Background: Non-suicidal self-injury (NSSI) and suicidality are common reasons for child and adolescent psychiatric emergencies. We aimed to investigate the incidence of pediatric emergency department (PED) utilization for psychiatric problems in children and adolescents and to identify demographic and clinical characteristics of youths who visited the PED for suicide attempt (SA) and/or NSSI. Methods: The medical records of children and adolescents who visited the PED for psychiatric problems from January 2015 to November 2019 were reviewed retrospectively.Demographic and clinical variables including psychiatric disorders were collected. We compared the characteristics of youths who presented to the PED for SA and/or NSSI with those of youths without SA or NSSI. Student's t-test, χ2 test, and multivariate logistic regression were used for statistical analysis. Results: During 59 months of observation, 194 youths visited the PED and the number of total PED visits was 336. Among them, 46 youths (23.7%) visited the PED for SA and/or NSSI at least once, and the number of visits was 91 (27.1% of PED visits). Youths with SA and/or NSSI were older (P = 0.001) and more likely to be a girl (P = 0.005) and to report parental absence (P = 0.023). Bipolar and related disorders (P = 0.032) and depressive disorders (P = 0.004) were more common in youths with SA and/or NSSI, while schizophrenia spectrum and other psychotic disorders (P = 0.030) and somatic symptom and related disorders (P = 0.007) were more common in those without SA and NSSI. After adjusting for age, sex, and parental marital status, bipolar and related disorders (odds ratio [OR], 6.72), depressive disorders (OR, 9.59), and somatic symptom and related disorders (OR, 0.12) were significantly associated with SA and/or NSSI. Youths with SA and/or NSSI also stayed longer in the PED (P = 0.007). Conclusion SA and NSSI are one of the main reasons for child and adolescent admittance to psychiatric services in the PED and are associated with psychiatric comorbidities. An appropriate risk assessment for suicidality and self-injury and proper management and referral to mental health services at the PED are of the utmost importance.

OBJECTIVE: The purpose of this retrospective study was to investigate short-term and long-term skeletodental outcomes of Class III activator treatment. METHODS: A Class III activator treatment group (AG) comprised of 22 patients (9 boys, 13 girls) was compared with a Class III control group (CG) comprised of 17 patients (6 boys, 11 girls). The total treatment period was divided into three stages; the initial stage (T1), the post-activator treatment or post-mandibular growth peak stage (T2), and the long-term follow-up stage (T3). Cephalometric changes were evaluated statistically via the Mann-Whitney U-test and the Friedman test. RESULTS: The AG exhibited significant increases in the SNA angle, ANB angle, Wits appraisal, A point-N perpendicular, Convexity of A point, and proclination of the maxillary incisors, from T1 to T2. In the long-term follow-up (T1-T3), the AG exhibited significantly greater increases in the ANB angle, Wits appraisal, and Convexity of A point than the CG. CONCLUSIONS: Favorable skeletal outcomes induced during the Class III activator treatment period were generally maintained until the long-term follow-up period of the post-mandibular growth peak stage.
Follow-Up Studies ; Humans ; Incisor ; Retrospective Studies

Air embolism can occur during central venous catheter removal. We encountered a patient diagnosed with cerebral air embolism associated with the removal of an internal jugular venous catheter. The patient was 65 years old and was admitted to the intensive care unit due to pneumonia. He had a catheter placed in the right internal jugular vein. Five days thereafter, the catheter was removed in semi-Fowler's position using the Valsalva maneuver. Immediately after the catheter removal, the patient became pale, felt dyspneic, lost consciousness and exhibited seizure activity. A neurological examination, revealed left upper arm (grade I) and lower leg paralysis (grade II) as well as left facial palsy. A brain computed tomogram showed that, air was trapped in the cavernous sinus. In diffusion weighted magnetic resonance imaging, signal changes were reported in the right frontal cortex, indicating acute cerebral infarction. Hyperbaric oxygen therapy and ventilatory support with synchronized intermittent mandatory ventilation mode was applied. Twenty days thereafter, consciousness and motor functions were recovered completely except for mild weakness of the upper arm (grade IV).
Arm ; Brain ; Catheters ; Cavernous Sinus ; Central Venous Catheters ; Cerebral Infarction ; Consciousness ; Diffusion ; Embolism, Air ; Facial Paralysis ; Humans ; Hyperbaric Oxygenation ; Intensive Care Units ; Intracranial Embolism ; Jugular Veins ; Leg ; Magnetic Resonance Imaging ; Neurologic Examination ; Paralysis ; Pneumonia ; Seizures ; Valsalva Maneuver ; Ventilation

