Suicidal cases involving sodium nitrite have been reported worldwide. However, postmortem features, such as brownish or grayish livor mortis, remain difficult to interpret, especially as decomposition advances. Here, we present three fatal cases (2020-2023) presumably caused by sodium nitrite ingestion. In these cases, characteristic nitrite-induced changes were inconsistent or obscured by decomposition, but ingestion traces (cup or bottle near the decedents) were observed at each scene. Additionally, containers labeled “sodium nitrite” were found in two cases; however, since sodium nitrite is designated a suicide-hazardous material in South Korea, future scenes may rarely reveal such clear labeling. Although autopsy, including methemoglobin testing, can confirm the cause of death, any delay in the investigative process risks the loss of critical evidence about the ingestion process and other factors. This underscores the importance of focusing on early scene evidence, particularly ingestion traces, and conducting thorough chemical and forensic examinations. Our findings illustrate that timely detection of ingestion-related evidence and subsequent forensic analysis, in conjunction with autopsy results, can elucidate a decedent’s cause and manner of death and clarify any criminal implications.

Suicidal cases involving sodium nitrite have been reported worldwide. However, postmortem features, such as brownish or grayish livor mortis, remain difficult to interpret, especially as decomposition advances. Here, we present three fatal cases (2020-2023) presumably caused by sodium nitrite ingestion. In these cases, characteristic nitrite-induced changes were inconsistent or obscured by decomposition, but ingestion traces (cup or bottle near the decedents) were observed at each scene. Additionally, containers labeled “sodium nitrite” were found in two cases; however, since sodium nitrite is designated a suicide-hazardous material in South Korea, future scenes may rarely reveal such clear labeling. Although autopsy, including methemoglobin testing, can confirm the cause of death, any delay in the investigative process risks the loss of critical evidence about the ingestion process and other factors. This underscores the importance of focusing on early scene evidence, particularly ingestion traces, and conducting thorough chemical and forensic examinations. Our findings illustrate that timely detection of ingestion-related evidence and subsequent forensic analysis, in conjunction with autopsy results, can elucidate a decedent’s cause and manner of death and clarify any criminal implications.

Suicidal cases involving sodium nitrite have been reported worldwide. However, postmortem features, such as brownish or grayish livor mortis, remain difficult to interpret, especially as decomposition advances. Here, we present three fatal cases (2020-2023) presumably caused by sodium nitrite ingestion. In these cases, characteristic nitrite-induced changes were inconsistent or obscured by decomposition, but ingestion traces (cup or bottle near the decedents) were observed at each scene. Additionally, containers labeled “sodium nitrite” were found in two cases; however, since sodium nitrite is designated a suicide-hazardous material in South Korea, future scenes may rarely reveal such clear labeling. Although autopsy, including methemoglobin testing, can confirm the cause of death, any delay in the investigative process risks the loss of critical evidence about the ingestion process and other factors. This underscores the importance of focusing on early scene evidence, particularly ingestion traces, and conducting thorough chemical and forensic examinations. Our findings illustrate that timely detection of ingestion-related evidence and subsequent forensic analysis, in conjunction with autopsy results, can elucidate a decedent’s cause and manner of death and clarify any criminal implications.

Suicidal cases involving sodium nitrite have been reported worldwide. However, postmortem features, such as brownish or grayish livor mortis, remain difficult to interpret, especially as decomposition advances. Here, we present three fatal cases (2020-2023) presumably caused by sodium nitrite ingestion. In these cases, characteristic nitrite-induced changes were inconsistent or obscured by decomposition, but ingestion traces (cup or bottle near the decedents) were observed at each scene. Additionally, containers labeled “sodium nitrite” were found in two cases; however, since sodium nitrite is designated a suicide-hazardous material in South Korea, future scenes may rarely reveal such clear labeling. Although autopsy, including methemoglobin testing, can confirm the cause of death, any delay in the investigative process risks the loss of critical evidence about the ingestion process and other factors. This underscores the importance of focusing on early scene evidence, particularly ingestion traces, and conducting thorough chemical and forensic examinations. Our findings illustrate that timely detection of ingestion-related evidence and subsequent forensic analysis, in conjunction with autopsy results, can elucidate a decedent’s cause and manner of death and clarify any criminal implications.

