The digastric muscle is located in the suprahyoid region which consists of anterior belly, intermediate tendon and posterior belly. This muscle is an important landmark when performing an operation of submental and upper neck region. Previous researches have reported about variations of the anterior and posterior belly of digastric muscle. However, there are few studies about the general morphology of the digastric muscle and the relationship with surrounding muscles. The purpose of this study was to analyze the morphology of the anterior belly of digastric muscle and confirm the topographic relationship between the digastric muscle and the stylohyoid muscle of Korean. Thirty-four cadavers (21 males, 13 females; mean age 65 years; range 24~89 years) were used in this study. The skin, subcutaneous tissues, superficial fascia and platysma were removed and a detailed dissection was performed, with extreme care being taken not to damage underlying the muscles of submental and upper neck region. After the dissections, all specimens were sketched and photographed. In 8 specimens, we observed the accessory bellies of the anterior belly of digastric muscle. We classified the accessory bellies into the crossover type (five specimens, 14.7%) that cross the mandibular raphe and unilateral type (three specimens, 8.82%). The findings resulting from observation of the anatomical relationship between the posterior belly of digastric and stylohyoid muscles, the posterior belly of digastric muscle perforated the stylohyoid muscle in 32 cases (65%) out of 49 sides. This case was subdivided into the belly of the stylohyoid muscle lean to the lateral (twenty-one specimens, 42.9%) or medial side (eleven specimens, 22.4%) of the posterior belly of digastric muscle. In 17 specimens (35%), the stylohyoid muscle existed on the medial side of the posterior belly of digastric muscle.
Anatomic Variation ; Cadaver ; Humans ; Male ; Muscles ; Neck ; Skin ; Subcutaneous Tissue ; Tendons

PURPOSE: This study was performed to suggest reference line-pair values of panoramic images with clinically desirable qualities using an arch-form phantom stand. MATERIALS AND METHODS: The line-pair test phantom was chosen. A real skull model was selected for setting the arch-form model of the phantom stand. The phantom stand had slits in four regions (incisor, premolar, molar, TMJ). Four raw images of the test phantom in each region and one raw image of the real skull were converted into 50 test phantom images and 50 skull phantom images with various line-pair values. 50 post-processed real skull phantom images were divided into 4 groups and were randomly submitted to 14 evaluators. Image quality was graded on a 4 point scale (1. good, 2. normal, 3. poor but interpretable, and 4. not interpretable). The reference line pair was determined as the first line-pair value scored less than 2 points. RESULT: The mean scores tended to decrease as the line-pair values increased. The reference line-pair values were 3.19 LP/mm in the incisor, 2.32 LP/mm in the premolar and TMJ, and 1.88 LP/mm in the molar region. CONCLUSION: Image quality evaluation methods and criteria should be able to assess various regions considering the characteristics of panoramic systems. This study suggested overall and regional reference line-pair values and established a set of standard values for them.
Bicuspid ; Incisor ; Molar ; Phantoms, Imaging ; Radiography, Panoramic ; Skull ; Temporomandibular Joint

OBJECTIVES: The purpose of this study is to evaluate the preliminary effects of school-based short term mental health awareness and school bullying prevention programs. METHODS: From April to December 2013, the Child and Adolescent Mental Health Promotion team of Seoul National Hospital conducted school-based short term social skill training (N=56, 4 sessions), mental health awareness (N=84, 4 sessions) and school bullying prevention programs (N=171, 1 session) in elementary and junior high schools located in Seoul. The changes in the subjects before and after the program were assessed. RESULTS: The a social skills training program improved the 'helping' behaviors in boys (t=-2.355, p<.05) and 'sharing' (t=-3.223, p<.01), 'cooperation' (t=-2.235, p<.05), and 'comforting' (t=-2.830, p<.01) behaviors in girls, assessed using the Prosocial Behavior Questionnaire. The mental health awareness program improved 'general health awareness' (t=2.620, p<.05), measured using the Korean General Health Questionnaire. The school bullying prevention program resulted in decreased 'self esteem' (t=3.769, p<.01), measured using the Self Esteem Scale and decreased 'anger' (t=4.198, p<.01), assessed using the Novaco Anger Scale. CONCLUSION: The results of our preliminary analysis suggest that school-based mental health awareness and school bullying prevention programs may be effective even when conducted for a short term. Future investigation is necessary in order to validate the long term effects of these programs.
Adolescent ; Anger ; Bullying* ; Child ; Education ; Female ; Humans ; Mental Health* ; Self Concept ; Seoul ; Surveys and Questionnaires

