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A death certificate (DC) can be considered a legal document and in terms of societal use, it is a public document. A DC includes facts such as the time and place of death, as well as judgments as to the cause and manner of death. Whether it pertains to facts or judgments, recording false information results in a false DC. According to the National Association of Medical Examiners (NAME) in the United States, it is acknowledged that there are varying opinions and approaches when it comes to classifying the manner of death. Therefore, it may require a final judgment, including input from the legal system. Generally, deaths resulting from complications that occur during drug administration or medical procedures are classified as natural deaths, while deaths due to unforeseen complications that occur suddenly, are categorized as accidental deaths. Applying this classification by NAME to the principles and legal precedents related to the duty of explanation and medical lowas of the Korean Medical Association, it is reasonable to classify deaths resulting from complication, during medical care, as natural death. However, if the death occurs due to injury or poisoning during medical care, it falls under external causes, according to the principle of following the primary cause. In conclusion, it is considered reasonable to classify complications that occur during medical treatment as natural deaths when they are foreseeable and within the accepted range of complications determined by medical standards at that the time.
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Purpose@#: This study aimed to examine the relationship between sleep quality and its influencing factors in patients with coronary artery disease (CAD). @*Methods@#: This descriptive correlational study included 130 patients with CAD admitted to the cardiology department of a general hospital in B City between September 2019 and February 2020. Data were collected using structured questionnaires and research instruments to measure sleep quality, anxiety, depression, chronotype, and daytime sleepiness. @*Results@#: The mean scores for sleep quality, daytime sleepiness, anxiety, and depression were 7.59±3.45, 6.45±3.46, 6.58±3.88, and 7.74±4.05, respectively. In terms of chronotypes, 10.8%, 48.5%, and 40.7% of the participants had evening-, intermediate-, and morning-type patterns, respectively. Sleep quality was significantly correlated with anxiety (r=0.38, p＜.001), depression (r=.37, p＜.001), and daytime sleepiness (r=.26, p =.002). Factors associated with sleep quality in patients with CAD included anxiety (β=.29), heart failure (β=.22), daytime sleepiness(β=.21), and sleeping alone (β=.19). Collectively, these factors had an explanatory power of 23.1% for sleep quality variance. @*Conclusion@#Patients with CAD often experience poor sleep quality owing to various factors such as anxiety, daytime sleepiness, heart failure, and sleeping alone. It is recommended that healthcare providers objectively evaluate sleep and identify factors that influence sleep quality. This will enable the development of effective methods for sleep management as part of nursing care.
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BACKGROUND@#Decellularized extracellular matrix (dECM) is a non-cellular scaffold with various functions in tissue engineering and regenerative medicine. Elastin is related to tissue elasticity and scarless wound healing, abundantly found in lung and blood vessel tissues. We studied the characteristics of blood vessel-derived dECM (VdECM) and its effect in wound healing. @*METHODS@#VdECM was prepared from porcine blood vessel tissue. Weight percentages of elastin of VdECM and atelocollagen were analyzed. Migratory potential of VdECM was tested by scratch assay. VdECM in hydrogel form was microscopically examined, tested for fibroblast proliferation, and examined for L/D staining. Cytokine array of various growth factors in adipocyte-derived mesenchymal stem cell (ASC) media with VdECM was done. Animal wound model showed the wound healing effect of VdECM hydrogel in comparison to other topical agents. @*RESULTS@#VdECM contained 6.7 times more elastin than atelocollagen per unit weight. Microscopic view of 0.35% VdECM hydrogel showed consistent distribution. Compared to 3% atelocollagen, 0.35% VdECM showed superior results in fibroblast migration. Fluorescent microscopic findings of L/D assay had highest percentage of cell survival in 1% VdECM compared to atelocollagen. Growth factor expression was drastically amplified when VdECM was added to ASC media. In the animal study model, epithelialization rate in the VdECM group was higher than that of control, oxytetracycline, and epidermal growth factor ointments. @*CONCLUSION@#VdECM contains a high ratio of elastin to collagen and amplifies expressions of many growth factors. It promotes fibroblast migration, proliferation, and survival, and epithelialization comparable to other topical agents.
