Diabetes mellitus (DM) is a group of metabolic disorders, that have become a major cause of death worldwide. This study aimed to determine the usefulness of diabetes-related laboratory tests for diagnosis of postmortem DM. From March to August 2018, among the autopsy cases investigated by the National Forensic Service, heart blood and vitreous humor samples from 253 cases that had not been decomposed were collected, and the data from 208 cases except 45 cases that were incapable of testing were analyzed for statistical significance and compared with the causes of death on autopsy reports. The levels of C-peptide, insulin, acetoacetate, β-hydroxybutyrate (β-HA), total ketone, and HbA1c were measured in the heart blood, and the levels of glucose, blood urea nitrogen, creatinine, and potassium were measured in the vitreous humor. The levels of glucose in the vitreous humor and HbA1c, β-HA, and total ketone in the heart blood were significantly correlated. C-peptide and insulin levels were lower than normal levels in most cases (C-peptide 92.3%, P=0.480, insulin 97.6%, P=0.589), and were not useful measures indicating diabetic complications. In the group with DM history, the average levels of HbA1c from the heart blood and glucose from the vitreous humor were higher than in those with no or unknown history of DM, indicating their usefulness as diagnostic tools. The results of this study suggest a postmortem DM diagnosis model.Therefore, postmortem DM-related tests can help diagnose the cause of death in forensic medicine.

OBJECTIVES: This pilot study aimed to obtain preliminary data on the associations between atherosclerosisand periodontitis, physical health status, and general and oral health behaviors. METHODS: Thirty-three subjects were recruited from among those who underwent carotid computed tomography (CT) angiography and general health check-up at the Seoul National University Hospital Health Examination Center (SNUHHEC). Two trained dentists conducted a periodontal examination to evaluate probing pocket depth and clinical attachment loss. A self-administered questionnaire was completed by study subjects, following informed consent. Data on physical health status were collected through review of medical records from the SNUHHEC. Information on general health behavior was obtainedfrom the self-reported questionnaire. Descriptive and comparative analyses were performed using IBM SPSS Statistics 21.0®. Statistical significance was set at P<0.05. RESULTS: A marginal, but non-significant association was noted between atherosclerosis and periodontitis(P=0.373). Flossing habit showed a significant association with periodontitis (P=0.007) and obesity (P=0.033). A possible association was noted between daily exercise and flossing (P=0.073). The habitual use of interdental brush also showed borderline association with smoking (P=0.098) and a stronger associationwith previous periodontal treatment (P=0.067); however, these associations were not statisticallysignificant. CONCLUSIONS: Our pilot study did not show an association between arteriosclerosis and periodontal disease.However, positive oral health care behavior, especially flossing, seems to alleviate arteriosclerosis. In other words, in this pilot survey, we confirmed the possibility that healthy oral care behavior can help to alleviate arteriosclerosis. Future large-scale studies are needed to confirm whether positive oral health care behaviors improve overall health.
Angiography ; Arteriosclerosis ; Atherosclerosis* ; Dental Care* ; Dentists ; Health Behavior ; Humans ; Informed Consent ; Medical Records ; Obesity ; Oral Health ; Overweight ; Periodontitis* ; Pilot Projects* ; Seoul ; Smoke ; Smoking

