Saline versus Plasma Solution-A in Initial Resuscitation of Patients with Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.

BACKGROUND: Although saline is commonly used during cardiopulmonary resuscitation (CPR) or post-cardiac arrest care, it has detrimental effects. This trial aimed to evaluate the efficacy of a balanced crystalloid solution (Plasma Solution-A [PS]) in out-of-hospital cardiac arrest (OHCA) patients and compare it with the efficacy of saline. METHODS: A randomized, unblinded clinical trial was conducted using PS and saline for intravenous fluid administration during CPR and post-cardiac arrest care of non-traumatic OHCA patients admitted to the emergency department of a tertiary university hospital. Patients received saline (saline group) or PS (PS group) within 24 h of hospital arrival. The primary outcomes were changes in arterial pH, bicarbonate, base excess (BE), and chloride levels within 24 h. The secondary outcomes were clinical outcomes including mortality. RESULTS: Of the 364 patients, data from 27 and 26 patients in the saline and PS groups, respectively, were analyzed. Analysis using a linear mixed model revealed a significant difference in BE change over time between the groups (treatment-by-time p = 0.044). Increase in BE and bicarbonate levels from 30 min to 2 h was significantly greater (p = 0.044 and p = 0.024, respectively) and the incidence of hyperchloremia was lower (p < 0.001) in the PS group than in the saline group. However, there was no difference in clinical outcomes. CONCLUSION: Use of PS for resuscitation resulted in a faster improvement in BE and bicarbonate, especially in the early phase of post-cardiac arrest care, and lower hyperchloremia incidence than the use of saline, without differences in clinical outcomes, in OHCA patients.

Comparison of Prognostic Performance between Procalcitonin and Procalcitonin-to-Albumin Ratio in Post Cardiac Arrest Syndrome.

(1) Background: Post-cardiac arrest syndrome (PCAS) is a type of global ischemic reperfusion injury that occurs after the return of spontaneous circulation (ROSC). The procalcitonin to albumin ratio (PAR) has been studied as an independent prognostic factor of various diseases. There are no previous studies of PAR in patients with PCAS. We assessed if PAR is more effective than procalcitonin (PCT) in predicting prognosis for patients with PCAS. (2) Methods: This retrospective cohort study included a total of 187 patients with PCAS after non-traumatic out-of-hospital cardiac arrest (OHCA) between January 2016 and December 2020. Multivariate logistic regression analysis was conducted to assess the association between PAR and PCAS prognosis. The predictive performance of PAR was compared with PCT via the receiver-operating characteristic (ROC) analysis and DeLong test.; (3) Results: PAR at 24 and 48 h after hospital admission were independently associated with one-month neurological outcome (OR: 1.167, 95% CI: 1.023-1.330; OR: 1.077, 95% CI: 1.012-1.146, p < 0.05). By ROC analysis, PAR showed better performance over PCT at 48 h after admission in predicting one-month CPC (0.763 vs. 0.772, p = 0.010). (4) Conclusions: Our findings suggest that PAR at 48 h after admission is more effective in predicting a one-month neurological outcome than PCT at 48 h after admission in patients with PCAS after OHCA.

Early response to intravenous methylprednisolone therapy for restrictive myopathy in patients with thyroid eye disease.

PURPOSE: To report the therapeutic efficacy of intravenous methylprednisolone (IVMP) in patients with restrictive myopathy caused by thyroid eye disease (TED). METHODS: The present prospective uncontrolled study comprised 28 patients with TED and restrictive myopathy who presented with diplopia that had developed within 6 months before their visit. All patients were treated with IVMP for 12 weeks. Deviation angle, limitation of extraocular muscle (EOM) movement, binocular single vision score, Hess score, clinical activity score (CAS), modified NOSPECS score, exophthalmometric value, and the size of EOMs on computed tomography were evaluated. The patients were divided into two groups: those whose deviation angle had decreased or remained unchanged 6 months after treatment (group 1; n = 17) and those whose deviation angle had increased in that time (group 2; n = 11). RESULTS: The mean CAS of the whole cohort significantly decreased from baseline to 1 month and 3 months after treatment (P = 0.03 and P = 0.02, respectively). The mean deviation angle significantly increased from baseline to 1, 3, and 6 months (P = 0.01, P < 0.01, and P < 0.01, respectively). The deviation angle decreased in 10 (36%), remained constant in seven (25%), and increased in 11 (39%) of the 28 patients. When groups 1 and 2 were compared, no single variable was identified as a cause of deviation angle deterioration (P > 0.05). CONCLUSIONS: When treating patients with TED who have restrictive myopathy, physicians should be aware that some patients show worsening of the strabismus angle despite inflammation control with IVMP therapy. Uncontrolled fibrosis can result in motility deterioration.

