Widening Social Inequalities in Cancer Mortality of Children Under 5 Years in Korea

Background@#To investigate the effect of parental social class on cancer mortality in children under 5 in Korea, two birth cohorts were constructed by linking national birth data to under-5 death data from the Statistics Korea for 1995–1999 (3,323,613 births) and 2010–2014 (2,297,876 births). @*Methods@#The Cox proportional hazards model adjusted for covariates was used in this study. @*Results@#Social inequalities of under-5 cancer mortality risk in paternal education and paternal employment status were greater in 2010–2014 than in 1995–1999. The gap of hazard ratio (HR) of under-5 cancer mortality between lower (high school or below) and higher (university or higher) paternal education increased from 1.23 (95% confidence interval, 1.041.46) in 1995–1999 to 1.45 (1.11–1.97) in 2010–2014; the gap of HR between parents engaged in manual work and non-manual work increased from 1.32 (1.12–1.56) in 1995–1999 to 1.45 (1.12–1.89) in 2010–2014 for fathers, and from 1.18 (0.7–1.98) to 1.69 (1.03–2.79) for mothers. When the parental social class was lower, the risk of under-5 cancer mortality was higher in not only adverse but normal births. @*Conclusion@#Social inequalities must be addressed to reduce the disparity in cancer mortality of children under 5 years old.

Intradermal Low-Fat Spindle Cell Lipoma: A Case Report

Spindle cell lipoma is a rare benign neoplasm that features a mixture of evenly aligned spindle cells, mature adipocytes, and ropey collagen. Most cases of spindle cell lipoma are found in the subcutaneous tissue, and intradermal spindle cell lipoma is rarely reported. We present a case of intradermal spindle cell lipoma in a 46-year-old female who presented with a 0.7-cm flesh-colored and dome-shaped nodule on the right temple that had developed 6 years ago. This mass was excised, and upon histopathologic examination, an unencapsulated lesion was located in the dermis, which consisted of bland spindle cells, scanty mature adipocytes, rare lipoblasts, and ropey collagen bundles with prominent basophilic myxoid stroma. Immunohistochemical staining showed diffuse positivity for CD34, negativity for the S-100 protein, and loss of retinoblastoma protein expression. Based on these features, intradermal low-fat spindle cell lipoma was diagnosed. No evidence of local recurrence was observed 4 months after excision. Intradermal low-fat spindle cell lipomas are extremely rare and can easily be mistaken for tumors that have similar clinical and histopathological findings. Herein, we report a globally rare case of an intradermal low-fat spindle cell lipoma.

Superficial CD34-Positive Fibroblastic Tumor: Two Case Reports

Superficial CD34-positive fibroblastic tumor (SCPFT) is a recently described disease entity characterized by marked nuclear pleomorphism, low mitotic count, and diffuse CD34 positivity. It is a rare, distinctive, low-grade fibroblastic neoplasm. To date, only 44 cases have been reported in the English-language literature. Herein, we report two cases of SCPFT involving a 48-year-old male and a 22-year-old male with superficial tumors on the right and left thighs, respectively. Excision was performed in both cases. Histologically, both tumors showed spindle-to-epithelioid cells arranged in fascicular or sheet-like patterns. Most cells displayed granular or eosinophilic glassy cytoplasm, marked nuclear pleomorphism, and a low mitotic rate. On immunohistochemical staining, tumor cells were diffusely positive for CD34 and negative for S100 protein, smooth muscle actin, and desmin. After wide excision, neither patient experienced recurrence or metastasis after 16 months and 11 months of clinical follow-up, respectively. To the best of our knowledge, these are the first two cases of SCPFT reported in Korea. We believe these case reports would contribute to the clinicopathological understanding of SCPFT and assist clinicians in differentiating this tumor from other superficial soft tissue neoplasms.

Development of a Guideline for Antipsychotic-induced Hyperprolactinemia in Korea Using the ADAPTE Process

Objective@#To develop an evidence-based guideline for the diagnosis and treatment of antipsychotic-induced hyperprolactinemia by adapting existing high-quality clinical guidelines with a view to improve the clinical symptoms and long-term quality of life of patients by providing appropriate management. @*Methods@#This guideline was developed according to the ADAPTE methodology. The adaptation process included determining key health questions, systematically searching and screening guidelines, evaluating the quality and contents of these guidelines, deriving recommendations for key questions, and performing a peer review. The selection criteria for the guideline search were (1) evidence-based guidelines, (2) published within the last 5 years, and (3) written in English or Korean. @*Results@#After evaluating the quality and content, we finally selected three guidelines for adaptation. The final output of the development process was 25 recommendations for 10 key questions. We adopted the Agency for Health Research Quality methodology and presented the level of evidence from levels I to IV. In addition, we defined the recommendation grades from grade A (strongly recommended) to D (no recommendation) based on the level of evidence and clinical significance of the recommendation. @*Conclusion@#The development and dissemination of the adapted guideline is expected to increase the certainty of medical decision making and improve the quality of medical care. Further studies on the effectiveness and applicability of the developed guideline are necessary.

A Case of Generalized Cutaneous Piloleiomyomatosis / 대한피부과학회지

Piloleiomyoma originates from the arrector pili muscles. Multiple piloleiomyoma lesions may occur, especially on the trunk and extremities. However, multiple lesions throughout the body are rare. We present a case of generalized cutaneous piloleiomyomatosis in a 72-year-old man who had numerous lesions throughout his body. Clinically, the patient presented with fixed and non-tender reddish to brownish papules and nodules mainly on the back and extensors of extremities. Punch biopsy was performed, and the specimen was stained with hematoxylin and eosin, revealing interweaving fascicles of cigar-like spindle cells on the upper dermis. On immunohistochemical staining, tumor cells were positive for smooth muscle actin. Based on these features, we diagnosed the patient with generalized cutaneous piloleiomyomatosis.