Previously, we constructed a humanized antibody (HuS10) that binds to the common a antigenic determinant on the S protein of HBV. In this study, we evaluated its HBV-neutralizing activity in chimpanzees. A study chimpanzee was intravenously administered with a single dose of HuS10, followed by intravenous challenge with the adr subtype of HBV, while a control chimpanzee was only challenged with the virus. The result showed that the control chimpanzee was infected by the virus, and thus serum HBV surface antigen (HBsAg) became positive from the 14th to 20th week and actively acquired serum anti-HBc and anti-HBs antibodies appeared from the 19th and 23rd week, respectively. However, in the case of the study chimpanzee, serum HBsAg became positive from the 34th to 37th week, while actively acquired serum anti-HBc and anti-HBs antibodies appeared from the 37th and 40th week, respectively, indicating that HuS10 neutralized the virus in vivo and thus delayed the HBV infection. This novel humanized antibody will be useful in the immunoprophylaxis of HBV infection.
Animals ; CHO Cells ; Cricetinae ; Cricetulus ; Hepatitis B/blood/immunology/virology ; Hepatitis B Antibodies/blood/*immunology ; Hepatitis B Surface Antigens/*immunology ; Hepatitis B virus/*immunology ; Neutralization Tests ; Pan troglodytes/blood/*immunology/*virology

Paroxysmal nocturnal hemoglobinura is a very rare acquired clonal hematopoietic cell disorder leading to chronic intravascular hemolysis caused by abnormal complement activation. Pregnancy in a patient with paroxysmal nocturnal hemoglobinuria is often complicated with thrombosis resulting serious materno-fetal morbidity and mortality. A case of successful maintenance of the pregnancy, delivery and postpartum in a woman at gestational age of 37 weeks and 2 days with paroxysmal nocturnal hemoglobinuria managed with prophylactic transfusions and anticoagulation therapy by low molecular weight heparin is presented with a review of literature.
Complement Activation ; Female ; Gestational Age ; Hemoglobinuria, Paroxysmal* ; Hemolysis ; Heparin, Low-Molecular-Weight* ; Humans ; Mortality ; Postpartum Period ; Pregnancy ; Thrombosis

PURPOSE: Thrombopoietin (TPO) has been currently used for ex vivo expansion of hematopoietic stem cells. Previously, we have reported that TPO induces apoptosis during ex vivo expansion of cord blood CD34 cells. In this study, we have investigated the stem cell factor (SCF) to determine whether it affects the TPO-induced apoptosis. METHPDS: CD34+ cells, purified from four separate human cord bloods by magnetic bead selection, were expanded in Iscoves modified Dulbeccos medium with several cytokines. Apoptosis has been confirmed by several ways; 7-amino-actinomycin D (7-AAD) or annexin V staining, and morphologic analysis with light and electron microscopic examinations. And cell maturation was also analysed with DNA staining. RESULTS: Apoptosis was reached peak (67.8+/-5.24% of total cells) at day 9 in the cultures with TPO alone. Morphological examination of Giemsa-stained cytospin preparations revealed many immature cells with cytoplasmic blebbing and eccentric nuclei. However, multilobed nuclei were rarely observed while bilobed nuclei were frequently observed. These results suggest that premature senescence occurs in the megakaryocytic cells before full polyploidization. SCF was affective for the TPO-induced apoptosis; the peak apoptotic fraction was significantly decreased to 37.2+/-3.31% at day 9. In the cultures with SCF, the fractions of CD41+ cells were also decreased in parallel with decrease in apoptosis. Notwithstanding reduction of differentiation into megakaryocytic lineage, polyploidization(> 6N) in CD41 cell faction was significantly increased in the cultures with SCF at day 9 and day 11, respectively (P<0.05). CONCLUSION: These results suggest that SCF inhibits premature senescence of the differentiating cells of megakaryocytic lineage during ex vivo expansion using TPO.
Aging* ; Annexin A5 ; Apoptosis ; Blister ; Cytokines ; Cytoplasm ; DNA ; Fetal Blood* ; Hematopoietic Stem Cells ; Humans* ; Megakaryocytes* ; Polyploidy ; Stem Cell Factor* ; Stem Cells* ; Thrombopoietin*