Disaster Response to a Mass Casualty Incident in a Hospital Fire by Regional Disaster Medical Assistance Team: Characteristics of Hospital Fire.

OBJECTIVE: A disaster in the hospital is particularly serious and quite different from other ordinary disasters. This study aimed at analyzing the activity outcomes of a disaster medical assistance team (DMAT) for a fire disaster at the hospital. METHODS: The data which was documented by a DMAT and emergent medical technicians of a fire department contained information about the patient's characteristics, medical records, triage results, and the hospital which the patient was transferred from. Patients were categorized into four groups according to results of field triage using the simple triage and rapid treatment method. RESULTS: DMAT arrived on the scene in 37 minutes. One hundred and thirty eight (138) patients were evacuated from the disaster scene. There were 25 patients (18.1%) in the Red group, 96 patients (69.6%) in the Yellow group, and 1 patient (0.7%) in the Green group. One patient died. There were 16 (11.6%) medical staff and hospital employees. The injury of the caregiver or the medical staff was more severe compared to the family protector. CONCLUSIONS: For an effective disaster-response system in hospital disasters, it is important to secure the safety of medical staff, to utilize available medical resources, to secure patients' medical records, and to reorganize the DMAT dispatch system.

Factors associated with injury severity among users of powered mobility devices.

OBJECTIVE: To examine the features of powered mobility device-related injuries and identify the predictors of injury severity in such settings. METHODS: Emergency Department-based Injury In-depth Surveillance data from 2011 to 2018 were used in this retrospective study. Participants were assigned to the mild/moderate and severe groups based on their excess mortality ratio-adjusted injury severity score and their general injury-related factors and injury outcome-related factors were compared. RESULTS: Of 407 patients, 298 (79.2%) were assigned to the mild/moderate group and 109 (26.8%) to the severe group. The severe group included a higher percentage of patients aged 70 years or older (43.0% vs. 59.6%, P=0.003), injuries incurred in the daytime (72.6% vs. 82.4%, P=0.044), injuries from traffic accidents and falls (P=0.042), head injuries (38.6% vs. 80.7%, P<0.001), torso injuries (16.8% vs. 32.1%, P=0.001), overall hospital admission (28.5% vs. 82.6%, P<0.001), intensive care unit admission (1.7% vs. 37.6%, P<0.001), death after admission (1.4% vs. 10.3%, P=0.034), and total mortality (0.7% vs. 9.2%, P<0.001). The odds ratios (ORs) for injury severity were as follows: age 70 years or older (OR, 2.124; 95% confidence interval [CI], 1.239-3.642), head injury (OR, 10.441; 95% CI, 5.465-19.950), and torso injury (OR, 4.858; 95% CI, 2.495-9.458). CONCLUSION: The proportions of patients aged 70 years or older, head and torso injuries, injuries from traffic accidents and falls, and injuries in the daytime were higher in the severe group. Our results highlight the need for measures to address these factors to lower the incidence of severe injuries.

Usefulness of ischemia-modified albumin in the diagnosis of sepsis/septic shock in the emergency department.