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: 1) adenoma ≥10 mm in size; 2) 3-5 (or more) adenomas; 3) tubulovillous or villous adenoma; 4) adenoma containing high-grade dysplasia; 5) traditional serrated adenoma; 6) sessile serrated lesion (SSL) containing any grade of dysplasia; 7) serrated polyp of at least 10 mm in size; and 8) 3-5 (or more) SSLs. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

Background/Aims: The adenoma detection rate (ADR) does not reflect the complete detection of every adenoma during colonoscopy; thus, many surrogate indicators have been suggested.This study investigated whether the ADR and surrogate quality indicators reflect the adenoma miss rate (AMR) when performing qualified colonoscopy. Methods: We performed a prospective, multicenter, cross-sectional study of asymptomatic examinees aged 50 to 75 years who underwent back-to-back screening colonoscopies by eight endoscopists. The ADR and surrogate quality indicators, including polyp detection rate, total number of adenomas per colonoscopy, additional adenomas found after the first adenoma per colonoscopy (ADR-Plus), and total number of adenomas per positive participant, were calculated for the prediction of AMR. Results: A total of 371 back-to-back colonoscopies were performed. There was a significant difference in ADRs (range, 44% to 75.4%; p=0.024), polyp detection rates (range, 56% to 86.9%; p=0.008) and adenomas per positive participants (range, 1.19 to 2.30; p=0.038), and a tendency of a difference in adenomas per colonoscopy (range, 0.62 to 1.31; p=0.051) and ADR-Plus (range, 0.13 to 0.70; p=0.054) among the endoscopists. The overall AMR was 20.1%, and AMRs were not different (range, 13.9 to 28.6; p>0.05) among the endoscopists. No quality indicators were significantly correlated with AMR. The number of adenomas found during the first colonoscopy was an independent factor for increased AMR (odds ratio, 1.79; p<0.001). Conclusions The colonoscopy quality indicators were significantly different among high-ADR endoscopists, and none of the quality indicators reflected the AMR of good quality colonoscopy performances. The only factor influencing AMR was the number of adenomas detected during colonoscopy.

BACKGROUND/OBJECTIVES: A dietary restriction on the intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been reported to be effective in the treatment of gastrointestinal (GI) tract complications. Enteral nutrition (EN) is widely used for patients who cannot obtain their nutritional requirements orally, but many studies have reported EN complications, especially diarrhea, in up to 50% of patients. SUBJECTS/METHODS: We performed a single-center, non-randomized, controlled trial to determine the effects of a low-FODMAP enteral formula on GI complications in patients in intensive care units (ICUs). Patients in the ICU who needed EN (n = 66) were alternately assigned to the low-FODMAP group (n = 33) or the high-FODMAP group (n = 33). RESULTS: Anthropometric and biochemical parameters were measured, and stool assessment was performed using King's Stool Chart. We excluded patients who received laxatives, GI motility agents, proton pump inhibitors, antifungal agents, and antibiotics other than β-lactams. There were no differences in GI symptoms during 7 days of intervention, including bowel sound, abdominal distension, and vomiting between the 2 groups. However, diarrhea was more frequent in the high-FODMAP group (7/33 patients) than the lowFODMAP group (1/33 patients) (P = 0.044). CONCLUSIONS Our results suggest that a low-FODMAP enteral formula may be a practical therapeutic approach for patients who exhibit enteral formula complications. Our study warrants further randomized clinical trials and multicenter trials.

This study examined the relationships among personality traits, coping efficacy, and academic stress in medical and non-medical students in South Korea, and investigated the mediating effect of coping efficacy in the relationship between personality traits and academic stress. The study group comprised 210 medical students and 175 non-medical students. They were asked to rate their personality traits, coping efficacy, and academic stress. The data were analyzed using IBM SPSS ver. 26.0 (IBM Corp., Armonk, NY, USA) and AMOS ver. 26.0 (IBM Corp.). Medical students scored higher for examination stress and lower for extroversion than non-medical students. In both groups, extroversion and conscientiousness positively affected coping efficacy, while neuroticism influenced it negatively. Neuroticism directly influenced all types of academic stress in both groups, while extroversion and conscientiousness only had direct effects on examination stress among medical students. Coping efficacy mediated the associations between personality traits and academic stress, except for the relationship between neuroticism and grade stress among medical students. The study indicates that coping efficacy had a significant effect on relieving academic stress among students with higher scores for extroversion and conscientiousness. Efforts should be made to decrease neuroticism to lower academic stress, as the relationship between neuroticism and academic stress is not directly influenced by coping efficacy. The implications of these results are discussed regarding a consultation system for students, especially those in medical school.