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Objectives@#The objective of the present study was to examine whether patients with severe depression and/or anxiety show a difference in the level of body awareness compared with that of healthy controls. @*Methods@#Outpatients (n=100) with a diagnosis of moderate to severe depression and/or anxiety and 42 healthy controls were included in the study. Body awareness was assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) scale, and other clinical characteristics like anxiety and depression were measured using the State-Trait Anxiety Inventory and Patient Health Questionnaire, respectively. The data were analyzed using ANCOVA, and statistically significant differences between the two groups in both the overall MAIA score and subscale scores were documented. @*Results@#The overall MAIA scores of patients with depression and/or anxiety were significantly lower than that of healthy subjects. Specifically, the differences found in the subscales of trust, acceptance, attention-regulation, and return-to-body were significant, whereas the differences found in the subscales of notice and mind-to-body awareness were not. @*Conclusion@#These findings imply that the ability to monitor one’s own bodily sensations and to be aware of their connection with emotional states cannot serve as a marker for psychological well-being. Rather, it may be the aspects of attentional styles and attitudes toward bodily states that play a critical role in mental health. Further analyses examining the relationships between the subscales of body awareness and other psychological variables are deemed necessary.
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Objectives@#The purposes of this study were to compare the degree of sodium reduction practice and estimate sodium intake by salty food preference. @*Methods@#Sodium reduction practices, salty food preferences and estimated sodium intake were surveyed for restaurant owners (n = 80), employees (n = 82) and customers (n = 727) at the restaurants participating in the sodium reduction project in Daegu, Korea. Estimated sodium intake was performed by examining sex, age, body mass index (BMI), salty eating habit and dietary behaviors. @*Results@#The degree of sodium reduction practice was significantly higher in salinity meter use (P < 0.001), low salt seasonings (P < 0.001) and efforts to make the foods as bland as possible overall (P < 0.001) in the restaurants participating in sodium reduction project than in homes (P < 0.001). The degree of sodium reduction practice appeared lower in the high salty food preference group than in the low-preference group in such items as efforts to make the foods as bland as possible overall (P < 0.05) and washing the salty taste and then cooking (P < 0.05). The high-preference group showed high-salt dietary behavior, including eating all the soup until nothing was left (P < 0.05) more than the low-preference group, but low-salt dietary behavior included checking the sodium content in processed foods (P < 0 .0 5) less than the low-preference group. The high-preference group was higher in the soup and stew intake frequency than the low-preference group (P < 0.05) and much lower in nuts (P < 0.05) and fruits (P < 0.05) intake frequency. The high-preference group had a higher salty eating habit (P < 0.05), salty taste assessment (P < 0.05) and estimated sodium intake (P < 0.05) than the low-preference group. @*Conclusions@#The present study showed that the salty food preference was strongly associated with lower sodium reduction practice and higher estimated sodium intake.
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Herein, we report two rare cases of renal infection. The first case was renal subcapsular urine reflux in a 8-month-old girl with recurrent urinary tract infection and the second was subcapsular abscess in a 14-year-old girl with diabetes, who was successfully treated with percutaneous drainage. It has been suggested that renal subcapsular abscesses could be caused by the direct reflux of urine into the subcapsular space, rather than spread of infection from an existing parenchymal lesion, and that complete recovery can be achieved if percutaneous drainage is performed in a timely manner. We propose primary subcapsular reflux, in which urine directly refluxes upwards into the subcapsular space of the kidney, as one of the mechanisms for development of renal subcapsular abscesses.