OBJECTIVE: No studies have evaluated the diagnostic value of ischemia-modified albumin (IMA) for the early detection of sepsis/septic shock in patients presenting to the emergency department (ED). We aimed to assess the usefulness of IMA in diagnosing sepsis/septic shock in the ED. METHODS: This retrospective, observational study analyzed IMA, lactate, high sensitivity C-reactive protein, and procalcitonin levels measured within 1 hour of ED arrival. Patients with suspected infection meeting at least two systemic inflammatory response syndrome criteria were included and classified into the infection, sepsis, and septic shock groups using Sepsis-3 definitions. Areas under the receiver operating characteristic curves (AUCs) with 95% confidence intervals (CIs) and multivariate logistic regression were used to determine diagnostic performance. RESULTS: This study included 300 adult patients. The AUC (95% CI) of IMA levels (cut-off ≥85.5 U/mL vs. ≥87.5 U/mL) was higher for the diagnosis of sepsis than for that of septic shock (0.729 [0.667-0.791] vs. 0.681 [0.613-0.824]) and was higher than the AUC of procalcitonin levels (cut-off ≥1.58 ng/mL, 0.678 [0.613-0.742]) for the diagnosis of sepsis. When IMA and lactate levels were combined, the AUCs were 0.815 (0.762-0.867) and 0.806 (0.754-0.858) for the diagnosis of sepsis and septic shock, respectively. IMA levels independently predicted sepsis (odds ratio, 1.05; 95% CI, 1.00-1.09; P=0.029) and septic shock (odds ratio, 1.07; 95% CI, 1.02-1.11; P=0.002). CONCLUSION: Our findings indicate that IMA levels are a useful biomarker for diagnosing sepsis/septic shock early, and their combination with lactate levels can enhance the predictive power for early diagnosis of sepsis/septic shock in the ED.

Effect of alcohol intake on the severity of injuries caused by slipping down.

OBJECTIVE: Alcohol consumption is associated with an increased risk of injuries. However, its effects on injury severity and mortality remain unclear. Specifically, the effects of alcohol intake on the severity of slip injuries have not been thoroughly investigated. Therefore, our study aimed to investigate the effects of alcohol intake on injury patterns and severity in patients experiencing slip injuries. METHODS: Emergency department surveillance data collected from 2011 to 2016 were analyzed for this study. Among patients aged 15 and older who were admitted for slip injuries, we compared the type and severity of injuries between the alcohol-intake group and the no-alcohol-intake group. Injury severity was classified as non-severe and severe based on the excess mortality ratio-adjusted injury severity score. RESULTS: In total, 227,548 (alcohol-intake, n=48,581; no-alcohol-intake, n=178,967) patients were included. After adjusting for age, time of injury, use of public ambulance, and season, multivariate logistic regression analysis showed that injuries were more likely to be severe in the alcohol-intake group than in the no-alcohol-intake group (odds ratio, 1.60; 95% confidence interval, 1.47-1.75). In addition, male gender and alcohol consumption had a greater synergistic effect on injury severity than the mere sum of each effect of these factors (odds ratio, 2.65; 95% confidence interval, 2.53-2.78). CONCLUSION: Assessment of the patients influenced by alcohol was a challenge in the emergency department due to altered mental status. We suggest a considerate approach in testing and assessing male patients who slipped after alcohol-intake in the emergency department.

Solution-Processed Organic Light-Emitting Diodes Using a Photo-Crosslinkable Hole-Transporting Layer.

Photo-crosslinkable hole transporting layer (HTL) consisting of a blend of poly(bis-4-butylphenyl-N,N-bisphenyl)benzidine (poly-TPD) and bis(4-azido-2,3,5,6-tetrafluorobenzoate) (FPA) was applied to red and green organic light-emitting diodes (OLEDs) by solution processing. This photocrosslinking reaction rendered the HTL insoluble in organic solvents and enabled subsequent solution deposition of an upper emissive layer. The solvent resistance of the photo-crosslinked poly-TPD:FPA (1 wt%) film was enhanced compared to that of the non-crosslinked neat poly-TPD film. Solution-processed red and green OLEDs with the poly-TPD:FPA (1 wt%) photo-crosslinked HTL exhibited higher device performances than those with the non-crosslinked poly-TPD HTL.

Accuracy of Bedside Ultrasound for the Diagnosis of Skull Fractures in Children Aged 0 to 4 Years.

