Humans ; Immersion ; Male ; Medical Records ; Military Personnel ; Neck ; Oceans and Seas ; Retrospective Studies ; Ships

PURPOSE: We analyzed the characteristics and outcome of pediatric out-of-hospital cardiac arrest. METHODS: Pediatric out-of-hospital cardiac arrest from January 2000 to December 2005 at two tertiary hospitals were described and evaluated using the Utstein style. We reviewed the records retrospectively and analyzed the outcome variables which were any return of spontaneous circulation (ROSC), sustained ROSC, survived event, and survival to hospital discharge. Neurologic outcome was assessed by the Pediatric Cerebral Performance Category (PCPC) scale. RESULTS: The study included 62 children with out-of-hospital cardiac arrest. Any ROSC was achieved in twenty patients (32.3%). Sustained ROSC of any ROSC group was achieved in sixteen patients (80.0%). Of the sustained ROSC group, fourteen patients (87.5%) were admitted to hospital, and only four patients (28.6%) of survived event group survived to hospital discharge. The prevalent etiology were injuries. Although 35 children (56.5%) of the arrests occurred at home with family members present, only 1 patients received bystander CPR. Nonshockable rhythm (96.8%) were showed more than shockable rhythm (3.2%). In any ROSC group, time to initiation of CPR was 9.3 minutes,duration of total CPR was 20.4 minutes. CONCLUSION: Mortality of pediatric out-of-hospital cardiac arrest was high and neurologic outcome was poor. Factors that increased survival rate were prevention of injuries, enhanced education programs of bystander CPR, rapid initiation of CPR.
Cardiopulmonary Resuscitation ; Child ; Education ; Humans ; Mortality ; Out-of-Hospital Cardiac Arrest* ; Resuscitation ; Retrospective Studies ; Survival Rate ; Tertiary Care Centers

PURPOSE: Although alcohol is frequently present in injury patients, whether it exacerbates injury and whether tolerance to alcohol changes such a relationship is less clear. We investigated alcohol's role in injury and the effect of alcohol on the severity of injury. METHODS: This prospective study was performed from July 20, 2004, to October 20, 2004, at five university hospital emergency departments (ED). We studied trauma patients, excluding pediatric patients (15 year old and under), alcohol consumption over the 6 hours prior to visiting the ED and continuous drinking after injury. Patients were screened by blood tests for the presence of alcohol and were classified into two groups by alcohol consumption. The injury severity was measured by using the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). RESULTS: The study enrolled 361 injured patients, of whom 105 were intoxicated and 256 were not intoxicated. Alcohol consumption was significantly larger in males than in females and in cases involving violence. The injury severities were not correlated with alcohol consumption significantly between intoxicated patients and not intoxicated patients. were not significantly different. However, the number of days in the intensive care unit and the mortality correlated with alcohol consumption. In patients with severe injuries (ISS> or =15, AIS> or =3), alcohol consumption was correlated with severity of the injury. CONCLUSION: Alcohol intoxication is not associated with injury severity. But in patients with severe injuries (ISS> or =15, head AIS> or =3), alcohol consumption was correlated with injury severity.
Abbreviated Injury Scale ; Alcohol Drinking ; Drinking ; Eating* ; Emergency Service, Hospital ; Female ; Head ; Hematologic Tests ; Humans ; Injury Severity Score ; Intensive Care Units ; Male ; Mortality ; Prospective Studies ; Violence

PURPOSE: Bleaching agents containing sodium hypochlorite are widely used at home to bleach laundry and to disinfect hard surfaces. A retrospective study, with a literature review, was conducted to focus attention on the clinical outcome after accidental or intentional ingestion of sodium hypochlorite. METHODS: The medical records of 67 patients presented to the Inha University emergency department for sodium hypochlorite ingestion between June 1996 and July 2003 were retrospectively examined. RESULTS: The Mean volume of the bleach in the 56 patients who ingested the bleach in a suicide attempt was significantly larger than that of the 11 patients with accidental ingestion (P=0.001). Nausea and vomiting was present in 79% of the patients. The volume of ingestion in patients with vomiting was significantly larger than that in patients without vomiting (P=0.001). Patients with epigastric pain ingested larger volumes of bleach compared to patients without the pain (P=0.01). Endoscopic examinations were performed in seven patient, and normal findings were seen in three patients. Grade 1 caustic injury was observed in two patients, and Grade 2 injuries in the rest. CONCLUSION: The solution of the sodium hypochlorite may cause mild symptoms and seems to be safe after ingestion. However, careful evaluation with endoscopy and hospital admission should be considered if there are symptoms or signs suggesting caustic injury of the esophagus and/or stomach or if the ingested volume is large.
Bleaching Agents ; Caustics ; Eating ; Emergency Service, Hospital ; Endoscopy ; Esophagus ; Family Characteristics* ; Humans ; Medical Records ; Nausea ; Poisons ; Retrospective Studies* ; Sodium Hypochlorite* ; Sodium* ; Stomach ; Suicide ; Vomiting

