Two Cases of Suicidal Asphyxia by Neck Compression / 대한법의학회지

In majority of deaths from asphyxiation that affect the cerebral blood flow, compression occurs at the neck. Compressive asphyxia caused by a heavy weight is usually the result of an accident. The authors used the Korean national police agency's scientific crime analysis system to identify two cases of suicide by strangulation which were not otherwise specified, wherein asphyxiation occurred from an object pressing on the neck. In the first case, a man in his 50s died after the compression of his neck with a barbell shaft using a bench press. In the second case, a man in his 80s died due to compression from the side bar of a single bed that pressed on his neck. As far as the authors know, there have been no reported cases of suicide in forensic literature that occurred due to compression from an object such as a barbell shaft of a bench press or a side bar of a bed. Upon classifying the types of asphyxiation, accurate statistics should be prepared and researched, with accurate understanding and classification of the terms therein. Each case in the present report is discussed along with a brief literature review.

Risk factors for the development of asthma symptoms in children with allergic rhinitis

Purpose@#Both allergic rhinitis and asthma are considered one airway disease, which interacts with each other in disease onset and symptom worsening. We evaluated factors developing new or persistent asthma symptoms in elementary school children with allergic rhinitis. @*Methods@#We selected 343 children aged 6 to 7 years who had rhinitis symptoms within 12 months and allergic sensitization on skin prick tests among 2,491 elementary school children. The questionnaires on symptoms, medical history and environments, blood eosinophils, serum total IgE, pulmonary function test, and bronchial provocation tests were obtained. Using multiple regression analysis, we evaluated factors for later asthma symptoms during a follow-up period of 4 years. @*Results@#The independent risk factors for later asthma symptoms among children with allergic rhinitis were higher body mass index (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 1.06–1.56; P= 0.012), a parental diagnosis of asthma (aOR, 6.19; 95% CI, 1.59–24.06; P= 0.008), residence in the rural area (aOR, 5.37; 95% CI, 1.34–21.42; P= 0.017), and a history of bronchiolitis in the first 2 years (aOR, 5.82; 95% CI, 1.42–23.80; P= 0.014). However, pulmonary functions, the levels of bronchial hyper-responsiveness, and the patterns of sensitization showed not significant factors. Children whose allergic rhinitis was treated in the follow-up period were less likely to have asthma symptoms later (aOR, 0.30; 95% CI, 0.10–0.93; P= 0.036). @*Conclusion@#In the school-aged children with allergic rhinitis, body mass index and asthma-related risk factors are crucial for developing asthma symptoms. The appropriate treatment of rhinitis may decrease asthma symptoms.

Three Cases of Pierre Robin Sequence with Upper Airway Obstruction Relieved by Nasopharyngeal Airway Insertion

Pierre Robin sequence (PRS), also called Robin sequence, is a congenital anomaly characterized by a triad of micrognathia, glossoptosis, and upper airway obstruction. Infants with PRS can present with varying degrees of respiratory difficulty secondary to upper airway obstruction. There has been no consensus for the treatment of upper airway obstruction in infants with PRS, but recent studies recommend attempting non-surgical interventions before surgical treatment. In this case report, we present 3 cases of infants diagnosed with PRS who showed persistent respiratory difficulties after birth. Before considering surgical intervention, insertion of a nasopharyngeal airway was attempted in these infants. Following this procedure, symptoms of upper airway obstruction were relieved, and all infants were discharged without surgical interventions; the nasopharyngeal airway was removed 1 to 2 months later. To date, no infant has shown signs of upper airway obstruction. Nasopharyngeal airway insertion is a highly effective and less invasive treatment option for infants with PRS. However, it is not widely known and used in Korea. Nasopharyngeal airway insertion can be preferentially considered before surgical intervention for upper airway obstruction in such infants.

The association between nasal eosinophilia and aeroallergen sensitization in children and adolescents with rhinitis