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BACKGROUND@#Verapamil is used in the treatment of hypertension, angina pectoris, cardiac arrhythmia, hypertrophic scars, and keloids to block transmembrane calcium ion flux. Verapamil has antioxidant activity, which enhances the production of nitric oxide (NO). NO promotes the proliferation of fibroblasts, keratinocytes, endothelial cells, and epithelial cells during wound healing. In this study, we investigated the effect of verapamil and its antioxidant properties on the enhancement of acute wound healing via NO. @*METHODS@#A full-thickness wound healing model was created on the rat dorsal with a silicone ring. The wound closure rate was estimated every 2 days for 14 days. A histological study was performed to evaluate wound healing.Immunofluorescence staining was analyzed for angiogenesis. The expressions of collagen type I (COL I), collagen type III (COL III), and vascular endothelial growth factor (VEGF) were assessed by Western blot. Real-time polymerase chain reaction (qRT-PCR) was performed to examine the expression of endothelial NO synthase and inducible NO synthase, which are related to antioxidant activity in the process of wound healing. @*RESULTS@#The wound closure rate was faster in the verapamil group compared to the control and silicone groups.Histologic analysis revealed capillaries and stratum basale in the verapamil group. Immunofluorescence staining was shown vessel formation in the verapamil group. Western blot and qRT-PCR analysis revealed high expression levels of COL I, VEGF, eNOS, and FGF in the verapamil. @*CONCLUSION@#Verapamil’s antioxidant activity enhances NO production in acute wound healing. We suggest that verapamil can be used to promote acute wound healing.
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Sepsis, one of the most fatal diseases in the world, is known to culminate in multiple organ failure due to an uncontrolled inflammatory response. Hence, the use of animal models in sepsis research is very important to study complex immune responses. The current study was undertaken to compare commercial stocks with KFDA stocks of DBA/2 mice as an animal model for sepsis study. To compare responses of DBA/2 mice to lipopolysaccharides (LPS)-induced sepsis, we measured altered characteristics of various factors associated with sepsis, including survival curves, organ failure and inflammatory response, in DBA/2Korl stock and two commercial stocks (DBA/2A and DBA/ 2B). Survival rates after LPS exposure were similar for DBA/2Korl and DBA/2B; however, for times over 20 h, survival rates were reduced and concentration dependent in DBA/2A. In order to evaluate multiple organ failure caused by sepsis, H&E stains were evaluated for liver and spleen tissues obtained in the early (2 h) and later (20 h) stages after exposure to LPS; no significant differences were observed between the three stocks. mRNA and protein levels of proinflammatory cytokines were assessed for evaluating inflammatory reactions, and were found to increase in a dose-dependent manner in most DBA/2 mice after LPS treatment. However, no changes were observed in the mRNA levels of proinflammatory cytokines at 20 h after LPS exposure in the DBA/2A stock. The induction of inflammation-mediated factors by LPS exposure did not induce alterations in the mRNA levels of COX-2 and iNOS in all three DBA/2 stocks. Our results indicate that response of DBA/2Korl to LPS-induced sepsis is similar to the two commercial DBA/2 stocks, thus representing its potential as a useful biological resource established in Korea.
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Background@#In Korea, there were issues regarding the use of immunoassays for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies to detect infection. So, we compared antibody results of eight kinds of commercial immunoassays using clinical remnant specimens. @*Methods@#We compared the results of several immunoassay kits tested on 40 serum samples from 15 confirmed patients and 86 remnant serum samples from clinical laboratory.Eight kinds of IVD kits—four enzyme-linked immunosorbent assay, two lateral flow rapid immunochromatographic assays, and two chemiluminescent immunoassays with one RUO kit were tested. @*Results@#Among 40 serum samples from 15 coronavirus disease 2019 (COVID-19) patients, 35 yielded at least one positive result for detecting antibodies in the combined assessment. There were inconsistent results in 12 (28%) samples by single immunoassay. Forty samples collected in 2019 before the first COVID-19 Korean case showed negative results except for one equivocal result. @*Conclusion@#The discrepant results obtained with different immunoassay kits in this study show that serological assessment of SARS-CoV-2 by a single immunoassay requires caution not only in detecting infection but also in assessing immunologic status.
