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.

BACKGROUND AND OBJECTIVES: Although increasing evidence has indicated that radial access is a beneficial technique, few studies have focused on Korean subjects. The aim of this study was to evaluate current practice of coronary angiography (CAG) and percutaneous coronary intervention (PCI) using radial access in South Korea. SUBJECTS AND METHODS: A total of 6338 subjects were analyzed from Korean Transradial Intervention prospective registry that was conducted at 20 centers in Korea. After evaluating the initial access, subjects intended for radial access were assessed for their baseline, procedure-related, and complication data. Subjects were categorized into three groups: group of overall subjects (n=5554); group of subjects who underwent PCI (n=1780); and group of subjects who underwent primary percutaneous coronary intervention (PPCI) (n=167). RESULTS: The rate of radial artery as an initial access and the rate of access site crossover was 87.6% and 4.4%, respectively, in overall subjects. Those rates were 82.4% and 8.1%, respectively, in subjects who underwent PCI, and 60.1% and 4.8%, respectively, in subjects who underwent PPCI. For subjects who underwent CAG, a 6-F introducer sheath and a 5-F angiographic catheter was the most commonly used. During PCI, a 6-F introducer sheath (90.6%) and a 6-F guiding catheter were standardly used. CONCLUSION: The large prospective registry allowed us to present the current practice of CAG and PCI using radial access. These data provides evidence to achieve consensus on radial access in CAG and PCI in the Korean population.
Catheters ; Consensus ; Coronary Angiography* ; Korea ; Percutaneous Coronary Intervention ; Prospective Studies* ; Radial Artery ; Registries

Saponated cresol solutions are common household disinfectants worldwide. Their main component, concentrated cresol, is extremely toxic and fatal; however, precise information on the clinical manifestations of cresol intoxication is not available. We report on a case of suicidal poisoning by ingestion of saponated cresol. A 63-year-old male presented with unconsciousness and brownish discoloration on the neck and anterior chest wall after ingesting 100 ml of 50% saponated cresol solution with suicidal attempt. The patient showed a wide range of clinical features of cresol intoxication, including decreased consciousness, respiratory distress, strong carbolic acid odor, dark brown urine, and chemical dermal burns on multiple areas. General treatment of cresol intoxication is intensive supportive care. In addition, reducing systemic absorption is most important in patients with cresol intoxication who present with cresol burns. Because the rate of cresol absorption through the skin is proportional to the size of the area involved and the duration of contact of the chemical with the skin rather than to the concentration of the cresol solution, gross decontamination, including removal of contaminated clothing and vigorous flushing with water, is very important. Quantitative assays for cresol and its metabolites in blood or urine are needed in order to confirm the diagnosis. However, because these analytical methods are time consuming and are not routinely available in most emergency departments, the clinical manifestations of this case may be useful in early diagnosis and treatment.
Absorption ; Burns* ; Clothing ; Consciousness ; Decontamination ; Diagnosis ; Disinfectants ; Early Diagnosis ; Eating* ; Emergency Service, Hospital ; Family Characteristics ; Flushing ; Humans ; Liver* ; Male ; Middle Aged ; Neck ; Odors ; Phenol ; Poisoning ; Skin ; Thoracic Wall ; Unconsciousness ; Water

Saponated cresol solutions are common household disinfectants worldwide. Their main component, concentrated cresol, is extremely toxic and fatal; however, precise information on the clinical manifestations of cresol intoxication is not available. We report on a case of suicidal poisoning by ingestion of saponated cresol. A 63-year-old male presented with unconsciousness and brownish discoloration on the neck and anterior chest wall after ingesting 100 ml of 50% saponated cresol solution with suicidal attempt. The patient showed a wide range of clinical features of cresol intoxication, including decreased consciousness, respiratory distress, strong carbolic acid odor, dark brown urine, and chemical dermal burns on multiple areas. General treatment of cresol intoxication is intensive supportive care. In addition, reducing systemic absorption is most important in patients with cresol intoxication who present with cresol burns. Because the rate of cresol absorption through the skin is proportional to the size of the area involved and the duration of contact of the chemical with the skin rather than to the concentration of the cresol solution, gross decontamination, including removal of contaminated clothing and vigorous flushing with water, is very important. Quantitative assays for cresol and its metabolites in blood or urine are needed in order to confirm the diagnosis. However, because these analytical methods are time consuming and are not routinely available in most emergency departments, the clinical manifestations of this case may be useful in early diagnosis and treatment.
Absorption ; Burns* ; Clothing ; Consciousness ; Decontamination ; Diagnosis ; Disinfectants ; Early Diagnosis ; Eating* ; Emergency Service, Hospital ; Family Characteristics ; Flushing ; Humans ; Liver* ; Male ; Middle Aged ; Neck ; Odors ; Phenol ; Poisoning ; Skin ; Thoracic Wall ; Unconsciousness ; Water