OBJECTIVES: The aim of this study was to investigate the accuracy of bedside ultrasound (US) performed by emergency physicians for diagnosing skull fractures in children 0 to 4 years old compared with the accuracy of head computed tomography (CT). We also sought to investigate characteristics and precautions associated with US. METHODS: This single-center prospective study involved children 0 to 4 years old who had a history of head trauma. Bedside US was performed by emergency medicine physicians, and the results were compared with CT scan interpretations provided by attending radiologists. The accuracy of US for the diagnosis of skull fractures was calculated, and the errors were reviewed. RESULTS: A total of 87 patients were enrolled. Skull fracture was present in 13 patients (14.9%), according to CT. Bedside US had a sensitivity and specificity of 76.9% (95% confidence interval [CI], 46.0%-93.8%) and 100% (95% CI, 93.9%-100%), respectively. Overall positive predictive value was 100% (95% CI, 65.5%-100%), and negative predictive value was 96.1% (95% CI, 88.3%-99.0%). Three false-negative cases were observed. CONCLUSIONS: Bedside US performed by emergency medicine physicians with short focused US training is a useful tool for diagnosing skull fractures in children 0 to 4 years of age. However, there were 3 false-negative cases. A meticulous examination is needed in the area adjacent to the orbital wall and skull base.

Relationship between age and injury severity in traffic accidents involving elderly pedestrians.

OBJECTIVE: This study aimed to examine whether injury severity differs with respect to age among elderly pedestrians involved in traffic accidents and identify factors affecting injury severity. METHODS: Using emergency department-based injury in-depth surveillance data, we analyzed the data of patients aged ≥60 years who were victims of pedestrian traffic accidents during 2011 to 2016. The pedestrians' ages were divided into 5-year age strata beginning at 60 years. In a multivariate analysis, injury severity was classified as severe to critical or mild to moderate. RESULTS: The analysis included 10,449 patients. All age groups had a female predominance, and accidents most frequently occurred during the early morning. Multivariate analyses revealed that compared to the 60 to 64 years group, the odds ratios for incurring a severe injury were 1.18 (95% confidence interval [CI], 1.02 to 1.37) for the 65 to 69 years group, 1.42 (95% CI, 1.23 to 1.64) for the 70 to 74 years group, 1.70 (95% CI, 1.45 to 1.98) for the 75 to 79 years group, and 1.83 (95% CI, 1.56 to 2.15) for the ≥80 years group. CONCLUSION: In this study of emergency department-based data, we found that injury severity increased with age among elderly victims of traffic accidents. Furthermore, injury severity varied with respect to sex, time and location of the accident, and type of vehicle involved. Therefore, measures intended to reduce and prevent traffic accidents involving elderly pedestrians should consider these findings.

Thermally Cross-Linkable Styrene-Based Host Materials for Solution-Processed Organic Light-Emitting Diodes.

Thermally cross-linkable host materials, DV-TPACZ, DV-TPADBCZ, and TV-TPBI, were designed and synthesized for solution-processed organic light-emitting diodes (OLEDs). The synthesized styrene-functionalized host materials were thermally cross-linked by curing at 150-200 °C without using a polymerization initiator. Excellent solvent resistance was observed for all cured host films. They exhibited low highest occupied molecular orbital energy levels of 5.4-5.7 eV, which indicated a low hole injection barrier from the hole transport layer to the emissive layer. A solution-processed red phosphorescent OLED with 5 wt% (MPHMQ)2Ir (tmd) dopant in the thermally cross-linkable DV-TPACZ host exhibited a current efficiency of 5.3 cd/A, power efficiency of 3.2 lm/W, and external quantum efficiency of 3.6%.

Combination of S100B and procalcitonin improves prognostic performance compared to either alone in patients with cardiac arrest: A prospective observational study.