Hepatocellular carcinoma (HCC) is one of the major cancers with a high incidence and mortality in Korea. A Korean multidisciplinary collaborative committee consisting of hepatologists, radiologists, epidemiologists and family medicine doctors systematically reviewed clinical practice guidelines in the world and literatures. The level of evidence for each recommendation was assessed and discussed to reach a consensus. Meta-analysis was also conducted to evaluate the grade of recommendation for the five key questions. Several randomized controlled studies and cohort studies showed a survival gain associated with surveillance for those at risk of developing HCC. The target populations for HCC surveillance were identified as hepatitis B virus or hepatitis C virus carriers and cirrhotic patients, since numerous studies revealed that these patients have significantly higher risk of HCC compared with non-infected or non-cirrhotic controls. Individual surveillance strategy according to treatment history or degree of fibrosis in patients with viral hepatitis remains to be settled. Based on several cohort and randomized studies, a surveillance interval of six months was recommend. The starting age of surveillance was determined as 40 years from the epidemiologic data. Although ultrasonography (US) is the mainstay for detection of HCC, its sensitivity is not fully accepted. Measurement of serum alpha-fetoprotein can complement US examination, increasing the sensitivity of HCC detection. The recommendation for HCC surveillance is that those with hepatitis B virus (or hepatitis C virus) infection or cirrhosis should have liver US and serum alpha-fetoprotein measurement every six months from 40 years of age or at the time of diagnosis of cirrhosis.
alpha-Fetoproteins ; Carcinoma, Hepatocellular* ; Cohort Studies ; Complement System Proteins ; Consensus ; Diagnosis ; Fibrosis ; Health Services Needs and Demand ; Hepacivirus ; Hepatitis ; Hepatitis B virus ; Hepatitis C ; Humans ; Incidence ; Korea ; Liver ; Mortality ; Ultrasonography

Sump syndrome is one of the late complications of a side to side choledochoduodenostomy, but it is a rare malady. The anastomosis of the bile duct and small bowel results in exclusion of the distal limb of the common bile duct from drainage of bile with the potential formation of a sump. Food material and bile sludge may accumulate in distal segment of common bile duct and so this cause recurrent bile duct stones. Bezoars frequently result from disturbed passage of the gastrointestinal tract, especially after surgery, and it may develop various symptoms by irritating or obstructing the gastrointestinal tract. The bezoar accompanied with sump syndrome after choledochoenterostomy has not yet been reported in the literature. We report here on a case of small intestinal obstruction due to bezoars accompanied with sump syndrome.
Bezoars ; Bile ; Bile Ducts ; Choledochostomy ; Common Bile Duct ; Drainage ; Extremities ; Gallstones ; Gastrointestinal Tract ; Intestinal Obstruction ; Postcholecystectomy Syndrome ; Sewage

PURPOSE: The aims of this project were to increase organ donation by developing potential brain dead donor actively and to provide basic data to settle up independent Organ Procurement Organization (OPO) in Korea. METHODS: Hospital based Organ Procurement Organization (HOPO) of Keimyung university worked as a regional OPO and all the reported potential brain dead patient were treated by OPO team during May through October, 2007. Every reported and confirmed brain dead patient was evaluated for their eligibility of organ donation and these organs were allocated by Korean Network for Organ Sharing (KONOS). In order to increase the development of organ donation, campaign was done for public and medical personnels. To estimate the capacity of brain death donor pool, medical records of the dead patients with brain injury were evaluated. Accommodations and educations to the care-giver to the potential donor, neurosurgeon, neurologist and emergency department physicians were also done. For standardization of potential donor care, frame a clinical pathway of the care of the potential donor from the data of computerized records. The cash flow of whole process from developing potential donor to final procurement of organs were calculated to provide minimum expenses for operating Independent OPO in our environment. RESULTS: Total 33 solid organs were procured from 11 brain dead donor during the experimental period. Twelve more organs were possible to donate but not procured because there were no matched recipient at that time. The reported number of potential donor was increased 2.5 times, compare to the same period of previous year (19 from 5 hospital in 2006 but 47 from 14 collaborating hospitals in 2007). Among 47 notified potential donor, only 11 were succeeded to procure. The reasons of failure for procurement in 36 patients were no familial consent in 12, poor patient condition to donate in 9, not in brain death criteria in 15. These results mean that we have at least 21 more potential donors if we can get familial consent and use marginal donor, and early notification. Mean medical expenses were 3 million won for individual expense beside insurance coverage and 5 million won for management expense of donor care from the detection to organ procurement. CONCLUSION: Our results showed the number of the potential donor and actual organ donation can be increased by continued active relationship with regional hospital and adequate care of the donor. The big gap between the profit from our donor care and calculated donor management expenses of IOPO can be progressively covered by increasing number of brain dead donor, increasing procurement rate and increasing organ fee paid by recipient. But for a certain periods, financial support is necessary to settle up IOPO. Our result can be used as a basic data for management plan of IOPO in the future.
Brain Death ; Brain Injuries ; Critical Pathways ; Emergencies ; Fees and Charges ; Financial Support ; Humans ; Insurance Coverage ; Korea ; Medical Records ; Tissue and Organ Procurement ; Tissue Donors