Fentanyl, a synthetic, highly selective opioid micro-receptor agonist, is 50 to 100 times more potent than morphine. The low molecular weight, high potency, great transdermal permeation rate and lipid solubility of fentanyl make it very suitable for transdermal administration. Durogesic is a novel matrix transdermal system providing continuous systemic delivery of fentanyl. In recently, there are many reports that misused or overused fentanyl transdermal patches result in severe intoxication of fentanyl. We present a case of fentanyl toxicity with misused durogesic transdermal patch and discuss the safe and appropriate application of the patches. In conclusion, fentanyl patches should be used in opioid tolerant patients and prescribed at the lowest possible dose and titrated upward as needed. All patients and their caregivers should be educated safe application of fentanyl patches and advised to avoid exposing the patches application site to direct external heat sources, such as heating pads, or electric blankets, heat lamps, sauna, hot tubs, and others. In addition, concomittant medications that affect fentanyl's metabolism should be avoided.
Administration, Cutaneous ; Caregivers ; Fentanyl ; Heating ; Hot Temperature ; Humans ; Molecular Weight ; Morphine ; Solubility ; Steam Bath ; Transdermal Patch

Following are brief statements about the delayed encephalopathy of a patient who recovered without disturbance of consciousness after acute carbon monoxide poisoning. A 72-year-old male was found without consciousness at home and then visited the ER center. Later we learned that the patient was using briquettes as a household heating source. Blood carbon monoxide hemoglobin level was 17.5%. As carbon monoxide poisoning was uncertain after the first interview with the patient, hyperbaric oxygen therapy was not administered at the early stage. After supplying 100% oxygen, the patient recovered consciousness, however, the strength of the lower limb muscle had decreased to class II. The patient showed continued weakening of the lower limb muscle and an increase of CPK; therefore, he was diagnosed as carbon monoxide intoxication and rhabdomyolysis and then admitted to the intensive care unit (ICU) for conservative treatment. During the hospitalization period, continued weakening of the lower limb muscle was observed and he was diagnosed as myopathy after EMG/MCV. However, he suddenly showed altered mentality on the 20th day of hospitalization, and underwent brain MRI. T2 weighted MRI showed typically high signal intensity of both globus pallidus and periventricular white matter; therefore, he was diagnosed as delayed carbon monoxide encephalopathy. This case showed delayed encephalopathy accompanied by rhabdomyolysis and myopathy of a patient who recovered without disturbance of consciousness.
Aged ; Brain ; Carbon ; Carbon Monoxide ; Carbon Monoxide Poisoning ; Consciousness ; European Continental Ancestry Group ; Family Characteristics ; Globus Pallidus ; Heating ; Hemoglobins ; Hospitalization ; Hot Temperature ; Humans ; Hyperbaric Oxygenation ; Intensive Care Units ; Lower Extremity ; Male ; Muscles ; Muscular Diseases ; Oxygen ; Rhabdomyolysis

Ethylene glycol poisoning is treated mainly by alcohol dehydrogenase inhibition therapy and hemodialysis. Early recognition and initiation of treatment is important because toxic metabolites increase over time by hepatic metabolism; however, there is no confirmative diagnostic tool in our clinical setting. Therefore, diagnosis is dependent on history, high anion gap acidosis, high osmolal gap, etc.. Diagnosis and treatment are delayed in cases where history taking is not possible, such as a mental changed patient. Authors report on two cases of ethylene glycol poisoning by contrasting clinical outcomes, demonstrating the importance of early diagnosis and treatment for achievement of a good outcome.
Achievement ; Acid-Base Equilibrium ; Acidosis ; Alcohol Dehydrogenase ; Early Diagnosis ; Ethylene Glycol ; Ethylenes ; Osmolar Concentration ; Renal Dialysis

Acute organophosphate intoxication is important because of its high morbidity and mortality. The mortality is still high despite the use of atropine as specific antidotal therapy and oximes for reactivation of acetylcholinesterase. Inhibition of acetylcholinesterase by organophosphate can cause acute parasympathetic system dysfunction, muscle weakness, seizure, coma, and respiratory failure. Acute alteration in conscious state or a coma, which may occur following organophosphate intoxication, is an indication of severe intoxication and poorer prognosis. This acute decline in conscious state often reverses when the cholinergic crisis settles; however, it may be prolonged in some patients. We report on a case of a 60-year-old male who showed prolonged decline in conscious state due to of Central Nervous System (CNS) toxicity after a suicide attempt with organophosphate.
Acetylcholinesterase ; Atropine ; Brain Injuries ; Central Nervous System ; Coma ; Humans ; Male ; Middle Aged ; Muscle Weakness ; Organophosphate Poisoning ; Oximes ; Prognosis ; Respiratory Insufficiency ; Seizures ; Suicide

Dextromethorphan and chlorpeniramine are common ingredients of over-the-counter (OTC) cough pills. They are known to be safe when used alone, however, combination with other serotonergic drugs or use of an overdose can cause serotonergic toxicity. We report on a 43-year-old male and a 57-year-old female who ingested an overdose of antitussive drugs containing dextromethorphan and chlorpeniramine. They commonly presented with altered mentality and hyperreflexia on both upper and lower extremities. After conservative therapies, they were discharged with alert mentality. These cases are meaningful in that there are few cases of serotonin syndrome with an overdose of a combination of dextromethorphan and chlorpeniramine. Careful use with medication counseling for OTC cough pills is needed in order to prevent overdose of these ingredients.
Adult ; Antitussive Agents ; Cough ; Counseling ; Dextromethorphan ; Female ; Humans ; Lower Extremity ; Male ; Middle Aged ; Reflex, Abnormal ; Serotonin ; Serotonin Agents ; Serotonin Syndrome