PURPOSE: To identify the correlation between nasal eosinophilia and aeroallergen sensitization in children and adolescents. METHODS: This is a retrospective study of patients below 18 years of age who had a history of rhinitis that lasted more than 2 weeks or had been repeated more than once a year, received nasal eosinophil examinations, and had serum specific IgE to aeroallergens measured at an Allergy Clinic in a single tertiary teaching hospital in Seoul, Korea. The percentage of nasal eosinophils was calculated by the number of eosinophils per total leukocytes in a high-power field of 1,000×. Data was analyzed to determine the association between nasal eosinophilia and 18 aeroallergens. RESULTS: Of the 245 patients included, 156 (63.7%) were male and the mean age (±standard deviation) was 7.9 years (±3.8). In total, 175 patients (71.4%) were sensitized to at least 1 of the 18 aeroallergens tested, and sensitization to house dust mite was most common. In addition, 118 (48.2%) and 69 patients (28.2%) had nasal eosinophilia of at least 1% and 5%, respectively. There were no significant correlations between serum total IgE or age and the percentage of nasal eosinophils. However, the percentage of nasal eosinophils in the group sensitized to any aeroallergens was significantly increased compared to the nonsensitized group (P=0.002). The percentage of nasal eosinophils was significantly higher in patients who were sensitized to Birch-Alder Mix, oak white, Bermuda grass, orchard grass, timothy grass, sweet vernal grass, rye, mugwort, short ragweed, Alternaria alternata, cats, dogs or Dermatophagoides farinae compared to those nonsensitized. CONCLUSION: Nasal eosinophilia was significantly associated with sensitization to aeroallergens.

Chest radiographs and computed tomography scans in children with airway foreign body

PURPOSE: This study aimed to evaluate the diagnostic value of radiologic findings in children with suspected foreign body aspiration. METHODS: A retrospective medical chart review was done on 32 children with suspected foreign bodies in terms of age, sex, symptoms, signs, bronchographic findings, and type and location of foreign bodies. The diagnostic value of radiography was analyzed: 29 with chest anteroposterior (AP) or posteroanterior (PA) view, 23 with chest lateral decubitus view, 27 with chest computed tomography (CT), 29 with chest AP, PA or chest lateral decubitus view, and 25 with bronchoscopy. RESULTS: As a measure for detecting foreign body aspiration, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of radiologic findings were: chest AP or PA view, 50%, 100%, 100%, 29.4%, and 58.6%, respectively; chest lateral decubitus view, 57.9%, 50.0%, 84.6%, 20.0%, and 56.5%, respectively; chest AP, PA or chest lateral decubitus view, 69.6%, 66.7%, 88.8%, 36.4%, and 69.0%, respectively; and chest CT, 100.0%, 85.7%, 95.2%, 100.0%, and 96.2%, respectively. CONCLUSION: There is clinical benefit to take chest radiographs to diagnose foreign body aspiration. However, based on the results of this study, it may be not necessary to take chest lateral decubitus to diagnose foreign body aspiration. If chest radiographs show unilateral hyperinflation, foreign body aspiration can be diagnosed. In cases of normal chest radiography and history of a witnessed choking episode combined with positive signs, the diagnosis of airway foreign body aspiration should be made by using chest CT.

Correlation between serum cytokines and clinical feature of children with mild lower respiratory infection

PURPOSE: Acute lower respiratory infection (ALRI), which is frequently encountered in pediatric patients, is the leading cause of hospitalization. We aimed to identify particular cytokines that correlated with ALRI clinical characteristics. We also aimed to identify any differences in cytokines between respiratory syncytial virus (RSV)-related ALRI and non-RSV-related ALRI. METHODS: Cytokine levels were measured in the sera sampled from 103 pediatric patients diagnosed with ALRI and admitted to Seoul St. Mary's Hospital between May 2012 and April 2013. The correlations between cytokine levels and the length of hospitalization, the number of days with fever, body temperature, pulse rate, respiration rate, oxygen saturation upon admission, and duration of oxygen supplementation were analyzed. RESULTS: In children with ALRI, the level of interleukin (IL)-6, granulocyte-colony stimulating factor (G-CSF), and IL-10 were correlated with a higher body temperature on admission. In addition, the IL-8 level was correlated with pulse rate and respiration rate, and IL-1β level was related with oxygen saturation on admission. In children with RSV-related ALRI, the IL-6 was correlated the with duration of fever, and the IL-1β, IL-2, and IL-8 levels were related to pulse rate and respiration rate. In addition, the increase in interferon-gamma-inducible protein-10 (IP-10) level was correlated with a higher body temperature on admission and a longer duration of hospitalization in children with RSV-related ALRI. CONCLUSION: In children with ALRI, the levels of IL-6, IL-8, IL-1β, G-CSF, and IP-10 were correlated with its clinical features. In children with RSV-related ALRI, the IL-1β, IL-2, IL-6, IL-8, and IP-10 level was correlated with the severity of the disease.

