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Autoerotic death is an accidental death during sexual pleasure, usually caused by a device or equipment used to enhance pleasure. Autoerotic deaths can be classified as typical or atypical. Typical autoerotic deaths occur due to asphyxiation by mechanical compression, while atypical autoerotic deaths occur by means other than asphyxiation. Narcissism-associated accidental deaths during tube and wire insertion into the urethra and rectum are extremely rare. The victim, a man in his 40s, was found dead at his home. Several tools for masturbation and wires for urethral and rectal insertion were observed around the victim and many pornographic videos were also identified. Family accounts and medical records indicated that he masturbated often by inserting plastic tubes and wires into the urethra and rectum. Moreover, the victim had a history of surgeries to remove foreign objects from the urethra and rectum as well as a history of psychiatric treatment. The autopsy results revealed no specific findings indicative of the cause of death. In conclusion, the investigators determined the cause of death as an atypical autoerotic death based on the death scene investigation, autoerotic sexual behavior, personal history, and autopsy results.

Monoclonal antibodies are pure antibodies that react to a specific epitope. Plasmapheresis is a treatment that separates and eliminates disease-causing substances before replacing the blood with plasma. Plasmapheresis has insufficient evidence for treating new-onset refractory status epilepticus (NORSE). Sequential plasmaphereses gradually improved a female cryptogenic NORSE patient who did not benefit from monoclonal antibody treatment.

The purpose of this study is to identify issues related to software manpower, which became more important in the era of the Fourth Industrial Revolution in Korea. The results of this study can provide guidelines for those who establish software manpower training policies for solving the software industry’s human resource paradox. As for the research method, the quantitative text network and qualitative analyses from industry experts were used to interpret the results. A total of 14,752 news data mentioning software manpower were extracted, and data pre-processing for the synonyms and negative words were performed. The network was non-directional and consisted of 14,074 words (nodes) and 1,542,383 word combinations (edges). In addition, the network was clustered based on Modularity, and the degree of connection and eigenvector centrality were used to determine the importance of nodes. The analysis of the results showed that the government’s efforts through the Korean Ministry of Science and ICT were vital in creating jobs that fueled software innovation growth, and that software education was actively promoted to develop software talent. This study had the following implications. It was confirmed that software is making a high contribution to the expansion of business opportunities and job creation in the fields of new technology and software convergence technology. To resolve the software manpower supply-demand mismatch, it is necessary to cultivate high-quality software talent and provide mid- to long-term activities to attract competent human resources. In addition, it is necessary to develop and expand programs that link education and recruitment in terms of public-private cooperation along with government-led investment to strengthen national software competitiveness.

Introduction To our knowledge, there have been studies actively looking for patients with suspected SA in the Stroke Unit (SU), but most of them were conducted using a portable polysomnography (PSG), and no study has performed Level 1 PSG (L1PSG) to date. We conducted L1PSG to the acute stroke patients selected in the SU, and conducted L1PSG to patients who visited the Neurology Outpatient Clinic (NOC) with subjective SA symptoms at the same time. By comparison, we tried to find out the SA characteristics of acute stroke patients. Methods This study was conducted on patients admitted to SU from April 1, 2021 to October 31, 2022, and patients who visited NOC during the same period and underwent L1PSG. Among patients admitted to the SU, trained night shift nurses selected patients with SA symptoms with a modified mallampati score of 3 or higher. Cases under intracranial pressure control or other interventions were excluded. Outpatients were enrolled in patients who underwent L1PSG by visiting the NOC to examine only SA. The results of the pre-sleep questionnaire and L1PSG were compared. Results Of a total of 829 stroke patients admitted to SU, 31 SU patients received L1PSG, and during the same period, 74 patients received L1PSG for SA testing at NOC. The average age of SU and NOC was 56 and 57 years, and the median BMI was 26.9 and 26.4. In the survey, the ISI (7 vs 12, p=0.04) and PSQI (5 vs 7, p=0.021) scores were statistically significantly higher in NOC patients. As a result of the L1PSG, AHI (38.8 vs 23.1, p=0.027), AHI in Supine (59.3 vs 25.6, p=0.004) and NonREM AHI (36.3 vs 20.9, p=0.027) were statistically significantly higher in SU patients. Conclusion Patients screened SA at SU overlooked their symptom and thought their sleep quality was better than that of NOC patients, but the actual AHI was higher. In particular, acute stroke patients show a large difference in AHI in supine compared to NOC, so lateral position can be recommended when absolute bed rest is needed in situations where SA is suspected in SU. More follow-up studies will be needed. Support (if any)

A brain-computer interface (BCI) is a technology that acquires and analyzes electrical signals from the brain to control external devices. BCI technologies can generally be used to control a computer cursor, limb orthosis, or word processing. This technology can also be used as a neurological rehabilitation tool for people with poor motor control. We reviewed historical attempts and methods toward predicting arm movements using brain waves. In addition, representative studies of minimally invasive and noninvasive BCI were summarized.