PURPOSE: Our study aimes to examine the outcome of open fractures with associated vascular injury and to assess the diagnostic value of angiography in patients who visit the emergency department (ED). METHODS: The records of 22 patients who were diagnosed as open fracture in the ED of Inha University Hospital between June 1996 and December 2001 were selected for review. Angiography was done on the suspicion of vascularinjury for patients with abnormal vascular examination results and an unclear level of injury that might require vascular repair. RESULTS: There were 21 men and one woman with a mean age of 37 years. The injury resulted from traffic accidents in 59.2% of the patients. The femur and tibia were most commonly involved and the popliteal artery was too. 18 patients were confirmed vascular injury by angiography (81.8%). 14 abnormal angiographic findings were found in 15 (93.3%) of the patients who were predicted the vascular injury by clinical findings. 4 abnormal angiographic findings were found in 7 (57.1%) of the patients who were not predicted the vascular injury. The group of patients who had demonstrated vascular injury and repair was performed within 6 hours of injury showed lesser incidence of complication than 6 hours after injury. The overall amputation rate was 22.7% (5 of 22). CONCLUSION: The most important factor in successful management is early recognition and early repair of vascular injury in open fracture. In conclusion, we suggest that emergency angiography is valuable diagnostic procedures for patients who visit the emergency department with the open fracture.
Accidents, Traffic ; Amputation ; Angiography* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Femur ; Fractures, Open* ; Humans ; Incidence ; Male ; Popliteal Artery ; Tibia ; Vascular System Injuries

PURPOSE: The purpose of our study is to evaluate the initial diagnostic value of magnetic resonance imaging (MRI) and electroencephalogrphy (EEG) in children who visit the emergency department (ED) with first afebrile seizure attacks. METHODS: We reviewed the medical records of children who visited the emergency department of Inha University Hospital with first afebrile seizure attacks and who underwent the diagnostic procedures of MRI & EEG during their visits. The study duration was for the 72 months from January 1997 to December 2002. One year after the study, we followed up the patients by using a telephone survey and by reviewing their medical records. RESULTS: The records of 46 patients, 23 boys and 23 girls, were reviewed. Generalized tonic clonic seizures appeared in 37 (80%) of the children and focal seizures in 9 (20%) of the children. Twenty nine (63%) of the children had two or more seizures during a single episode. There were 8 (17%) cases in which the seizures lasted for over 30 minutes. MRI abnormalities were found in only a small portion (9 cases, 20%) of the patients, but all of the MRI abnormalities were significant. The MRI abnormalities were as follows: brain atrophy (n=2), leptomeningeal enhancement (n=2), aneurysm (n=1), arachnoid cyst (n=1), ventriculomegaly (n=1), demyelinating disease (n=1), and hypoxic damage (n=1). Abnormal EEG findings were found in 15 (33%) of the children: Eleven showed partial seizures and 4 showed cerebral dysfunctions. CONCLUSION: Even though abnormal MRI & EEG findings were revealed in only a small portion of the patients, all of the revealed abnormal findings were very serious and were associated with significant problems. In conclusion, we suggest that initial MRI & EEG evaluations are valuable diagnostic procedures for children who visit the emergency department with first attacks of afebrile seizures.
Aneurysm ; Arachnoid ; Atrophy ; Brain ; Child* ; Demyelinating Diseases ; Electroencephalography* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Magnetic Resonance Imaging* ; Medical Records ; Seizures* ; Telephone

The vertebral artery is infrequently injured because it lies deep in the neck, surrounded for the most part by bony foramina. Vertebral artery injuries are caused by penetrating traumas, blunt traumas and iatrogenic injuries. Sequela of vertebral artery injury include arteriovenous (AV) fistulae, and pseudoaneurysms may appear months after injury. Angiography is currently the gold standard for evaluating vascular injuries, such as vertebral artery injuries, and can be therapeutic. A vertebral artery fistula can also be treated by operative ligation. We experienced a rare case of a vertebro-jugular AV fistula secondary to a cervical stab wound. In this case, the patient was successfully treated by coil embolization and glue injection during angiography, which was confirmed by a postangiograpy operation.
Adhesives ; Aneurysm, False ; Angiography ; Arteriovenous Fistula* ; Embolization, Therapeutic ; Fistula ; Humans ; Ligation ; Neck ; Vascular System Injuries ; Vertebral Artery ; Wounds, Stab

PURPOSE: Due to its rapidity and easy accessibility, the fingerstick blood glucometer has been used in almost all hospitals and private clinics, and even by patients themselves. We also have used it even in shock patient care, but shock shows global tissue hypoperfusion, especially in peripheral tissue. The changes of peripheral circulation have an influence on the results for fingerstick glucose. To evaluate the accuracy of the glucometer for patients with poor peripheral perfusion, we designed this study. METHODS: A prospective, nonrandomized comparison group study was done. A hypotensive group and a normotensive group were compared. We obtained three data from each patient: venous blood glucose level (clinicopathologic laboratory), venous blood glucose level (by glucometer) and fingerstick glucose level (by glucometer). RESULTS: We saw a significant difference between the fingerstick glucometer results and the laboratory glucose levels in hypotensive patients: 131.67+/-55.33 mg/dl vs. 1 4 7 . 2 3+/-62.06 mg/dl (paired t-test, p<0.05). There was no significant difference between fingerstick and laboratory glucose in normotensive patients: 101.75+/-20.14 mg/dl vs. 1 0 5 . 6 0+/-21.95 mg/dl (paired t-test, p>0.05). There was no significant difference between the results of venous glucometer and laboratory test in either group: 142.37+/-61.27 mg/dl vs. 147.23+/-62.06 mg/dl (paired t-test, p>0.05) and 102.98+/-17.02 mg/dl vs. 105.60+/-21.95 mg/dl (paired t-test, p>0.05). Although some statistical differences existed between the results, all of the error rates were in an acceptable range (within 15%, accepted by American Diabetes Association consensus). CONCLUSION: These results suggest that the blood glucose level of the glucometer with venous blood is more accurate than that with peripheral blood in patients with poor peripheral circulation.
Blood Glucose* ; Glucose ; Humans ; Patient Care ; Perfusion ; Prospective Studies ; Shock