A 9-year-old Korean boy with lissencephaly was found dead at home. He had previously been diagnosed with lissencephaly that presented with infantile spasm on the basis of magnetic resonance imaging and electroencephalogram results. Antemortem chromosomal banding revealed a normal karyotype. A legal autopsy was requested to eliminate the possibility of neglect or abuse by his parents. The autopsy findings revealed type I lissencephaly with the associated microcephaly. No external wounds or decubitus ulcers were noted. Postmortem fluorescence in situ hybridization for the LIS1 locus and nucleotide sequence analysis of the whole coding regions of the LIS1 gene did not reveal any deletions. The antemortem and postmortem findings revealed that lissencephaly syndrome was associated with isolated lissencephaly sequence. External causes of death were excluded by the full autopsy and toxicology test results. Because patients with mental retardation are frequently victimized and suffer neglect or abuse, thorough external and internal examinations should be conducted at the time of autopsy.
Autopsy ; Base Sequence ; Cause of Death ; Child ; Child Abuse ; Classical Lissencephalies and Subcortical Band Heterotopias ; Clinical Coding ; Electroencephalography ; Fluorescence ; Forensic Pathology ; Humans ; In Situ Hybridization ; Infant ; Infant, Newborn ; Intellectual Disability ; Karyotype ; Lissencephaly ; Magnetic Resonance Imaging ; Microcephaly ; Parents ; Pressure Ulcer ; Spasms, Infantile ; Toxicology

We studied the intradural variations of spinal nerve rootlets in 100 cases of Korean adults. The results of the study are as follows ; 1. The incidence of intrasegmental variations (abberrant rootlets) is high in cervical segments and decreased toward lumbosacral segments. The incidence is higher in posterior rootlets than anterior, except cervical sesments. 2. The incidence of intersegmental variations is higher in posterior rootlets than anterior, and generally high in cervical and lumbar segments. 3. We divide the intersegmental variations into supernumerary rootlets, dividing rootlets, and anastomosing rootlets, and among them the incidence of anastomosing rootlets is higher. We divide the anastomosing rootlets into parallel anastomosing rootlets, uniting anastomosing rootlets, and rearrangement anastomosing rootlets. 4. The anterior to posterior anastomosing of spinal nerve rootlet is present in 4 of cases studied.
Adult ; Humans ; Incidence ; Spinal Nerves*

PURPOSE: To examine the putative seizure-protective properties of ketamine in lithium-pilocarpine induced status epilepticus (LPSE). METHODS: Lithium chloride followed 24 h later by pilocarpine was administered for seizure induction. Ketamine (40 mg/kg) or phenytoin (50 mg/kg) was injected intraperitoneally 10 min or 60 min after the onset of continuous ictal discharge. Then the seizure behavior and EEG were observed and histological changes were compared through Nissl stain at 72 hours. RESULTS: The antiepileptic effect of ketamine, injected during the early stages of LPSE (10 min after the onset of continuous ictal discharge), was comparable to that of phenytoin. Ketamine was more effective than phenytoin in decreasing spike frequency, when administered on the plateau of LPSE (injection 60 min after onset of continuous ictal discharge electrographically). Anticonvulsant action of ketamine was confirmed by a less neuronal injury in hippocampus compared with control rats injected with phenytoin. CONCLUSIONS: In prolonged status epilepticus rat model, ketamine was effective as an antiepileptic, but phenytoin was not. Ketamine was also neuroprotective on the neuronal injury in the hippocampus. These results suggest that ketamine might be useful as an antiepileptic drug when standard antiepileptic drugs fail in the treatment of the refractory cases of status epilepticus.
Animals ; Anticonvulsants ; Electroencephalography ; Hippocampus ; Ketamine* ; Lithium Chloride ; Models, Animal* ; Neurons ; Neuroprotective Agents* ; Phenytoin ; Pilocarpine ; Rats* ; Seizures ; Status Epilepticus*

This research was conducted to analyze websites that provide hypertension information in Korea and to provide a proper model for developing sites that give information about hypertension to educate Korean people on promoting their health. Quantitative analysis of the 168 websites, which are categorized as health institutions in popular search engines, and qualitative analysis for the 16 websites that provide hypertension information were carried out. Only 27% of the university hospitals/tertiary hospital websites provided hypertension related information, and most of them provided only a single page of hypertension related information. Among 16 hypertension information-providing websites, 75% have a bulletin board to receive user's opinions and requests, however, 50% was not responsive, and therefore, interactivity is not guaranteed. Most of the websites do not provide information sources and did not employ full multimedia capabilities. Only 50% of the websites provided the last updated time. Websites providing professional hypertension information must be developed to educate the Korean public about measures they can take to promote general health level.
Health Status ; Hypertension* ; Internet* ; Korea ; Multimedia ; Search Engine