PURPOSE: The of common carotid artery intima media thickness (IMT) is an acknowledged noninvasive marker for early atherosclerotic changes. We investigate whether common carotid IMT is different between obese and normal-weight children and also evaluate the relationships IMT with cardiovascular risk factors. METHODS: We collected the clinical data (age, sex, pubertal stage, body mass index) and measured blood pressure, glucose, insulin, lipid profiles and adiponectin in 49 obese children (mean age, 12 years) and 24 nonobese children as controls. The control group was composed of 24 nonobese children of the same age, sex and pubertal stage. We measured the carotid IMT of all subjects by B-mode ultrasound with a 7.5-MHz linear transducer and analyzed. RESULTS: Obese children demonstrated a significantly thicker intima media (mean, 0.34 mm, peak, 0.42 mm) compared to the control group (mean, 0.31 mm, peak, 0.38 mm, P<0.01). IMT was significantly correlated to the BMI (r=0.431, P<0.01), age (r=0.317, P<0.01), total cholesterol (r=0.377, P<0.01), triglyceride (r=0.253, P<0.05) and low-density lipoprotein cholesterol (r=0.289, P<0.05). Serum adiponectin was significantly lower in obese children than in controls (11.2 ng/mL vs. 14.7 ng/mL, P<0.05) and negatively related with IMT (r=-0.267, P<0.05). CONCLUSION: Obesity is associated with increased carotid artery IMT in children. Our results suggest vascular changes in obesity seem to occur already in childhood and vascular ultrasonography may helpful for screening cardiovascular complications in obese children.
Adiponectin ; Blood Pressure ; Carotid Arteries* ; Carotid Artery, Common ; Child* ; Cholesterol ; Glucose ; Humans ; Insulin ; Lipoproteins ; Mass Screening ; Obesity ; Risk Factors* ; Transducers ; Triglycerides ; Ultrasonography

PURPOSE: The of common carotid artery intima media thickness (IMT) is an acknowledged noninvasive marker for early atherosclerotic changes. We investigate whether common carotid IMT is different between obese and normal-weight children and also evaluate the relationships IMT with cardiovascular risk factors. METHODS: We collected the clinical data (age, sex, pubertal stage, body mass index) and measured blood pressure, glucose, insulin, lipid profiles and adiponectin in 49 obese children (mean age, 12 years) and 24 nonobese children as controls. The control group was composed of 24 nonobese children of the same age, sex and pubertal stage. We measured the carotid IMT of all subjects by B-mode ultrasound with a 7.5-MHz linear transducer and analyzed. RESULTS: Obese children demonstrated a significantly thicker intima media (mean, 0.34 mm, peak, 0.42 mm) compared to the control group (mean, 0.31 mm, peak, 0.38 mm, P<0.01). IMT was significantly correlated to the BMI (r=0.431, P<0.01), age (r=0.317, P<0.01), total cholesterol (r=0.377, P<0.01), triglyceride (r=0.253, P<0.05) and low-density lipoprotein cholesterol (r=0.289, P<0.05). Serum adiponectin was significantly lower in obese children than in controls (11.2 ng/mL vs. 14.7 ng/mL, P<0.05) and negatively related with IMT (r=-0.267, P<0.05). CONCLUSION: Obesity is associated with increased carotid artery IMT in children. Our results suggest vascular changes in obesity seem to occur already in childhood and vascular ultrasonography may helpful for screening cardiovascular complications in obese children.
Adiponectin ; Blood Pressure ; Carotid Arteries* ; Carotid Artery, Common ; Child* ; Cholesterol ; Glucose ; Humans ; Insulin ; Lipoproteins ; Mass Screening ; Obesity ; Risk Factors* ; Transducers ; Triglycerides ; Ultrasonography

