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A 40s-year-old woman with previous history of injury due to contact with crown-of-thorns starfish, Acanthaster planci, was stung on the right middle finger. After immediately losing consciousness, she died 13 h after injury despite intensive medical treatment. Examination of the respiratory system revealed narrowing due to severe edema of the laryngopharynx, as well as alveolar hemorrhage, eosinophilic infiltration, and extensive neutrophil and eosinophil aggregation in the intravascular lumen of the lungs. Examination of the liver revealed severe diffuse hepatocellular necrosis and extremely high levels of liver transaminases, indicating severe liver damage. Based on these findings, we concluded that she had died from anaphylactic shock induced by circulation of crown-of-thorns starfish venom in the bloodstream. Injurious contact with the spine of the crown-of-thorns starfish can cause severe symptoms as well as systematic reactions, including anaphylaxis. To our knowledge, this is the first case of anaphylactic shock or death caused by human contact with the crown-of-thorns starfish reported in the English-language literature. Although rare, anaphylaxis due to injury by marine animals is potentially fatal. Saving lives requires providing education regarding prevention and enabling prompt response to possible anaphylaxis, including preparation of adrenaline for auto-injection. [ABSTRACT FROM AUTHOR]

Abstract: Background: The effective energy density (ED) diet model for customized meal plans has not been adequately explored, and the specific differences in appetite sensation among age groups remain unclear. Design: A randomized, crossover study was conducted in 2010 to examine the effects of lunches with different dietary EDs on sensory properties across age groups. Participants/setting: In this experiment, 276 healthy Japanese subjects aged 22 to 59 years consumed packed lunches over six sessions. Using the control meal (150 g cooked rice, sautéed beef menu containing 40 g raw beef, and 240 g vegetable) as a reference, a high-meat/low-rice meal, a low-vegetable meal, a medium-fat/low-vegetable meal, a high-fat meal, and a high-fat/low-vegetable meal were served as modified test meals with varying macronutrient distribution and ED. Main outcome measures: Subjective levels of fullness and satisfaction were assessed over time by visual analogue scale ratings. Statistical analyses performed: Data were analyzed using analysis of variance with body mass index as a covariate followed by Bonferroni post hoc tests. Results: Meals with high vegetable content resulted in greater fullness and satisfaction than meals with low vegetable content, regardless of the diner’s age. Particularly among the 500-kcal low-ED meals, a high-meat meal resulted in greater fullness and satisfaction than a medium-fat/low-vegetable meal among participants aged 30 to 40 years. Postprandial fullness was significantly higher with control meal than with high-meat meal among participants aged 40 to 50 years. Conclusions: This study indicated that high vegetable content in the low-ED diet model provided sufficient fullness and satisfaction despite the low energy content and increased rice content is more effective for satiety than increased meat content for Japanese adults aged around 40 years. [Copyright &y& Elsevier]