BACKGROUND: Hematopoietic stem cells (HSC) remain one of the most promising target cells for gene therapeutic approaches, but is currently limited by a number of issues, including the low gene transfer efficiency. METHODS: We evaluated the effect of recombinant fibronectin fragment (retronectin) and cytokines during retroviral transduction of CD34+ cells and analyzed the characteristics of transduced cells. To rapidly characterize and isolate transduced cells, we used a retroviral vector coding for the truncated form of the low-affinity nerve growth factor receptor (delta LNGFR). RESULTS: The total number of CD34+ cells (1.5~6.3-fold) and the amount of cycling (S+G2/M) cell fractions (2~6-fold) were increased after cytokine prestimulation, especially using thrombopoietin (TPO)-based cytokines. The immunophenotype of CD34+ cells showed no significant differences according to the cytokines. However, CD34+AC133+ cells were more effectively maintained in the presence of TPO. The transduction efficiency of CD34+ cells was significantly increased in the presence of retronectin (6.7+/-2.3% vs 23.1+/-4.4%). Immunomagnetic selection of the transduced cells allowed us to enrich these effectively (6.7+/-2.3% --> 86.3+/-6.5%). Compared with control, delta LNGFR transduction did not influence on the immunophenotype and cloning efficiency of CD34+ cells. Among the delta LNGFR+/-derived colonies, 85.0% were shown to contain an integrated delta LNGFR gene. CONCLUSION: These data show that retronectin and TPO-based cytokines can be used to facilitate retroviral transduction of CD34+ cells. Also, delta LNGFR transduced cells could be rapidly characterized by FACS analysis and effectively enriched by immunomagnetic selection method. Further improvement of transduction conditions for stimulation of HSC proliferation without differentiation and development of new vectors that obviate the requirement for cell division are likely to enhance transduction of primitive HSC.
Cell Division ; Clinical Coding ; Clone Cells ; Cloning, Organism ; Cytokines* ; Fibronectins* ; Hematopoietic Stem Cells ; Nerve Growth Factor ; Thrombopoietin ; Zidovudine*

OBJECTIVES: According to the World Health Organization, there have been frequent reports of Ebola virus disease (EVD) since the 2014 EVD pandemic in West Africa. We aim to estimate the outbreak scale when an EVD infected person arrives in Korea. METHODS: Western Africa EVD epidemic mathematical model SEIJR or SEIJQR was modified to create a Korean EVD outbreak model. The expected number of EVD patients and outbreak duration were calculated by stochastic simulation under the scenarios of Best case, Diagnosis delay, and Case missing. RESULTS: The 2,000 trials of stochastic simulation for each scenario demonstrated the following results: The possible median number of patients is 2 and the estimated maximum number is 11 when the government intervention is proceeded immediately right after the first EVD case is confirmed. With a 6-day delay in diagnosis of the first case, the median number of patients becomes 7, and the maximum, 20. If the first case is missed and the government intervention is not activated until 2 cases of secondary infection occur, the median number of patients is estimated at 15, and the maximum, at 35. CONCLUSIONS Timely and rigorous diagnosis is important to reduce the spreading scale of infection when a new communicable disease is inflowed into Korea. Moreover, it is imperative to strengthen the local surveillance system and diagnostic protocols to avoid missing cases of secondary infection.

PURPOSE: The incidence of type 2 diabetes mellitus is increasing worldwide because of the increase in the incidence of obesity. We performed this study to determine the type of diabetes and the clinical characteristics and laboratory data of the children who were newly diagnosed with diabetes mellitus (DM). METHOD: We reviewed the medical data of 75 children (35 boys and 40 girls) who were diagnosed with DM at Kyungpook National University Hospital between January 2001 and June 2008. RESULTS: Sixty patients (80%) were diagnosed with type 1 DM and 15 (20%) with type 2 DM. Approximately 70% of the study subjects developed DM in spring and winter. Further, 38% and 60% of the patients had a family history of type 1 and type 2 DM, respectively. The average age of the patients with type 1 DM was 10.6+/-2.6 years. Diabetic ketoacidosis was the first symptom in 15% of these patients. The average body mass index of these patients was 18.2+/-4.5 kg/m2. At least one of autoantibodies against pancreas was positive in 69%. The average age of the patients with type 2 DM was 13.4+/-1.2 years. Fifty-three percent of these patients was diagnosed without any symptom. Fatty liver and hypertension were diagnosed in 20% of the patients. Fifty-three percent of these patients were obese or overweight. CONCLUSION: Twenty percent of the children who were newly diagnosed with diabetes at our institute had type 2 DM. Since the incidence of type 2 DM in children appears to be increasing with an increase in the occurrence of childhood obesity, special attention should be provided to obese children.
Autoantibodies ; Body Mass Index ; Child ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Fatty Liver ; Humans ; Hypertension ; Incidence ; Obesity ; Pancreas

