Highly accurate detection of the intracranial hemorrhage without delay is a critical clinical issue for the diagnostic decision and treatment in an emergency room. In the context of a study on diagnostic accuracy, there is a tradeoff between sensitivity and specificity. In order to improve sensitivity while preserving specificity, we propose a cascade deep learning model constructed using two convolutional neural networks (CNNs) and dual fully convolutional networks (FCNs). The cascade CNN model is built for identifying bleeding; hereafter the dual FCN is to detect five different subtypes of intracranial hemorrhage and to delineate their lesions. Using a total of 135,974 CT images including 33,391 images labeled as bleeding, each of CNN/FCN models was trained separately on image data preprocessed by two different settings of window level/width. One is a default window (50/100[level/width]) and the other is a stroke window setting (40/40). By combining them, we obtained a better outcome on both binary classification and segmentation of hemorrhagic lesions compared to a single CNN and FCN model. In determining whether it is bleeding or not, there was around 1% improvement in sensitivity (97.91% [± 0.47]) while retaining specificity (98.76% [± 0.10]). For delineation of bleeding lesions, we obtained overall segmentation performance at 80.19% in precision and 82.15% in recall which is 3.44% improvement compared to using a single FCN model.

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Introduction: We experienced an emergency room (ER) shutdown related to an accidental exposure to a patient with COVID-19 who had not been isolated. To prevent in-hospital transmission of the disease, we subsequently isolated patients with suspected symptoms, relevant radiographic findings, or epidemiology. The SARS-CoV-2 reverse-transcriptase polymerase chain reaction was performed in most patients requiring hospitalization. Universal mask policy and comprehensive use of personal protective equipment (PPE) were implemented. Materials and Methods: The effect of the interventions was analyzed in a 635-bed, tertiary-care hospital in Daegu, South Korea. Results: From the pre-shutdown (February 10 to 25) to the post-shutdown (February 28 to March 16, 2020) period, the mean hourly turnaround time (23:31±6:43 versus 9:27±3:41, P<0.001) was shortened, which increased the proportions of the patients tested (5.8% [N=1,037] versus 64.6% [N=690], P<0.001) and the average number of tests per day (3.8±4.3 versus 24.7±5.0, P<0.001). All 23 patients with COVID-19 in the post-shutdown period were isolated in the ER without any problematic accidental exposure or in-hospital transmission. From the pre- to the post-shutdown period, the median duration of stay in the ER among hospitalized patients (4:30 hr [2:17-9:48] versus 14:33 hr (6:55-24:50), P<0.001), rates of intensive care unit admissions (1.4% versus 2.9%, P=0.023), and mortality (0.9% versus 3.0%, P=0.001) increased. Conclusions: Problematic accidental exposure and in-hospital transmission of COVID-19 can be successfully prevented through active isolation and surveillance policy and comprehensive PPE use despite longer ER stays and the presence of more severely ill patients during an explosive COVID-19 outbreak.

PurposeThe aim of this study is to investigate the changing prevalence rate of Helicobacter pylori infection in children, of different age groups, with recurrent abdominal pain over a 10-year period.MethodsChildren with recurrent abdominal pain who visited the pediatric outpatient clinic at university hospital were screened for H. pylori. Children were divided into 3 age categories of 4-5, 6-11, and 12-16 years. To study the changes in the annual prevalence rates of H. pylori infection, the study period was divided into 3 time periods: 2004-2007, 2008-2010, and 2011-2014. Urea breath test was performed for all children aged 4-16 years, with a cut-off value of 4.0‰ for children aged ≥6 years and 7‰ for children aged <6 years.ResultsA total of 2,530 children (1,191 boys) with a mean age of 10.0±3.0 years (range, 4.0-16.9 years) were included in the study. The total prevalence of H. pylori infection was 7.4% (187/2,530). The prevalence rate of H. pylori infection in children with recurrent abdominal pain was 8.0% (70/873) in 2004-2007, 7.7% (51/666) in 2008-2010, and 6.7% (66/991) in the 2011-2014. Nevertheless, a significant difference was observed in the prevalence rate between children <12 years old and ≥12 years of age (p=0.018).ConclusionThe prevalence of H. pylori infection in Korean children with recurrent abdominal pain was 7.4%, showing no significant decrease in the last 11 years; however, the prevalence rate in children <12 years old was significantly lower than that in those ≥12 years old.

Intussusception is rarely observed in adults. Adult cases account for only 5% of all cases of intussusceptions and almost 1%-5% of bowel obstruction cases. The etiology, presentation and management of intussusception in adults are different from those in children. The clinical presentation in adults often includes nonspecific signs and symptoms, thereby complicating differential diagnosis from other causes of abdominal pain. We report a 29-year-old Asian woman who visited our emergency department with complaints of fever associated with epigastric pain since one day. Abdominal computed tomography demonstrated ileocolic intussusception, and laparoscopic small bowel luminal mass resection was performed. Histopathology report confirmed a 3.5 cm × 2.7 cm submucosal lipoma in the terminal ileum. Sufficient vigilance and appropriate investigations are important for prompt diagnosis and surgical referral of patients to enable favorable outcomes. A computed tomography scan can be a helpful modality in establishing a diagnosis.