PURPOSE: The purpose of this study is to suggest a treatment strategy for stage IV gastric cancer by investigating the behavioral difference between initially and recurrent metastatic disease. METHODS: We reviewed the medical records of the patients who underwent chemotherapy alone for metastatic gastric cancer between January 2006 and September 2013. Patients were divided into those who underwent chemotherapy for metastatic disease since initial diagnosis (IM group) and for metastatic recurrence after curative surgery (RM group). Survival and causes of death were compared between the 2 groups, and significant prognostic factors were also investigated. RESULTS: A total of 170 patients were enrolled in this study. Of these patients, 104 were included in the IM group and 66 in the RM group. Overall survival of the IM group did not differ from that of RM (P = 0.569). In the comparison of the causes of death, the IM group had a greater tendency to die from bleeding (P = 0.054) and pneumonia (P = 0.055). In multivariate analysis, bone metastasis (P < 0.001; HR = 2.847), carcinoma peritonei (P = 0.047; HR = 1.766), and the frequency of chemotherapy (P < 0.001; HR = 0.777) were significantly associated with overall survival of IM group. CONCLUSION: Disease-burden mainly contributes to the prognosis of metastatic gastric cancer, although noncurative gastrectomy may be helpful in reducing the mortality of initially metastatic disease. Therefore, disease-burden should be also prioritized in determining the treatment strategies for stage IV gastric cancer.
Cause of Death ; Diagnosis ; Drug Therapy ; Gastrectomy* ; Hemorrhage ; Humans ; Medical Records ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Pneumonia ; Prognosis ; Recurrence ; Stomach Neoplasms*

Background: Mast cells are skin immune sentinels located in the upper dermis, where wheal formation and sensory nerve stimulation take place. Skin inflammation is occasionally accompanied by mast cell-driven responses with wheals, angioedema, or both. Immunoglobulin E (IgE) antibodies are regarded as typical stimuli to drive mast cell activation. However, various causative factors, including microbial infections, can drive IgE-independent mast cell response. When infected, the innate immunity orchestrates an immune response by activating receptor signaling via Toll-like receptors (TLRs). Objective: In this study, we determined the effect of TLR7 stimulation on mast cells to investigate the possible mechanism of IgE-independent inflammatory response. Methods: Human mast cell (HMC) line, HMC-1 cells were treated with TLR7 agonist and the morphologic alteration was observed in transmission electron microscopy. Further, TLR7 agonist treated HMC-1 cells were conducted to RNA sequencing to compare transcriptomic features. Results: HMC-1 cells treated with TLR7 agonist reveals increase of intracellular vesicles, lipid droplets, and ribosomes. Also, genes involved in pro-inflammatory responses such as angiogenesis are highly expressed, and Il12rb2 was the most highly upregulated gene. Conclusion Our data suggest that TLR7 signaling on mast cells might be a potential therapeutic target for mast cell-driven, IgE-independent skin inflammation.

Metofluthrin is a volatile pyrethroid insecticide. Despite being widely used as a safe household insecticide, it could cause severe systemic symptoms. A 19-month-old girl was taken to the emergency department after ingesting 1 mL of a mosquito repellent containing metofluthrin. After the arrival, the girl developed respiratory distress, which worsened progressively despite the administration of oxygen with nebulized salbutamol and budesonide. Additionally, she underwent application of high-flow nasal cannula, and administration of activated charcoal and systemic steroids. Her dyspnea gradually improved, and she was thus discharged on day 4 with oral prednisolone. All medications were discontinued 10 days after the discharge without any complication. Respiratory distress can develop after the ingestion of even a small amount of metofluthrin. Symptomatic and adjunctive steroid therapies can be effective therapeutic options.

