1.Myositis Ossificans of the Thighs Due to Repeated Assault: A Case Report
Jin-Haeng HEO ; Jeong-hwa KWON ; Jang Gyu CHA ; Seon Jung JANG
Korean Journal of Legal Medicine 2024;48(4):180-184
Myositis ossificans (MO) is defined as a lesion where abnormal ossification forms in soft tissues, such as muscle, fascia, and ligament, usually as a result of trauma. It commonly appears in areas such as the thigh, hip, and elbow, though it can affect any part of the body. In the forensic field, MO resulting from trauma is reported to be valuable evidence of repeated physical abuse. This case report describes a deceased adult male with an intellectual disability, whose cause of death was multiple injuries from assault. Postmortem computed tomography (PMCT) and autopsy findings revealed MO of both thighs associated with repeated physical abuse. This case also showed typical findings of MO on PMCT imaging, characterized by well-defined, high-density lesions within the quadriceps. Adults with intellectual disabilities are at high risk of abuse and assault. Therefore, autopsy findings of MO can serve as important evidence in forensic practice, considering the possibility of repeated abuse.
2.Statistical Analysis of Forensic Autopsies in Busan and Gyeongnam: Changes and Characteristics in the Past 10 Years
In-Gyu SON ; Joo-Young NA ; Jin-Haeng HEO ; Jeong-hwa KWON ; Seon Jung JANG
Korean Journal of Legal Medicine 2024;48(4):165-174
The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.
3.Myositis Ossificans of the Thighs Due to Repeated Assault: A Case Report
Jin-Haeng HEO ; Jeong-hwa KWON ; Jang Gyu CHA ; Seon Jung JANG
Korean Journal of Legal Medicine 2024;48(4):180-184
Myositis ossificans (MO) is defined as a lesion where abnormal ossification forms in soft tissues, such as muscle, fascia, and ligament, usually as a result of trauma. It commonly appears in areas such as the thigh, hip, and elbow, though it can affect any part of the body. In the forensic field, MO resulting from trauma is reported to be valuable evidence of repeated physical abuse. This case report describes a deceased adult male with an intellectual disability, whose cause of death was multiple injuries from assault. Postmortem computed tomography (PMCT) and autopsy findings revealed MO of both thighs associated with repeated physical abuse. This case also showed typical findings of MO on PMCT imaging, characterized by well-defined, high-density lesions within the quadriceps. Adults with intellectual disabilities are at high risk of abuse and assault. Therefore, autopsy findings of MO can serve as important evidence in forensic practice, considering the possibility of repeated abuse.
4.Statistical Analysis of Forensic Autopsies in Busan and Gyeongnam: Changes and Characteristics in the Past 10 Years
In-Gyu SON ; Joo-Young NA ; Jin-Haeng HEO ; Jeong-hwa KWON ; Seon Jung JANG
Korean Journal of Legal Medicine 2024;48(4):165-174
The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.
5.Myositis Ossificans of the Thighs Due to Repeated Assault: A Case Report
Jin-Haeng HEO ; Jeong-hwa KWON ; Jang Gyu CHA ; Seon Jung JANG
Korean Journal of Legal Medicine 2024;48(4):180-184
Myositis ossificans (MO) is defined as a lesion where abnormal ossification forms in soft tissues, such as muscle, fascia, and ligament, usually as a result of trauma. It commonly appears in areas such as the thigh, hip, and elbow, though it can affect any part of the body. In the forensic field, MO resulting from trauma is reported to be valuable evidence of repeated physical abuse. This case report describes a deceased adult male with an intellectual disability, whose cause of death was multiple injuries from assault. Postmortem computed tomography (PMCT) and autopsy findings revealed MO of both thighs associated with repeated physical abuse. This case also showed typical findings of MO on PMCT imaging, characterized by well-defined, high-density lesions within the quadriceps. Adults with intellectual disabilities are at high risk of abuse and assault. Therefore, autopsy findings of MO can serve as important evidence in forensic practice, considering the possibility of repeated abuse.