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BACKGROUND@#Verapamil is used in the treatment of hypertension, angina pectoris, cardiac arrhythmia, hypertrophic scars, and keloids to block transmembrane calcium ion flux. Verapamil has antioxidant activity, which enhances the production of nitric oxide (NO). NO promotes the proliferation of fibroblasts, keratinocytes, endothelial cells, and epithelial cells during wound healing. In this study, we investigated the effect of verapamil and its antioxidant properties on the enhancement of acute wound healing via NO. @*METHODS@#A full-thickness wound healing model was created on the rat dorsal with a silicone ring. The wound closure rate was estimated every 2 days for 14 days. A histological study was performed to evaluate wound healing.Immunofluorescence staining was analyzed for angiogenesis. The expressions of collagen type I (COL I), collagen type III (COL III), and vascular endothelial growth factor (VEGF) were assessed by Western blot. Real-time polymerase chain reaction (qRT-PCR) was performed to examine the expression of endothelial NO synthase and inducible NO synthase, which are related to antioxidant activity in the process of wound healing. @*RESULTS@#The wound closure rate was faster in the verapamil group compared to the control and silicone groups.Histologic analysis revealed capillaries and stratum basale in the verapamil group. Immunofluorescence staining was shown vessel formation in the verapamil group. Western blot and qRT-PCR analysis revealed high expression levels of COL I, VEGF, eNOS, and FGF in the verapamil. @*CONCLUSION@#Verapamil’s antioxidant activity enhances NO production in acute wound healing. We suggest that verapamil can be used to promote acute wound healing.
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Sepsis, one of the most fatal diseases in the world, is known to culminate in multiple organ failure due to an uncontrolled inflammatory response. Hence, the use of animal models in sepsis research is very important to study complex immune responses. The current study was undertaken to compare commercial stocks with KFDA stocks of DBA/2 mice as an animal model for sepsis study. To compare responses of DBA/2 mice to lipopolysaccharides (LPS)-induced sepsis, we measured altered characteristics of various factors associated with sepsis, including survival curves, organ failure and inflammatory response, in DBA/2Korl stock and two commercial stocks (DBA/2A and DBA/ 2B). Survival rates after LPS exposure were similar for DBA/2Korl and DBA/2B; however, for times over 20 h, survival rates were reduced and concentration dependent in DBA/2A. In order to evaluate multiple organ failure caused by sepsis, H&E stains were evaluated for liver and spleen tissues obtained in the early (2 h) and later (20 h) stages after exposure to LPS; no significant differences were observed between the three stocks. mRNA and protein levels of proinflammatory cytokines were assessed for evaluating inflammatory reactions, and were found to increase in a dose-dependent manner in most DBA/2 mice after LPS treatment. However, no changes were observed in the mRNA levels of proinflammatory cytokines at 20 h after LPS exposure in the DBA/2A stock. The induction of inflammation-mediated factors by LPS exposure did not induce alterations in the mRNA levels of COX-2 and iNOS in all three DBA/2 stocks. Our results indicate that response of DBA/2Korl to LPS-induced sepsis is similar to the two commercial DBA/2 stocks, thus representing its potential as a useful biological resource established in Korea.
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Background@#In Korea, there were issues regarding the use of immunoassays for anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies to detect infection. So, we compared antibody results of eight kinds of commercial immunoassays using clinical remnant specimens. @*Methods@#We compared the results of several immunoassay kits tested on 40 serum samples from 15 confirmed patients and 86 remnant serum samples from clinical laboratory.Eight kinds of IVD kits—four enzyme-linked immunosorbent assay, two lateral flow rapid immunochromatographic assays, and two chemiluminescent immunoassays with one RUO kit were tested. @*Results@#Among 40 serum samples from 15 coronavirus disease 2019 (COVID-19) patients, 35 yielded at least one positive result for detecting antibodies in the combined assessment. There were inconsistent results in 12 (28%) samples by single immunoassay. Forty samples collected in 2019 before the first COVID-19 Korean case showed negative results except for one equivocal result. @*Conclusion@#The discrepant results obtained with different immunoassay kits in this study show that serological assessment of SARS-CoV-2 by a single immunoassay requires caution not only in detecting infection but also in assessing immunologic status.