Objective: This study aimed to investigate the changes in interpersonal relationships, behavioral patterns, and emotional states of children and adolescents with psychiatric disorders and their caregivers immediately after the coronavirus disease of 2019 (COVID-19) outbreak in Daegu, South Korea. Methods: A total of 147 patients and 147 caregivers participated in the Survey for Outing and Time Usage for Child, Adolescent, and Parents and the COVID-19 Visual Analog Scale for Emotion. We classified the patients and their caregivers into the internalizing disorder (ID) and externalizing disorder (ED) groups and compared the changes. Results: Parent–child relationships for adolescent patients and caregivers were interrupted, and friend relationships in all participants were disrupted, while sibling relationships improved in adolescent patients. They experienced negative emotional changes. Time spent outdoor decreased and digital screen time increased for all participants. Friend and parent–child relationships were interrupted in the ED group compared to those in the ID group. ED patients experienced negative changes in emotional states, while ID patients showed no significant changes. Conclusion Results are meaningful as a reference for predicting changes in interpersonal relationships and mental status of pediatric psychiatric patients and for determining healthcare system adaptations to allow mental health support during the COVID-19 outbreak.

Background: Mast cells are skin immune sentinels located in the upper dermis, where wheal formation and sensory nerve stimulation take place. Skin inflammation is occasionally accompanied by mast cell-driven responses with wheals, angioedema, or both. Immunoglobulin E (IgE) antibodies are regarded as typical stimuli to drive mast cell activation. However, various causative factors, including microbial infections, can drive IgE-independent mast cell response. When infected, the innate immunity orchestrates an immune response by activating receptor signaling via Toll-like receptors (TLRs). Objective: In this study, we determined the effect of TLR7 stimulation on mast cells to investigate the possible mechanism of IgE-independent inflammatory response. Methods: Human mast cell (HMC) line, HMC-1 cells were treated with TLR7 agonist and the morphologic alteration was observed in transmission electron microscopy. Further, TLR7 agonist treated HMC-1 cells were conducted to RNA sequencing to compare transcriptomic features. Results: HMC-1 cells treated with TLR7 agonist reveals increase of intracellular vesicles, lipid droplets, and ribosomes. Also, genes involved in pro-inflammatory responses such as angiogenesis are highly expressed, and Il12rb2 was the most highly upregulated gene. Conclusion Our data suggest that TLR7 signaling on mast cells might be a potential therapeutic target for mast cell-driven, IgE-independent skin inflammation.

Missed lung cancers on chest radiograph (CXR) may delay the diagnosis and affect the prognosis. CXR is the primary imaging modality to evaluate the lungs and mediastinum in daily practice. The purpose of this article is to review chest radiographs for common blind spots and highlight the importance of various radiologic presentations in primary lung cancer to avoid significant diagnostic errors on CXR.

Objective: This study aimed to investigate the changes in interpersonal relationships, behavioral patterns, and emotional states of children and adolescents with psychiatric disorders and their caregivers immediately after the coronavirus disease of 2019 (COVID-19) outbreak in Daegu, South Korea. Methods: A total of 147 patients and 147 caregivers participated in the Survey for Outing and Time Usage for Child, Adolescent, and Parents and the COVID-19 Visual Analog Scale for Emotion. We classified the patients and their caregivers into the internalizing disorder (ID) and externalizing disorder (ED) groups and compared the changes. Results: Parent–child relationships for adolescent patients and caregivers were interrupted, and friend relationships in all participants were disrupted, while sibling relationships improved in adolescent patients. They experienced negative emotional changes. Time spent outdoor decreased and digital screen time increased for all participants. Friend and parent–child relationships were interrupted in the ED group compared to those in the ID group. ED patients experienced negative changes in emotional states, while ID patients showed no significant changes. Conclusion Results are meaningful as a reference for predicting changes in interpersonal relationships and mental status of pediatric psychiatric patients and for determining healthcare system adaptations to allow mental health support during the COVID-19 outbreak.