This study aimed to determine whether the combination of procalcitonin (PCT) and S100B improves prognostic performance compared to either alone in cardiac arrest (CA) patients treated with targeted temperature management (TTM).We performed a prospective cohort study of CA patients treated with TTM. PCT and S100B levels were obtained at 0, 24, 48, and 72 hours after return of spontaneous circulation. The prognostic performance was analyzed using each marker and the combination of the 2 markers for predicting poor neurological outcome at 3 months and mortality at 14 days and 3 months.A total of 97 patients were enrolled, of which 67 (69.1%) had poor neurological outcome. S100B showed a better prognostic performance (area under the curve [AUC], 0.934; sensitivity, 77.6%; and specificity, 100%) than PCT (AUC, 0.861; sensitivity, 70.2%; and specificity, 83.3%) with the highest prognostic value at 24 hours. The combination of 24-hour PCT and S100B values (S100B ≥0.2 µg/L or PCT ≥6.6 ng/mL) improved sensitivity (85.07%) compared with S100B alone. In multivariate analysis, PCT was associated with mortality at 14 days (odds ratio [OR]: 1.064, 95% confidence interval [CI]: 1.014-1.118), whereas S100B was associated with neurological outcomes at 3 months (OR: 9.849, 95% CI: 2.089-46.431).The combination of PCT and S100B improved prognostic performance compared to the use of either biomarker alone in CA patient treated with TTM. Further studies that will identify the optimal cutoff values for these biomarkers must be conducted.

Pediatric Trampoline-Related Injuries in a Nationwide Registry in South Korea, 2011 to 2016.

PURPOSE: Trampoline-related injuries are steadily increasing. To our knowledge, there have been very few studies on trampoline injuries in Asia. The purpose of this study is to report the characteristics of pediatric trampoline injuries in Korea. MATERIALS AND METHODS: We conducted a nationwide retrospective cohort study. Data were collected from prospective nationwide databases (Emergency Department-based Injury In-depth Surveillance databases of the Korea Centers for Disease Control and Prevention) for patients who visited emergency departments (EDs) after injuries during 2011-2016. RESULTS: Of 263712 patients between 0 and 17 years of age, 2799 patients with trampoline injuries visited EDs. The median age of the patients was 5 years (interquartile range, 3-8 years), and 63% of the patients were under 6 years old. Of the patients, 1526 (54.2%) were male. Seventy-six percent of injuries occurred at trampoline parks. Trampoline injuries and trampoline park injuries have increased steadily, while ages at injury have gradually decreased year by year (p<0.001). Injury locations included the lower extremity (47%), head and face (24%), and upper extremity (24%). A fracture was sustained by 886 (31.7%) patients. The distal humerus and proximal tibia were the most common fracture sites (34% and 23%, respectively). Fractures occurred more commonly in trampoline parks than in homes (33.7% vs. 21.1%, p<0.001). CONCLUSION: In Korea, pediatric trampoline injuries and trampoline park injuries have tended to increase, while ages at injury have tended to decrease. Policies to prevent trampoline injuries are needed.

Blue Phosphorescent Bipyridine-Based Iridium(III) Complex for Vacuum-Deposited Organic Light-Emitting Diodes.

We have synthesized and characterized a blue phosphorescent iridium(III) complex (dfpypy)2Ir(tftamp), which contains 2',6'-difluoro-2,3'-bipyridine (dfpypy) as the main ligand and 4-methyl-2-(3'-trifluoromethyl-1'H-1',2',4'-triazol-5'-yl)pyridine (tftamp) as the ancillary ligand. The photophysical, electrochemical, and electroluminescent (EL) properties of (dfpypy)2Ir(tftamp) were investigated. Vacuum-deposited blue and white organic light-emitting diodes (OLEDs) were fabricated using (dfpypy)2Ir(tftamp) in 1,3-bis(carbazol-9-yl)benzene (mCP) as the emitting layer. The EL spectrum of (dfpypy)2Ir(tftamp) exhibited emission maximum at 472 nm with a full-width at half-maximum (FWHM) of 81 nm and Commission Internationale de L'Eclairage (CIE) coordinates of (0.17, 0.27) at 100 cd · m-2. In addition, white-light-emitting devices were fabricated, which exhibited CIE coordinates of (0.42, 0.40) and a correlated color temperature (CCT) of 3,237 K at 1000 cd · m-2, close to the standard warm-white light CIE coordinates of (0.44, 0.40) and CCT of 3,000 K.