International Classification of Diseases 10th edition-based disability adjusted life years for measuring of burden of specific injury

OBJECTIVE: We aimed to develop an International Classification of Diseases (ICD) 10th edition injury code-based disability-adjusted life year (DALY) to measure the burden of specific injuries. METHODS: Three independent panels used novel methods to score disability weights (DWs) of 130 indicator codes sampled from 1,284 ICD injury codes. The DWs were interpolated into the remaining injury codes (n=1,154) to estimate DWs for all ICD injury codes. The reliability of the estimated DWs was evaluated using the test-retest method. We calculated ICD-DALYs for individual injury episodes using the DWs from the Korean National Hospital Discharge Injury Survey (HDIS, n=23,160 of 2004) database and compared them with DALY based on a global burden of disease study (GBD-DALY) regarding validation, correlation, and agreement for 32 injury categories. RESULTS: Using 130 ICD 10th edition injury indicator codes, three panels determined the DWs using the highest reliability (person trade-off 1, Spearman r=0.724, 0.788, and 0.875 for the three panel groups). The test-retest results for the reliability were excellent (Spearman r=0.932) (P<0.001). The HDIS database revealed injury burden (years) as follows: GBD-DALY (138,548), GBD-years of life disabled (130,481), and GBD-years of life lost (8,117) versus ICD-DALY (262,246), ICD-years of life disabled (255,710), and ICD-years of life lost (6,537), respectively. Spearman’s correlation coefficient of the DALYs between the two methods was 0.759 (P<0.001), and the Bland-Altman test displayed an acceptable agreement, with exception of two categories among 32 injury groups. CONCLUSION: The ICD-DALY was developed to calculate the burden of injury for all injury codes and was validated with the GBD-DALY. The ICD-DALY was higher than the GBD-DALY but showed acceptable agreement.

A Case of Rheumatoid Arthritis with Chronic Eosinophilic Pneumonia Associated with Eosinophilic Pleural Effusion

We describe a 48-year-old man with family history of rheumatoid arthritis (RA) affected by chronic eosinophilic pneumonia (CEP) with severe peripheral eosinophilia. CEP might develop as a complication of longstanding active RA. The patient with 5 months history of seropositive RA and chronic respiratory symptoms, alveolar and blood eosinophilia, peripheral pulmonary infiltrates and pleural effusion on chest imaging. The lung may be involved as an extraarticular manifestation of RA. However, CEP is not recognized as a typical lung manifestation of RA, and the two diseases rarely coexist. The effusion was an eosinophil predominant exudates and was characterized by low pH, and glucose level and high lactic dehydrogenase. The patient responded rapidly to combination of steroids and disease modifying anti-rheumatic drugs.

Overexpression of Human Arginine Decarboxylase Rescues Human Mesenchymal Stem Cells against H2O2 Toxicity through Cell Survival Protein Activation

In this study, we explored the potentiality of human arginine decarboxylase (ADC) to enhance the survival of mesenchymal stem cells (MSCs) against unfavorable milieu of host tissues as the low survival of MSCs is the issue in cell transplantation therapy. To address this, human MSCs overexpressing human ADC were treated with H2O2 and the resultant intracellular events were examined. First, we examined whether human ADC is overexpressed in human MSCs. Then, we investigated cell survival or death related events. We found that the overexpression of human ADC increases formazan production and reduces caspase 3 activation and the numbers of FITC, hoechst, or propidium iodide positive cells in human MSCs exposed to H2O2. To elucidate the factors underlying these phenomena, AKT, CREB, and BDNF were examined. We found that the overexpression of human ADC phosphorylates AKT and CREB and increases BDNF level in human MSCs exposed to H2O2. The changes of these proteins are possibly relevant to the elevation of agmatine. Collectively, our data demonstrate that the overexpression of human ADC stimulates pro-survival factors to protect human MSCs against H2O2 toxicity. In conclusion, the present findings support that ADC can enhance the survival of MSCs against hostile environment of host tissues.

Kodamaea ohmeri Fungemia Associated with Colonoscopic Stent Insertion: A Case Report / 대한내과학회지

Kodamaea (Pichia) ohmeri is a rare fungal pathogen that has recently been identified as an etiological agent of fungemia in immunocompromised patients. We report a case of K. ohmeri fungemia after colonoscopic stent insertion in a 73-year-old female who was successfully treated with a 2-week course of amphotericin B without stent removal. This is the first case report of K. ohmeri fungemia that developed after colonoscopic stent insertion.