Background Non-invasive painless signaling therapy (NPST) is an electro-cutaneous treatment that converts endogenous pain information into synthetic non-pain information. This study explored whether pain improvement by NPST in failed back surgery syndrome (FBSS) patients is related to cerebral modulation. Methods Electroencephalography (EEG) analysis was performed in 11 patients with FBSS. Subjects received daily NPST for 5 days. Before the first treatment, patients completed the Brief Pain Inventory (BPI) and Beck Depression Inventory and underwent baseline EEG. After the final treatment, they responded again to the BPI, reported the percent pain improvement (PPI), and then underwent post-treatment EEG. If the PPI grade was zero, they were assigned to the ineffective group, while all others were assigned to the effective group. We used standardized low-resolution brain electromagnetic tomography (sLORETA) to explore the EEG current-source distribution (CSD) associated with pain improvement by NPST. Results The 11 participants had a median age of 67.0 years, and 63.6% were female. The sLORETA images revealed a beta-2 CSD increment in 12 voxels of the right anterior cingulate gyrus (ACG) and the right medial frontal area. The point of maximal CSD changes was in the right ACG. The alpha band CSD increased in 2 voxels of the left transverse gyrus. Conclusions Pain improvement by NPST in FBSS patients was associated with increased cerebral activity, mainly in the right ACG. The change in afferent information induced by NPST seems to be associated with cerebral pain perception.

Self-management is critical and essential for controlling non-alcoholic fatty liver disease, delaying progression, and preventing complications. However, information about the self-management characteristics of this population is scarce. This study explores the characteristics and self-management levels and the factors associated with self-management in patients with non-alcoholic fatty liver disease in Korea. A convenience sample of 150 patients diagnosed with non-alcoholic fatty liver disease was recruited from April to November 2019. Demographics and clinical findings were collected, and self-management, self-efficacy, fatigue, and depressive symptoms were assessed using questionnaires. Multiple linear regression analysis was performed to examine the factors associated with self-management. Self-management levels were moderate (Mean = 3.4, SD = 0.61). Self-management differed significantly by age, sex, marital status, occupation, and health education experience. Self-efficacy (β = 0.074, p = 0.020) showed a significant association with self-management, which explained 25.0% of the variance after controlling for age, sex, marital status, health education experience, occupation, controlled attenuation parameter score, and body mass index. Self-efficacy is a critical determinant of self-management among patients with non-alcoholic fatty liver disease. The study findings could assist healthcare professionals in facilitating self-management compliance and developing multidisciplinary team-based interventions for sustainable self-management.

Flipped learning, abbreviated as “FL” is a new pedagogical approach that reverses the order of a typical lecture. It was developed to compensate for the shortcomings of a typical teaching method. Students learn by watching video clips before class and continue to learn through peer discussion in the classroom. The educational benefits of FL like student’s positive attitude were revealed in the previous studies. FL can be a valuable alternative to the existing classes in the untact age of coronavirus disease 2019.

Study Objectives Rapid eye movement (REM) sleep without atonia (RWA) is essential for diagnosing REM sleep behavior disorder (RBD). Manual and automatic quantifications of RWA that use different criteria have been validated. This study compared the RWA quantification methods for diagnosing RBD. Methods The PubMed, EMBASE, Web of Science, and Cochrane Library databases were systemically searched for studies published from inception to December 2021. The inclusion criteria were cohort, cross-sectional, and case-control studies assessing the sensitivity and specificity of RWA quantification methods. Pooled estimates of the sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were determined. Risk of bias and certainty of evidence was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool and the Grading of Recommendations, Assessment, Development, and Evaluations framework, respectively. Results Fourteen articles including 402 patients with RBD met the inclusion criteria. Manual methods evaluating any chin and phasic flexor digitorum superficialis (FDS) activity had the highest DOR (138.8, 95% CI = 21.8% to 881.7%) and AUC (0.9686). The automatic REM atonia index (RAI) showed similar or higher sensitivity (89.1%, 95% CI = 84.6% to 92.7%) but a lower specificity (73.5%), DOR (43.1), and AUC (0.9369) than the manual techniques. Conclusions In this meta-analysis, manual RWA quantification that employed chin or phasic FDS activity had the best RBD diagnostic performance. The automatic RAI method may be useful for screening patients with RBD. The results should be interpreted carefully because of the high risk of bias in patient selection and significant heterogeneity among the studies. PROSPERO Registration number CRD42021276445.