6.Statistical Analysis of Forensic Autopsies in Busan and Gyeongnam: Changes and Characteristics in the Past 10 Years
In-Gyu SON ; Joo-Young NA ; Jin-Haeng HEO ; Jeong-hwa KWON ; Seon Jung JANG
Korean Journal of Legal Medicine 2024;48(4):165-174
The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.
7.Myositis Ossificans of the Thighs Due to Repeated Assault: A Case Report
Jin-Haeng HEO ; Jeong-hwa KWON ; Jang Gyu CHA ; Seon Jung JANG
Korean Journal of Legal Medicine 2024;48(4):180-184
Myositis ossificans (MO) is defined as a lesion where abnormal ossification forms in soft tissues, such as muscle, fascia, and ligament, usually as a result of trauma. It commonly appears in areas such as the thigh, hip, and elbow, though it can affect any part of the body. In the forensic field, MO resulting from trauma is reported to be valuable evidence of repeated physical abuse. This case report describes a deceased adult male with an intellectual disability, whose cause of death was multiple injuries from assault. Postmortem computed tomography (PMCT) and autopsy findings revealed MO of both thighs associated with repeated physical abuse. This case also showed typical findings of MO on PMCT imaging, characterized by well-defined, high-density lesions within the quadriceps. Adults with intellectual disabilities are at high risk of abuse and assault. Therefore, autopsy findings of MO can serve as important evidence in forensic practice, considering the possibility of repeated abuse.
8.Statistical Analysis of Forensic Autopsies in Busan and Gyeongnam: Changes and Characteristics in the Past 10 Years
In-Gyu SON ; Joo-Young NA ; Jin-Haeng HEO ; Jeong-hwa KWON ; Seon Jung JANG
Korean Journal of Legal Medicine 2024;48(4):165-174
The cause and manner of death in the Busan and Gyeongnam regions were analyzed using autopsy data performed by the National Forensic Service Busan Institute (NFS BI) for 10 years—from 2014 to 2023. In addition, changes in the number of autopsy cases of elderly individuals aged 65 and older, were analyzed in the Busan and Gyeongnam regions. A total of 6,374 cases were classified, excluding autopsies from the Ulsan area and the Coast Guard, from the NFS BI data. Analysis of the manner of death revealed that 3,203 cases (50.3%) were unnatural deaths; 2,031 cases (31.9%) were natural deaths; and 1,140 cases (17.9%) were deaths of unknown cause. Among the unnatural deaths, accidents were the most common at 1,149 cases (18.0%), followed by suicide at 979 cases (15.4%); and homicide at 583 cases (9.1%). Among natural deaths, heart disease was the most common with 764 cases (37.6%), followed by vascular disease with 351 cases (17.3%). The proportion of the population aged 65 or older in Busan and Gyeongnam has been steadily increasing from 13.7% in 2014 to 21.6% in 2023. Accordingly, the number of autopsies on people aged 65 or older has increased from 72 in 2014 to 174 in 2023, and the number of autopsies on people aged 65 or older accounted for one-quarter of the total number of forensic autopsies commissioned by Busan/Gyeongnam, and performed by NFS BI in 2023. Therefore, we plan to introduce emerging issues relating to population aging and geriatric forensic medicine.
9.Genomic Landscape of Pulmonary Sarcomatoid Carcinoma
Hyun Jung KWON ; Sejoon LEE ; Yeon Bi HAN ; Jeonghyo LEE ; Soohyeon KWON ; Hyojin KIM ; Jin-Haeng CHUNG
Cancer Research and Treatment 2024;56(2):442-454
Purpose:
Pulmonary sarcomatoid carcinoma (PSC) is a rare aggressive subtype of non–small cell lung cancer (NSCLC) with limited therapeutic strategies. We attempted to elucidate the evolutionary trajectories of PSC using multiregional and longitudinal tumor samples.