Performance on the APACHE II, SAPS II, SOFA and the OHCA score of post-cardiac arrest patients treated with therapeutic hypothermia.

OBJECTIVE: This study assessed the ability of the Acute Physiologic and Chronic Health Evaluation (APACHE) II score, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA) score, and out-of-hospital cardiac arrest (OHCA) score to predict the outcome of OHCA patients who underwent therapeutic hypothermia (TH). METHODS: This study included OHCA patients treated with TH between January 2010 and December 2013. The APACHE II score, SAPS II, and SOFA score were calculated at the time of admission and 24 h and 48 h after intensive care unit admission. The OHCA score was calculated at the time of admission. The area under the curve (AUC) of the receiver operating characteristic curve and logistic regression analysis were used to evaluate outcome predictability. RESULTS: Data from a total of 173 patients were included in the analysis. The APACHE II score at 0 h and 48 h, SAPS II at 48 h, and OHCA score had moderate discrimination for mortality (AUC: 0.715, 0.750, 0.720, 0.740). For neurologic outcomes, the APACHE II score at 0 h and 48 h, SAPS II at 0 h and 48 h, and OHCA score showed moderate discrimination (AUC: 0.752, 0.738, 0.771, 0.771, 0.764). The APACHE II score, SAPS II and SOFA score at various time points, in addition to the OHCA score, were independent predictors of mortality and a poor neurologic outcome. CONCLUSIONS: The APACHE II score, SAPS II, SOFA score, and OHCA score have different capabilities in discriminating and estimating hospital mortality and neurologic outcomes. The OHCA score, APACHE II score and SAPS II at time zero and 48 h offer moderate predictive accuracy. Other scores at 0 h and 48 h, except for the SOFA score, are independently associated with 30-day mortality and poor cerebral performance.

Age is related to neurological outcome in patients with out-of-hospital cardiac arrest (OHCA) receiving therapeutic hypothermia (TH).

INTRODUCTION: In this study, we retrospectively reviewed the patients' outcomes after cardiac arrest based on age in one center, to determine whether geriatric patients had worse outcomes. METHODS: This was a single-center, retrospective cohort study. The patients admitted to the intensive care unit on successful resuscitation after OHCA were retrospectively identified and evaluated. RESULTS: This was a retrospective cohort study of patients over 18years of-age with return of spontaneous circulation (ROSC) (>24h) after cardiac arrest who were admitted to the emergency intensive care unit (EICU) and received post-cardiac arrest care between March 2007 and December 2013. Finally, a total of 295 patients were enrolled during the study period; of these, 79 patients (36.6%) had a good cerebral performance category (CPC). In stepwise multivariate analysis, young age (per 10years) (odds ratio [OR] 1.42, 95% CI 1.00-1.99, p=0.044), high hemoglobin level (per 1g/dL) (OR 1.31, 95% CI 1.07-1.60, p=0.008), non-diabetic patients (OR 15.21, 95% CI 1.85-125.3, p=0.01), cardiogenic cardiac arrest (OR 8.68, 95% CI 3.72-20.30, p<0.001), pre-hospital cardiopulmonary resuscitation (CPR) by bystander (OR 3.61, 95% CI 1.23-10.57, p=0.019), short time from collapsed to ACLS (per 1min) (OR 1.12, 95% CI 1.06-1.18, p<0.001) had good CPC at 6-month post-admission. CONCLUSION: Elderly patients with OHCA had a poor neurological outcome; but several other factors were also related with the outcome. In decision-making for resuscitation, physicians should consider the patients' physiologic factors as well as age.

A New Lridium(III) Complex as a Deep-Red Phosphorescent Emitter in Organic Light-Emitting Diodes.