Background Reflex and spontaneous movements are not uncommon in brain death patients. However, most studies have been conducted in adults, while reports in infants and children are rare. Thus, we aimed to evaluate the frequency and characteristics of these movements in pediatric patients declared as brain death. Methods Records of pediatric patients who were diagnosed as brain death from 15 hospitals in the Yeongnam region, South Korea, between January 2013 and September 2016 were analyzed. All body movements in patients who met the criteria for brain death as established by the Korea Medical Association were assessed by medical doctors and trained organ transplant coordinators. The frequency and characteristics of these movements were identified. Additionally, the demographic and clinical factors of the brain death patients with and without these movements were compared. Results A total of 31 patients who met the criteria for brain death were enrolled. Seven patients (22.6%) showed either reflex or spontaneous movements; six of them (85.7%) showed reflex movements only, and one patient (14.3%) showed both types of movements. The most common types of reflex movements were the flexor/extensor plantar response and isolated finger jerk. Four of seven patients (57.1%) showed a single movement pattern, while three (42.9%) showed two different movement patterns. Conclusion It is essential for physicians who perform pediatric brain death examinations to recognize the frequency and characteristics of reflex and spontaneous movements, and this article may help in the accurate and prompt diagnosis of brain death.

Background and purpose The increased demand for donor organs has made it crucial to keep the organs of patients with impending brain death (PWIBDs) suitable for transplantation during the process of determining brain death. This study aimed to identify the time taken to determine brain death (TT-BD) in PWIBDs and the associated influencing factors. Methods This study analyzed data collected by the Korean Organ Donation Agency from 15 hospitals in the Yeongnam region of South Korea. There were 414 PWIBDs eligible for inclusion in this study. The data consisted of the TT-BD for PWIBDs and the potential variables influencing the TT-BD. Results The mean age of the 414 PWIBDs was 48.9 years, and 120 of them were female (29.0%). The mean TT-BD was 8.5 days. The presence of spontaneous movements (SMs) and craniotomy significantly affected the TT-BD. The mean TT-BDs were 13.9 and 8.2 days in the PWIBDs with and without SMs, respectively, and 9.8 and 8.0 days in the PWIBDs with and without craniotomy, respectively. Conclusions The SMs in PWIBDs and a craniotomy performed immediately before starting the process of determining brain death seem to be related to lengthening the TT-BD.

Latency and amplitude are the measurement parameters of mismatch negativity (MMN). The values of the parameters vary sensitively with the stimulus paradigm. A paradigm using the frequency difference of sounds for the MMN study is well known. This study obtained the reference values of the parameters in healthy young adults by performing the MMN study using the frequency paradigm. The authors recruited ten healthy adults. Their average age was 25.5 years; three were female, and seven were male. On the auditory paradigm for the MMN study, the frequency of sound was 1000 Hz for the standard stimulus, and 1032 Hz for the deviant stimulus. The mean values of latency and amplitude of MMN were 202 ms and 1.88 μV at Fz, 207 ms, and 1.46 μV at Cz, 212 ms, and 1.10 μV at C3, and 214 ms and 1.45 μV at C4. There was no correlation between the latency and amplitude of MMN. This study presented the reference values of the latency and amplitude of the MMN using a standard paradigm that is easy to apply. This information may make the MMN useful for clinical applications and basic research.