Objective: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is suggested as a prognostic biomarker for communityacquired pneumonia (CAP). However, its predictive value for an individual adult and elderly CAP patients has not been fully investigated. Methods: Patients with CAP aged 18 years and older, who visited the emergency department (ED) from March 1, 2016 to March 31, 2019, were included in this study. Patients were divided into the adult group and the elderly group (age ≥70 years). Data was collected from the ED-based registry, and medical charts were retrospectively reviewed. The registry data included sociodemographic and past medical characteristics, as well as laboratory findings including NT-proBNP and C-reactive protein (CRP), Pneumonia Severity Index (PSI), and CURB65 (confusion, urea, respiratory rate, blood pressure, and aged 65 or more). The independent potential of NT-proBNP to predict mortality was assessed in both groups using multivariable logistic regression, and its predictive ability was evaluated in terms of performance (using areas under the curve [AUCs]) and goodness-of-fit (using the Bayesian information criterion [BIC]). Results: Totally, 325 CAP patients were evaluated, of which 208 (64%) belonged to the elderly group. NT-proBNP was identified as an independent predictor of CAP mortality in elderly patients, but not in adult patients. Moreover, AUC of the NT-proBNP for mortality was comparable to AUC of the PSI, but was higher than that of the CURB65, in elderly CAP patients. Similarly, the NT-proBNP had a better overall fit (lower BIC value) compared to the CURB65, for mortality. Additionally, both AUC and overall fit of the NT-proBNP for mortality were significantly superior to values obtained for CRP. Conclusion For elderly CAP patients in the ED, the NT-proBNP is an independent and useful predictor of mortality.

The Korean Breast Cancer Society has constructed a nationwide breast cancer database through utilization of an online registration program. We have reported the basic facts about breast cancer in Korea in 2012, and analyzed the changing patterns in the clinical characteristics and management of breast cancer in Korea over the last 10 years. Data on patients newly diagnosed with breast cancer were collected for the year 2012 from 97 hospitals and clinics nationwide using a questionnaire survey, and from the online registry database. A total of 17,792 patients were newly diagnosed with breast cancer in 2012. The crude incidence rate of female breast cancer, including invasive cancer and in situ cancer, was 70.7 cases per 100,000 women. The median age at diagnosis was 51 years, and the proportion of postmenopausal women was higher than that of premenopausal women among those diagnosed with breast cancer. The proportion of cases of early breast cancer increased continuously, and breast-conserving surgery was performed in more cases than total mastectomy in that same year. The total number of breast reconstruction surgeries increased approximately 3-fold over last 10 years. The 5-year overall survival rate for all stages of breast cancer patients was extremely high. The clinical characteristics of breast cancer have changed in ways that resulted in high overall survival over the past 10 years in Korea, and the surgical management of the disease has changed accordingly. Analysis of nationwide registry data will contribute to a better understanding of the characteristics of breast cancer in Korea.
Breast Neoplasms* ; Diagnosis ; Female ; Humans ; Incidence ; Korea ; Mammaplasty ; Mastectomy, Segmental ; Mastectomy, Simple ; Online Systems ; Registries ; Survival Rate ; Surveys and Questionnaires

Objective: To compare the accuracy for detecting breast cancer in the diagnostic setting between the use of digital breast tomosynthesis (DBT), defined as DBT alone or combined DBT and digital mammography (DM), and the use of DM alone through a systematic review and meta-analysis. Materials and Methods: Ovid-MEDLINE, Ovid-Embase, Cochrane Library and five Korean local databases were searched for articles published until March 25, 2020. We selected studies that reported diagnostic accuracy in women who were recalled after screening or symptomatic. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to estimate pooled sensitivity and specificity. We compared the diagnostic accuracy between DBT and DM alone using meta-regression and subgroup analyses by modality of intervention, country, existence of calcifications, breast density, Breast Imaging Reporting and Data System category threshold, study design, protocol for participant sampling, sample size, reason for diagnostic examination, and number of readers who interpreted the studies. Results: Twenty studies (n = 44513) that compared DBT and DM alone were included. The pooled sensitivity and specificity were 0.90 (95% confidence interval [CI] 0.86–0.93) and 0.90 (95% CI 0.84–0.94), respectively, for DBT, which were higher than 0.76 (95% CI 0.68–0.83) and 0.83 (95% CI 0.73–0.89), respectively, for DM alone (p < 0.001). The area under the summary receiver operating characteristics curve was 0.95 (95% CI 0.93–0.97) for DBT and 0.86 (95% CI 0.82–0.88) for DM alone. The higher sensitivity and specificity of DBT than DM alone were consistently noted in most subgroup and meta-regression analyses. Conclusion Use of DBT was more accurate than DM alone for the diagnosis of breast cancer. Women with clinical symptoms or abnormal screening findings could be more effectively evaluated for breast cancer using DBT, which has a superior diagnostic performance compared to DM alone.