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Purpose@#The purpose of this study was to determine the lowest Tl-201 dose that does not reduce the image quality of myocardial perfusion SPECT (MPS) by Poisson resampling simulation. @*Methods@#One hundred and twelve consecutive MPS data from patients with suspected or known coronary artery disease were collected retrospectively. Stress and rest MPS data were resampled using the Poisson method with 33%, 50%, 67%, and 100% count settings. Two nuclear medicine physicians assessed the image quality of reconstructed data visually by giving grades from − 2 to + 2. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) were obtained on the workstation. Image quality grades and semi-quantitative scores were then compared among these resampled images. @*Results@#The proportions of “adequate” image quality were 0.48, 0.75, 0.92, and 0.96 for the groups of images with 33%, 50%, 67%, and 100% data, respectively. The quality of the resampled images was significantly degraded at 50% and 33% count settings, while the image quality was not different between 67 and 100% count settings. We also found that high body mass index further decreased image quality at 33% count setting. Among the semi-quantitative parameters, SSS and SRS showed a tendency to increase with a decline in count. @*Conclusion@#Based on the simulation results, Tl-201 dose for MPS can be reduced to 74 MBq without significant loss of image quality. However, the SSS and SRS can be changed significantly, and it needs to be further verified under the different conditions.
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Hepatobiliary scintigraphy has been widely used for the differential diagnosis of neonatal cholestasis. Relatively good hepatic uptake with no evidence of excretion into the bowel for up to 24 h is a representative finding of biliary atresia. Hepatobiliary scintigraphy has very high sensitivity and moderate specificity. Here, we report a false-positive case of hepatobiliary scintigraphy in a child with a choledochal cyst, which mimicked biliary atresia.
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Background@#To determine whether the background of BALB/c substrains affects the response to anti-tumor drugs, we measured for alterations in tumor growth, histopathological structure of the tumor, and expressions of tumorrelated proteins in three BALB/c substrains derived from different sources (BALB/cKorl, BALB/cA and BALB/cB), after exposure to varying concentrations of cisplatin (0.1, 1 and 5 mg/kg). @*Results@#Cisplatin treatment induced similar responses for body and organ weights, serum analyzing factors, and blood analyzing factors in all BALB/c substrains with CT26 syngeneic tumor. Few differences were detected in the volume and histopathological structure of the CT26 tumor. Growth inhibition of CT26 tumors after exposure to cisplatin was greater in the BALB/cB substrain than BALB/cKorl and BALB/cA substrains, and a similar pattern was observed in the histopathological structure of tumors. However, the expression levels of other tumor-related factors, including Ki67, p27, p53, Bcl-2-associated X protein (Bax), B-cell lymphoma 2 (Bcl-2), caspase-3 (Cas-3), matrix metallopeptidase 2 (MMP2) and vascular endothelial growth factor (VEGF) proteins, were constantly maintained in the tumors of all three substrains after cisplatin treatment. A similar decrease pattern was observed for the expressions of inflammatory cytokines, including interleukin (IL)-1β, IL-6 and IL-10, in the CT26 tumors of the three BALB/c substrains. @*Conclusions@#Taken together, results of the present study indicate that the genetic background of the three BALB/c substrains has no major effect on the therapeutic responsiveness of cisplatin, except growth and histopathology of the CT26 syngeneic tumor.
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Background@#The oral administration of polystyrene-microplastics (PS-MPs) causes chronic constipation of ICR mice, but there are no reports on their effects on the inflammatory response in the colon. To determine if the oral administration of MPs causes inflammation in the colon, the changes in the apoptosis-associated speck like protein containing a caspase recruitment domain (ASC)-inflammasome pathway, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway, and inflammatory cytokine expression were evaluated in the mid colon of ICR mice treated with 0.5 μm size PS-MPs for two weeks. @*Results@#The thicknesses of the mucosa, muscle, flat luminal surface, and crypt layer were decreased significantly (p < 0.01) in the mid colon of the MPs treated group compared to the Vehicle treated group. On the other hand, a remarkable increase in the expression levels of NOD-like receptor pyrin domain-containing protein (NLRP) 3, ASC, and Cleaved Caspase (Cas)-1 protein was observed in the MPs treated group. In addition, similar increasing pattern in the levels of p-NF-κB and phospho-inhibitory subunit of NF-κB (p-IkB) α protein was detected. Four inflammatory cytokines, including NF-κB, interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β, showed an increased expression level after the MPs treatment. @*Conclusions@#Therefore, the present study suggests that PS-MPs can be a novel cause of an inflammatory response in the mid colon of ICR mice.