Materials and Methods:
A total of 31 patients were enrolled in this study and 11 longitudinal samples were available from them. Using whole exome sequencing data, we analyzed the mutational signatures in both carcinomatous and sarcomatous areas in primary tumors of the 31 patients and longitudinal samples obtained from 11 patients. Furthermore, digital droplet polymerase chain reaction (ddPCR), and programmed death-ligand 1 (PD-L1) immunohistochemistry using the Ventana SP263 assay were performed.
Results:
TP53 was identified as the most frequently altered gene in the primary (74%) and metastatic (73%) samples. MET exon 14 skipping mutations, confirmed by ddPCR, and TP53 mutations were mutually exclusive; whereas, MET exon 14 skipping mutations frequently co-occurred with MDM2 amplification. Metastatic tumors showed dissimilar genetic profiles from either primary component. During metastasis, the signatures of APOBEC decreased in metastatic lesions compared with that in primary lesions. PSC showed higher MET and KEAP1 mutations and stronger PD-L1 protein expression compared with that recorded in other NSCLCs.
Conclusion
Decreased APOBEC signatures and subclonal diversity were detected during malignant progression in PSC. Frequent MET mutations and strong PD-L1 expression distinguished PSC from other NSCLCs. The aggressiveness and therapeutic difficulties of PSC were possibly attributable to profound intratumoral and intertumoral genetic diversity. Next-generation sequencing could suggest the appropriate treatment strategy for PSC.
10.Extrahepatic malignancies and antiviral drugs for chronic hepatitis B: A nationwide cohort study
Moon Haeng HUR ; Dong Hyeon LEE ; Jeong-Hoon LEE ; Mi-Sook KIM ; Jeayeon PARK ; Hyunjae SHIN ; Sung Won CHUNG ; Hee Jin CHO ; Min Kyung PARK ; Heejoon JANG ; Yun Bin LEE ; Su Jong YU ; Sang Hyub LEE ; Yong Jin JUNG ; Yoon Jun KIM ; Jung-Hwan YOON
Clinical and Molecular Hepatology 2024;30(3):500-514
Background/Aims:
Chronic hepatitis B (CHB) is related to an increased risk of extrahepatic malignancy (EHM), and antiviral treatment is associated with an incidence of EHM comparable to controls. We compared the risks of EHM and intrahepatic malignancy (IHM) between entecavir (ETV) and tenofovir disoproxil fumarate (TDF) treatment.
Methods:
Using data from the National Health Insurance Service of Korea, this nationwide cohort study included treatment-naïve CHB patients who initiated ETV (n=24,287) or TDF (n=29,199) therapy between 2012 and 2014. The primary outcome was the development of any primary EHM. Secondary outcomes included overall IHM development. E-value was calculated to assess the robustness of results to unmeasured confounders.
Results:
The median follow-up duration was 5.9 years, and all baseline characteristics were well balanced after propensity score matching. EHM incidence rate differed significantly between within versus beyond 3 years in both groups (P<0.01, Davies test). During the first 3 years, EHM risk was comparable in the propensity score-matched cohort (5.88 versus 5.84/1,000 person-years; subdistribution hazard ratio [SHR]=1.01, 95% confidence interval [CI]=0.88–1.17, P=0.84). After year 3, however, TDF was associated with a significantly lower EHM incidence compared to ETV (4.92 versus 6.91/1,000 person-years; SHR=0.70, 95% CI=0.60–0.81, P<0.01; E-value for SHR=2.21). Regarding IHM, the superiority of TDF over ETV was maintained both within (17.58 versus 20.19/1,000 person-years; SHR=0.88, 95% CI=0.81–0.95, P<0.01) and after year 3 (11.45 versus 16.20/1,000 person-years; SHR=0.68, 95% CI=0.62–0.75, P<0.01; E-value for SHR=2.30).
Conclusions
TDF was associated with approximately 30% lower risks of both EHM and IHM than ETV in CHB patients after 3 years of antiviral therapy.

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