BACKGROUND AND PURPOSES: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and METHODS: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002- 2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Fortythree items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. RESULTS: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. CONCLUSION: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.
Chronic Disease ; Classification ; Climate ; Korea ; National Institute for Occupational Safety and Health (U.S.) ; Reward ; Risk Factors

PURPOSE: The purpose of our study is to investigate the usefulness of B-type natriuretic peptide(BNP) assay as a biochemical marker of cardiovascular manifestations in children with Kawasaki disease(KD). METHODS: Blood was obtained to measure and compare plasma BNP concentrations in the acute phases of typical KD(n=56), atypical KD(n=25), viral febrile disease(n=30), Henoch-Shonlein purpura(n=20) and in the subacute phase of typical KD. Plasma BNP concentrations were measured using a commercial kit, Triage(R) BNP test kit. RESULTS: The mean BNP concentration in the acute phase of KD was significantly higher than in the acute phase of atypical KD, viral febrile disease and Henoch-Shonlein purpura(198.7+/-49.6 vs 55.9+/-10.4, 27.0+/-5.7, 13.7+/-3.1 pg/mL, P<0.001). In KD patients, the mean BNP concentration in the subacute phase was decreased significantly after the treatment with intravenous immunoglobulin and high-dose aspirin(78.0+/-23.5 pg/mL, P<0.001). The area under the Receiver Operating Characteristic curve using BNP level to differentiate KD from viral febrile disease was high: 0.826(95% CI, 0.735 to 0.918, P<0.001). A best cutoff of BNP concentrations for the differential diagnosis of Kawasaki disease was determined to be 30.8 pg/mL(sensitivity 76.8%, specificity 76.7%). CONCLUSION: This study shows the possibility that the rapid BNP assay is useful to detect cardiovascular manifestations associated with KD. Further studies are needed to clarify the mechanism by which the elevated levels of plasma BNP occur in the acute phase of KD.
Biomarkers* ; Child* ; Diagnosis, Differential ; Humans ; Immunoglobulins ; Mucocutaneous Lymph Node Syndrome* ; Natriuretic Peptide, Brain* ; Plasma ; ROC Curve ; Sensitivity and Specificity

PURPOSE: Earlier and accurate identification of preterm infants who are likely to develop hemodynamically significant patent ductus arteriosus (hsPDA) would allow for early prophylaxis and thus minimize the risk of neurologic and respiratory morbidity. The purpose of this study is to clarify the usefulness of plasma B-type natriuretic peptide (BNP) as an early biochemical predictive marker of subsequent symptomatic PDA (sPDA) in preterm infants. METHODS: Clinical and echocardiographic findings of PDA were evaluated at 24 and 48 hours of age in 69 infants ranging from 25 to 34 gestational weeks of age. Plasma BNP concentrations were simultaneously measured with a Triage(R) BNP test kit (Biosite Diagnositics, San Diego, California, U.S.A.). When two or more clinical symptoms of PDA and large ductal shunt from echocardiographic findings were found, sPDA was diagnosed and treated with indomethacin. RESULTS: The mean BNP level in sPDA group (N=22) was significantly higher than that of control group (N=47) at 24 and 48 hours. BNP levels were significantly correlated with the magnitudes of the ductal shunt, such as the ratio of left atrial to aortic root diameter and the diastolic flow velocity of the left pulmonary artery. At 24 hours of age, a cutoff BNP value of 468.5 pg/mL had a sensitivity of 90.9%, a specificity of 74.5% and a positive predictive value of 95.2% for prediction of sPDA (area under ROC curve: 0.908, P<0.001, 95% CI: 0.840 to 0.977). CONCLUSION: Rapid BNP assay allows early prediction of subsequent sPDA that may require treatment in preterm infants.
California ; Ductus Arteriosus, Patent* ; Echocardiography ; Humans ; Indomethacin ; Infant ; Infant, Newborn ; Infant, Premature* ; Natriuretic Peptide, Brain* ; Plasma ; Pulmonary Artery ; ROC Curve ; Sensitivity and Specificity