We synthesized a novel red-emitting iridium(III) complex, bis[2-(5-(9H-carbazole-9-yl)thiophene-2-yl)benzo[d]thiazole]iridium(III)acetylacetonate ([(CTBT)21 r(acac)]), for use in phosphorescent organic light-emitting diodes. The photophysical and electrochemical properties of [(CTBT)2Ir(acac)] were characterized using photoluminescence (PL) and cyclic voltammetry. The photophysical properties of [(CTBT)2Ir(acac)] included PL emission at 630 nm. The highest occupied molecular orbital (HOMO) and lowest unoccupied molecular orbital (LUMO) energy levels of [(CTBT)2Ir(acac)] were calculated to be -5.14 and -2.83 eV, respectively. Phosphorescent organic light-emitting diodes with a configuration of ITO/PEDOT:PSS (30 nm)/TAPC (30 nm)/TPBi (12.5 nm):TCTA (12.5 nm):dopant (3%, 5%, 10%)/TSPO1 (35 nm)/LiF (1 nm)/Al (100 nm) were fabricated and characterized. The fabricated device doped with 5% [(CTBT)2Ir(acac)] showed a high luminous efficiency of 2.06 cd/A, maximum external quantum efficiency of 4.32% at 4 V, maximum outstanding luminance of 398.8 cd/m2, and maximum power efficiency of 1.79 lm/W with Commission Internationale de L'Eclairage (CIE) coordinates of (0.69, 0.31).

Spontaneous rupture of intercostal artery after severe cough.

Pleural or abdominal hematomas induced by spontaneous rupture of intercostal artery are very rare but can often cause fatal problems leading to hypovolemic shock. Spontaneous rupture of intercostal artery mostly occurs in association with neurofibromatosis type 1, coarctation of aorta, or trauma. In the absence of these conditions, there are very few cases. We report a 39-year-old man who complained of left flank pain after severe cough for a few days. His final diagnosis was hematoma of the left lateral abdominal wall induced by rupture of the left 11th intercostal artery. He was treated immediately by transarterial embolization. Without any serious problems during hospitalization, he was discharged. This case indicates that, in generally healthy individuals, even mild physical force such as cough can lead to rupture of the intercostal artery. Although it is very rare, injury to the intercostal artery should be considered when patients complain of unexplained chest pain, abdominal pain, or flank pain after strong cough or sneezing.

Clinical and radiological outcomes following microscopic decompression utilizing tubular retractor or conventional microscopic decompression in lumbar spinal stenosis with a minimum of 10-year follow-up.

Satisfactory short- and mid-term results have been observed following microscopic decompression with tubular retractor (MDT) and conventional microscopic decompression (CMD) in lumbar spinal stenosis (LSS). It is not yet clear which surgical procedure is the optimal treatment for LSS, especially in long-term follow-up period. To the best of our knowledge, there is no comparative study analyzing the clinical-radiological outcomes of MDT and CMD over a 10-year follow-up periods. The purpose of this study was to evaluate and compare clinical and radiological outcomes of MDT and CMD over a 10-year follow-up period in patients with LSS. Of total 121 patients, 102 patients (53 MDT and 49 CMD) were followed for at least 10 years following MDT and CMD for LSS. We retrospectively reviewed surgical results and clinical outcomes based on the visual analogue scale, McNab's criteria, and the Oswestry Disability Index, and radiological analysis results with the parameters, including the change of disk height and intervertebral distance, obtained preoperatively and 3- and 6-month, and 1-, 6-, and 10-year postoperatively. There was no significant difference in patient demographics between the two groups. Five patients (two in MDT, three in CMD) required re-operation for re-stenotic change of the affected segment. The number of patients requiring re-operation was not significantly different between the two groups (p > 0.05). No statistically significant differences were observed between the groups in a long-term follow-up period after a 3-month follow-up (p > 0.05). However, in the acute postoperative phase of <3-month postoperatively, MDT appears to result in less postoperative pain and better clinical outcomes compared with the CMD. In conclusion, despite relatively small sample size with retrospective design, our study suggested that MDT appears to result in less postoperative pain and better clinical outcomes in the acute postoperative period of <3 months, but both MDT and CMD were no significant differences in clinical and radiological outcomes after that time.