Three cases of glycogenic hepatopathy mimicking acute and relapsing hepatitis in type I diabetes mellitus

Glycogenic hepatopathy (GH) is an uncommon cause of serum transaminase elevation in type I diabetes mellitus (DM). The clinical signs and symptoms of GH are nonspecific, and include abdominal discomfort, mild hepatomegaly, and transaminase elevation. In this report we describe three cases of patients presenting serum transaminase elevation and hepatomegaly with a history of poorly controlled type I DM. All of the cases showed sudden elevation of transaminase to more than 30 times the upper normal range (like in acute hepatitis) followed by sustained fluctuation (like in relapsing hepatitis). However, the patients did not show any symptom or sign of acute hepatitis. We therefore performed a liver biopsy to confirm the cause of liver enzyme elevation, which revealed GH. Clinicians should be aware of GH so as to prevent diagnostic delay and misdiagnosis, and have sufficient insight into GH; this will be aided by the present report of three cases along with a literature review.

A Study on Diet Education of Participants in Diabetic Education at Public Health Center

This study was carried out to see the effect of individualized diet education on the improvement of blood glucose level according to the changes of nutrient intake with the subjects of 25 people. Among 25 people who participated in diabetic education program held in Chilgok-gun public health center, Gyeongbuk, there were 15 diabetic patients(3 males and 12 females) and 10 healthy people(2 males and 8 females) and after the diet education, the results were as follows. As for clinical characteristics, the diabetic group tended to have slightly higher blood pressure than the control group, especially diastolic blood pressure of diabetic group was higher than the control group with a significant level(p<0.05). Blood glucose level measured 2 hours after the meal was higher in the diabetic group than the control group with significant level(p<0.0001). For the clinical characteristic changes before and after the diet education, the blood glucose level in the diabetic group reduced significantly(p<0.01). For the daily diet intake, intake of fat in the diabetic group increased significantly compared to the one before the education(p<0.05). When comparing the ratio of carbohydrate: protein: fat, it was changed from 72.9 : 16.2 : 12.9 before the education to 63.8 : 15.1 : 21.1 after the education. From the above results, it is necessary to perform the diet education which carries out in the health center for diabetic patients with individualized goal by stepwise way rather than as one time try, and by developing the diabetic education media which is appropriate for the patients.

Netrin Inhibits Regenerative Axon Growth of Adult Dorsal Root Ganglion Neurons in Vitro

Netrin is a neuronal guidance molecule implicated in the development of spinal commissural neurons and cortical neurons. The attractive function of netrin requires the receptor, Deleted in Colorectal Cancer (DCC), while the receptor Unc5h is involved in the repulsive action of netrin during embryonic development. Although the expression of netrin and its receptor has been demonstrated in the adult nervous system, the function of netrin in adult neurons has not yet been elucidated. Here, we show that netrin treatment inhibited neurite outgrowth of adult dorsal root ganglion (DRG) neurons in explant and dissociated cultures. In addition, unc5h1-3 mRNAs, but not the dcc mRNA, are abundantly expressed in the adult DRG. An in situ hybridization study demonstrated that unc5h mRNAs were expressed in DRG neurons. This finding indicates that netrin/Unc5h signaling may play a role in the neurite outgrowth of adult DRG neurons and that netrin may be involved in the regulation of peripheral nerve regeneration.

The Effect of Hydrogen Peroxide on the Migration and FAK Activation in Lens Epithelial Cells

PURPOSE: Hydrogen peroxide has been implicated as a causative factor of various cellular dysfunction, cell death, transformation. In addition, oxidative stress has been suggested as a crucial inducer of cataract formation not only the nuclear-type cataract but also anterior polar type cataract. Transformation of lens epithelial cells accompanying accumulation of extracellular matrix molecules, and cell migration is observed in the cataract forming area of lens. In the present study, we investigated in the migration of lens epithelial cells and the activation of focal adhesion kinase(FAK), because there have been many reports showing that activation of FAK increased cell migration. METHOD: After treatment hygrogen peroxide in a dose-dependent on HLE B-3 cell line, we have performed immuno fluorenscence staing of actin stress fiber and migration assay, and then isolated total RNA to identify expression of MMP-2 from the cell line. To examine FAK activity, we are performed Phosphotyrosine Immunoblot analysis. RESULT: We observed the increased cell migration in response to hydrogen peroxide in a dose dependent manner. In addition, we observed that the phosphorylation of focal adhesion kinase was increased with the treatment of hydrogen peroxide. Also, we examined the expression of the matrix metalloproteinases-2(MMP-2) which disintegrates extracellular matrix and participates in cell migration. The result showed that the mRNA level of MMP-2 did not increase by hydrogen peroxide. CONCLUSIONS: The results suggest that hydrogen peroxide enhanced migration of lens epithelial cell, and that FAK may play a role in the process of cell migration. In conclusion, migration of lens epithelial cell and phosphorylation of focal adhesion kinase was increased by treatment of hydrogen peroxide. Thus oxidative stress plays a crucial role in the transformation of lens epithelial cells and anterior polar type cataract formation.