Concern for patient safety underlies the need for interprofessional education (IPE). One way to measure the effectiveness of IPE is by measuring attitude change toward other healthcare professionals; however, there are currently no valid Korean tools to measure such a change in attitudes. Therefore, this study aims to develop and test a Korean version of the Interprofessional Attitudes Scale (IPAS). The original IPAS was translated into Korean according to the World Health Organization’s guidelines after obtaining permission from the article’s corresponding author. A total of 414 questionnaires were collected from third- and fourth-year medical and nursing students at four Korean institutions in December 2018. To analyze the validity of the Korean IPAS, exploratory and confirmatory factor analyses were conducted. Cronbach’s α was used to evaluate reliability. Results from the exploratory factor analysis identified four functions: teamwork, community-centeredness, patient-centeredness, and respect for diversity. Significant cross-correlations were found among the four functions (r=0.438–0.631, p

BACKGROUND The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in parallel with the epidemic of obesity and metabolic syndrome. Lifestyle modification is a crucial strategy for the treatment of NAFLD, which can lead to a reduction in liver fat with concomitant weight loss. The use of eHealth technologies is an effective approach to improve health outcomes in patients as they do not have any time and space limitations. OBJECTIVE This study aimed to evaluate published eHealth intervention studies for the improvement of lifestyle modifications among patients with NAFLD and to provide recommendations for future studies. METHODS We conducted a systematic review and meta-analysis. Five electronic databases (PubMed, Cochrane Central, CINAHL, EMBASE, and Web of Science) were searched for studies reporting the effect of lifestyle modification intervention using eHealth in patients with NAFLD published from inception to April 15, 2021. Study selection, data extraction, and quality assessment were performed by 3 researchers independently. The quality of included studies was assessed using the Cochrane risk of bias tool and the Risk of Bias Assessment Tool for Nonrandomized Studies. RESULTS In total, 2506 records were identified, and 37 full-text articles were assessed. Six studies were included in the systematic review. The participants of all interventions were 1,217 individuals with NAFLD, and the mean age ranged from 38.3 to 57.9 years. The duration of the interventions was 6-24 weeks, and all interventions were categorized into 3 types: internet-based computers, telephones, and mobile applications. Of these, 4 studies were randomized controlled trials. According to the meta-analysis, clear improvements in the eHealth intervention were observed in weight (p=.001; 95% CI −0.53 to −0.36), BMI (p CONCLUSIONS Lifestyle modification interventions using eHealth technologies are significantly effective for weight, BMI, AST, and ALT in NAFLD patients. Future research should conduct interventions with larger sample sizes and evaluate whether these interventions have sustained benefits, and how we can make these eHealth methods most effective on a large scale.

Background The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing in parallel with the epidemic of obesity and metabolic syndrome. Lifestyle modification is a crucial strategy for the treatment of NAFLD, which can lead to a reduction in liver fat with concomitant weight loss. The use of eHealth technologies is an effective approach to improve health outcomes in patients as they do not have any time and space limitations. Objective This study aimed to evaluate published eHealth intervention studies for the improvement of lifestyle modifications among patients with NAFLD and to provide recommendations for future studies. Methods We conducted a systematic review and meta-analysis. Five electronic databases (PubMed, Cochrane Central, CINAHL, Embase, and Web of Science) were searched for studies reporting the effect of lifestyle modification intervention using eHealth in patients with NAFLD published from inception to November 3, 2022. Study selection, data extraction, and quality assessment were performed by 3 researchers independently. The quality of included studies was assessed using the Cochrane risk of bias tool and the Risk of Bias Assessment Tool for Nonrandomized Studies. Results In total, 2688 records were identified, and 41 full-text articles were assessed. Seven studies were included in the systematic review. The participants of all interventions were 1257 individuals with NAFLD, and the mean age ranged from 38.3 to 57.9 years. The duration of the interventions was 3-24 months, and all interventions were categorized into 3 types: internet-based computers, telephones, and mobile apps. Of these, 4 studies were randomized controlled trials and were included in the meta-analysis: 3 studies for body weight and BMI and 4 studies for alanine aminotransferase (ALT) and aspartate aminotransferase (AST). According to the meta-analysis, clear improvements in BMI (P=.02; 95% CI –1.01 to –0.10), AST (P=.02; 95% CI –1.22 to –0.13), and ALT (P=.01; 95% CI –1.28 to –0.15) were observed in the eHealth intervention as compared with the control groups. Conclusions Lifestyle modification interventions using eHealth technologies are significantly effective for BMI, AST, and ALT in patients with NAFLD. Future research should conduct interventions with larger sample sizes and evaluate whether these interventions have sustained benefits, and how we can make these eHealth methods most effective on a large scale.