PURPOSE: Breast reconstruction with deep inferior epigastric perforator(DIEP) free flap is known to be the most advanced method of utilizing autologous tissue. The DIEP free flap method saves most of the rectus abdominis muscle as well as anterior rectus sheath. Therefore, the morbidity of the donor site is minimized and the risk of hernia is markedly decreased. METHODS: We chose the internal mammary artery and its venae comitantes as recipient vessels, and deep inferior epigastric vessels as donor vessels. The number and location of the perforators derived from medial or lateral branch of deep inferior epigastric artery(DIEA) in 23 DIEP flaps were identified. Ten patients underwent evaluation of their abdominal wall function preoperatively and 6 months postoperatively by using Lacote's muscle grading system. RESULTS: Of the 23 patients, a patient with one perforator from lateral branch of DIEA experienced partial necrosis of flap. Total flap loss occurred in one patient. Mild abdominal bulging was reported in one patient 4 months postoperatively probably because of early vigorous rehabilitational therapy for her frozen shoulder. Postoperative abdominal wall function tests in 10 patients showed almost complete recovery of muscle function upto their preoperative level of upper and lower rectus abdominis and external oblique muscle function at 6 months postoperatively. All patients have been able to resume their daily activities. CONCLUSION: The breast reconstruction with DIEP free flap is reliable and valuable method which provide ample soft tissue from abdomen without compromising the integrity of abdominal wall. Selection of reliable perforators is important and including more than two perforators may decrease fat necrosis and partial necrosis of flap.
Abdomen ; Abdominal Wall ; Breast* ; Bursitis ; Fat Necrosis ; Female ; Free Tissue Flaps* ; Hernia ; Humans ; Mammaplasty* ; Mammary Arteries ; Necrosis ; Perforator Flap ; Rectus Abdominis ; Tissue Donors

PURPOSE: Conventional contrast dacryocystography(C-DCG) has been used mainly for anatomical assessment of the lacrimal drainage apparatus, due to its limited information on the dynamics of the lacrimal system, and thus correlation role in epiphora. The purpose of study was to improve the diagnostic value in epiphora by utilizing RI dacryocystography(RI-DCG) with quantitative criteria. MATERIALS AND METHODS: The patient for RI dacryocystography set erect with the head fixed in front of gamma camera fitted with a standard 6 mm pinhole collimater. Both eyes of 85 patients(170 eyes) were scanned with 99rnTc-pertechnetate followed by conventional dacryocystography. The data from gamma camera were recorded simultaneously on a computer system for subsequent quantitative analysis. RESULTS: In 94 of 96 eyes without epiphora, RI-DCG was correlated with normal C-DCG and % of emptying was at least over 50%. In 58 of 74 eyes with epiphora, RI-DCG was correlated with abnormal C-DCG and % of emptying was at most below 50%. In 16 eyes with functional block, quantitative RI-DCG showed abnormal % of emptying. CONCLUSION: Nuclear DCG with quantitation had higher diagnostic yield in functional block and correlated higher with epiphora. Thus nuclear DCG with quantitation would be a valuable functional test after postprocedures such as dacryocystoplasty.
Computer Systems ; Drainage ; Gamma Cameras ; Head ; Humans ; Lacrimal Apparatus Diseases* ; Radionuclide Imaging*

Background: Generally, pharmacokinetics (PK) models could be stratified into two models. The compartment PK model uses the concept of simple compartmentalization to describe complex bodies, and the physiologically based pharmacokinetic (PBPK) model describes the body using multi-compartment networking. Notwithstanding sharing a theoretical background in both models, there was still a lack of knowledge to enhance compatibility in both models. Objective: This study aimed to evaluate the compatibility among PBPK, lumping model and compartment PK model with voriconazole PK case study. Methods: The number of compartments and blood flow on each tissue in the PBPK model were modified using the lumping method, considering physiological similarities. The concentration-time profiles and area under the concentration-time curve (AUC) parameters were simulated at each model, assuming taken voriconazole oral 400 mg single dose. After that, those mentioned PK parameters were compared. Results: The PK profiles and parameters of voriconazole in the three models were similar that proves their compatibility. The AUC of central compartment in the PBPK and lumping model was within a 2-fold range compared to those in the 2-compartment model. The AUC of non-eliminating tissues compartment in the PBPK model was similar to those in the lumping model. Conclusion Regarding the compatibility of the three PK models, the utilization of the lumping method was confirmed by suggesting its reliable PK parameters with PBPK and compartment PK models. Further case studies are recommended to confirm our findings.

Arteries ; Forearm ; Free Tissue Flaps ; Hospitalization ; Humans ; Prosthodontics ; Surgical Flaps ; Surgical Procedures, Operative ; Tissue Donors