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DNP (2,4-dinitrophenol) has been commonly used as a weight loss aid; in particular, it has been used by body builders to achieve significant fat loss while maintaining muscle mass. The sale of DNP was banned due to some cases of fatal poisoning. We describe an autopsy case of a 39-year-old man who died from taking DNP to treat obesity. He was 183 cm tall and weighed 101 kg (body mass index of 31). External examination did not reveal any specific findings implicating the cause of death. Gross examination revealed that the heart weight was 450 g, and there were no significant findings in the coronary arteries and myocardium, except for a few petechiae of the epicardium. The DNP concentration in the subject’s blood was 38.28 mg/L. According to references, a DNP blood concentration of 28 mg/L or higher would result in death. Therefore, the cause of death in this autopsy case was DNP toxicity.
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Purpose@#This study aimed to identify the effect of self-esteem and spouse support on prenatal depression. @*Methods@#The subjects were 131 pregnant women who visited two women clinics located in Changwon City. Data were collected from September 25 to November 20, 2019, and the self-report questionnaire included spouse support, self-esteem, and prenatal depression. The collected data were analyzed by IBM SPSS Statistics ver. 23.0 using descriptive statistics, independent t-test, one-way analysis of variance, Pearson correlation coefficients, and multiple regression analysis. @*Results@#Prenatal depression had a significant negative correlation with self-esteem (r=-0.39, p=0.001) and spouse support (r=-0.36, p<0.001). The factors affecting prenatal depression were religion (β=-0.16, p=0.035), monthly family income (β=-0.15, p=0.040), self-esteem (β=-0.25, p=0.002), and spouse support (β=-0.19, p=0.017); these variables explained 28.4% of the variance in prenatal depression. @*Conclusion@#To prevent depression in pregnant women, professional counseling and support systems such as spouses, religious and social environments should be applied to pregnant women, especially those with low self-esteem. Additionally, more financial support should be provided for low-income pregnant women. Further, there is a need to screen and manage the risk of depression in pregnancy.
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Purpose@#This study aimed to determine the current state of interventions for abused children and theireffectiveness by using a systemic review. @*Methods@#Published intervention studies were identified through MEDLINE, Embase, CINAHL, DBpia, RISS,and Kiss DB. Eligible studies included articles published between 2009 and 2019 in English and Korean. @*Results@#A total of 28 studies were selected for this review. The intervention elements of 28 selected studieswere categorized into 4 themes. The extracted intervention elements were divided into the themes of patient& situation-specific intervention, strengthen parent-child coping capacity and interaction, applyinggroup intervention and integrated intervention, Linkage with community resource and multidisciplinaryapproach. @*Conclusions@#The results demonstrate that social and psychological health of abused children has positivelychanged through these interventions. Therefore, it is important to implement treatment through active interventionaimed at helping the affected children.
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In vivo animal models are limited in their ability to mimic the extremely complex systems of the human body, and there is increasing disquiet about the ethics of animal research. Many authorities in different geographical areas are considering implementing a ban on animal testing, including testing for cosmetics and pharmaceuticals. Therefore, there is a need for research into systems that can replicate the responses of laboratory animals and simulate environments similar to the human body in a laboratory. An in vitro two-dimensional cell culture model is widely used, because such a system is relatively inexpensive, easy to implement, and can gather considerable amounts of reference data. However, these models lack a real physiological extracellular environment. Recent advances in stem cell biology, tissue engineering, and microfabrication techniques have facilitated the development of various 3D cell culture models. These include multicellular spheroids, organoids, and organs-on-chips, each of which has its own advantages and limitations. Organoids are organ-specific cell clusters created by aggregating cells derived from pluripotent, adult, and cancer stem cells. Patient-derived organoids can be used as models of human disease in a culture dish. Biomimetic organ chips are models that replicate the physiological and mechanical functions of human organs. Many organoids and organ-on-a-chips have been developed for drug screening and testing, so competition for patents between countries is also intensifying. We analyzed the scientific and technological trends underlying these cutting-edge models, which are developed for use as non-animal models for testing safety and efficacy at the nonclinical stages of drug development.