Foreign body (FB) ingestion of children is a common pediatric emergency requiring medical attention. Pediatric emergency physicians and gastroenterologists often encounter nervous and distressed situations, because of children presenting with this condition in the common clinical practice. When determining the appropriate timing and indications for intervention, physicians should consider multiple patient- and FB-related factors. The utilization of a flexible endoscopy is considered safe and effective to use in these cases, with a high success rate, for the effective extraction of FBs from the gastrointestinal tract of a child. Additionally, a Foley catheter and a magnet-attached Levin tube have been used for decades in the case of FB removal. Although their use has decreased significantly in recent times, these instruments continue to be used for several indications. Using a Foley catheter for this purpose does not require special training and does not necessarily require sedation of the patient or fluoroscopy, which serve as advantages of utilizing this method for foreign object retrieval. An ingested magnet or iron-containing FB can be retrieved using a magnet-attached tube, and can be effective to retrieve an object from any section of the upper gastrointestinal tract that can be reached. Simple and inexpensive devices such as Foley catheters and magnet-attached tubes can be used in emergencies such as with the esophageal impaction of disk batteries if endoscopy cannot be performed immediately (e.g., in rural areas and/or in patients presenting at midnight in a facility, especially in those without access to endoscopes or emergency services, or in any situation that warrants urgent removal of a foreign object).

ObjectivesEarly retirement occurs when one’s job satisfaction suffers due to employment mismatch resulting from factors such as inadequate compensation. Medical doctors report high levels of job stress and burnout relative to other professionals. These levels are highest among emergency physicians (EPs), and despite general improvements in their working conditions, early retirement continues to become more common in this population. The purpose of this study was to identify the factors influencing EPs intention to retire early and to develop a probability equation for its prediction.MethodsA secondary analysis of data from the 2015 Korean Society of Emergency Physicians Survey was performed. The variables potentially influencing early retirement were organized into personal characteristics, extrinsic factors, and intrinsic factors. Logistic regression analysis was performed to identify risk factors and to develop a probability equation; these findings were then arranged in a nomogram.ResultsOf the 377 survey respondents included in the analysis, 48.0% intended to retire early. Risk factors for early retirement included level of satisfaction with the specialty and its outlook, slanderous reviews, emergency room safety, health status, workload intensity, age, and hospital type. Intrinsic factors (i.e., slanderous reviews and satisfaction with the specialty and its outlook) had a stronger influence on early retirement than did extrinsic factors.ConclusionsTo promote career longevity among EPs, it is vital to improve emergency room safety and workload intensity, to enhance medical professionalism through a stronger vision of emergency medicine, and to strengthen the patient-doctor relationship.

The administration of adriamycin to rates increased (P < 0.01) the interval, measured in msec, of the electrocardiographic QRS traces in rats, and the magnitude of the increase was ca. 50%. The administration of coenzyme Qio to such adriamycin-treated rats allowed "rescue" or restoration of a normal QRS complex after 7 days of administration of coenzyme Qio. The QRS complex then remained normalized during the subsequent period of 21-30 days, by which time the cumulative dose of adriamycin had reached 24 mg/kg. Also, the QRS interval was lower (P < 0.01) on day 33 than it was for rats treated to the same day with adriamycin alone. Coenzyme Q1o offers promise of rescue from at least some of the cardiotoxicity occurring in adriamycin-treated cancer patients, probably by a similar mechanism to that of the clinical rescue from toxicity of methotrexate by a cofactor of folic acid (citrovorum factor).The cardiotoxicity of adriamycin to cancer patients has become a widely recognized side effect and has resulted in a recommended maximum dosage of 550 mg/M2 body surface. This cardiotoxicity has also been observed at dosage levels lower than 550 mg/M2, and a consideration to exceed this maximum dosage has necessitated decisions on comparing the risk of tumor growth with the risk of congestive heart failure that results from the side effect. The clinical importance of adriamycin for cancer therapy has led to ongoing and diversified broad investigations toward the elucidation of the mechanism of the cardiotoxicity and its possible control.Noting CoQ1O. Jaenke (7) reported extensively on cardiomyopathy in rabbits that was induced by adriamycin and related anthracyclines. Mettler et al. (8) summarized the adriamycin-induced cardiomyopathy and congestive heart failure in rats, and included histological data on myocardial changes and ultrastructural alterations. Lenaz and Page (9) reviewed the pathogenesis of the cardiomyopathy due to adriamycin and the clinical status of the cardiotoxicity.Combs et al. (10) found that treatment of mice with CoQiO before adriamycin administration allowed an increase (P < 0.05) in survival from 36% to 80% and from 42% to 86%, respectively, in two protocols. The sequential data of Zbinden et al. (11,12) indicated protection by CoQ against the electrocardiographic changes in rats subjected to the cardiotoxicity of adriamycin, but these workers considered their findings only preliminary. Choe et al. (13) definitively demonstrated that the widening of the electrocardiographic QRS interval did not appear when CoQ1o had been administered to adriamycintreated rats.The clinical practice of "rescue" by the citrovorum factor (a coenzyme) from the toxicity of deliberately chosen high dosages of methotrexate (an enzyme inhibitor) for cancer patients is widely known. It was considered important to test for the rescue by CoQ1o from at least some of the cardiotoxicity of adriamycin in rats, as judged by electrocardiographic parameters. The conduct and results of these rescue experiments are described...