Chancre with Clinical Features of Ulcerative Paronychia / 대한피부과학회지

Syphilis is a highly contagious sexually transmitted disease, and early diagnosis and prompt treatment significantly affect the prognosis. Syphilis usually presents with genital lesions in the early stages; therefore, extragenital syphilitic lesions can easily be misdiagnosed. A 20-year-old man presented with a 1-month history of a worsening hyperkeratotic black crusted ulcerative plaque on the right 4 th finger, with distorted periungual structures.Histopathological examination showed epidermal hyperplasia, mild endothelial swelling, and numerous plasma cells in the dermis. Excessive dermal infiltration of plasma cells suggested primary syphilis, which necessitated additional serological tests; the patient showed positive results on Venereal Disease Research Laboratory and Treponema pallidum hemagglutination testing. The lesion significantly improved after an intramuscular injection of 2.4 million units of benzathine penicillin G. We report a rare case of primary syphilis involving the finger in a patient with clinical features of ulcerative paronychia.

Body Mass Index and Somatic Symptom Severity in Patients with Somatic Symptom Disorder: The Mediating Role of Working Memory

Objective@#In somatic symptom disorder (SSD), cognitive dysfunction is related to perceptive distortion that excessively amplifies bodily sensations. The association between high body mass index (BMI) and cognitive dysfunction could be attributed to underlying systemic inflammation. We aimed to evaluate whether patients with SSD and high BMI exhibit increased somatic symptom severity and whether this is mediated by cognitive dysfunction. @*Methods@#This retrospective, cross-sectional study was conducted on 54 patients with SSD (20 males/34 females, mean age ± standard deviation: 40.65 ± 13.23 years). Participants’ BMI, laboratory data including complete blood count and lipid profile, results from the Korean Wechsler Adult Intelligence Scale-IV, and scores of the Korean-Symptom Checklist 95-Somatization (SCL95-SOM) were analyzed. We performed a path analysis to evaluate BMI as a predictor of somatic symptoms. @*Results@#In a path analysis, the SCL95-SOM score was directly influenced by working memory (b = −0.326, p = 0.032), which was significantly influenced by BMI (b = −0.338, p = 0.009), although there was no direct effect of BMI on the SCL95-SOM score. The path analytic model showed a close fit to the data with the following values: χ2 (df) = 0.918 (1), p = 0.338, root mean square error of approximation = 0.000 (＜ 0.001), and comparative fit index = 1.00. @*Conclusion@#Patients with SSD and high BMI may exhibit increased somatic symptom severity, and this is mediated by working memory dysfunction. Weight management may help improve symptoms in patients with SSD and high BMI.

Body Mass Index and Somatic Symptom Severity in Patients with Somatic Symptom Disorder: The Mediating Role of Working Memory

Objective@#In somatic symptom disorder (SSD), cognitive dysfunction is related to perceptive distortion that excessively amplifies bodily sensations. The association between high body mass index (BMI) and cognitive dysfunction could be attributed to underlying systemic inflammation. We aimed to evaluate whether patients with SSD and high BMI exhibit increased somatic symptom severity and whether this is mediated by cognitive dysfunction. @*Methods@#This retrospective, cross-sectional study was conducted on 54 patients with SSD (20 males/34 females, mean age ± standard deviation: 40.65 ± 13.23 years). Participants’ BMI, laboratory data including complete blood count and lipid profile, results from the Korean Wechsler Adult Intelligence Scale-IV, and scores of the Korean-Symptom Checklist 95-Somatization (SCL95-SOM) were analyzed. We performed a path analysis to evaluate BMI as a predictor of somatic symptoms. @*Results@#In a path analysis, the SCL95-SOM score was directly influenced by working memory (b = −0.326, p = 0.032), which was significantly influenced by BMI (b = −0.338, p = 0.009), although there was no direct effect of BMI on the SCL95-SOM score. The path analytic model showed a close fit to the data with the following values: χ2 (df) = 0.918 (1), p = 0.338, root mean square error of approximation = 0.000 (＜ 0.001), and comparative fit index = 1.00. @*Conclusion@#Patients with SSD and high BMI may exhibit increased somatic symptom severity, and this is mediated by working memory dysfunction. Weight management may help improve symptoms in patients with SSD and high BMI.

A Clinicopathological Study of Lichen Planus-like Keratosis / 대한피부과학회지

Background@#Lichen planus-like keratosis (LPLK), also known as benign lichenoid keratosis, usually presents as a single, brown to red, scaly, flat-topped plaque. Several large-scale studies have reported LPLK in Caucasians; however, no study has reported LPLK in Koreans. @*Objective@#To investigate the clinicopathological features of LPLK in Koreans. @*Methods@#We retrospectively investigated 60 patients with LPLK at Yeungnam University Hospital between 2001 and 2019. Diagnosis of LPLK was confirmed by histopathological examination in all patients. @*Results@#Most patients (96.6%) had a single lesion. The most common location was the face (63.3%), followed by the trunk (16.7%), and upper extremities (11.7%). Mean patient age was 62.7 years, and the female:male ratio was 1.3:1. The initial clinical impression involved seborrheic keratosis in 56.7% of cases and LPLK in only 16.7% of cases. Solar elastosis (58.3%) and red blood cell extravasation (55%) were also commonly observed in this study population. Histopathological findings revealed focal parakeratosis (35%), dermal eosinophils (30%), and plasma cells (10%). @*Conclusion@#LPLK may commonly be misdiagnosed, because it is often clinically indistinguishable from seborrheic keratosis and other epithelial neoplasms. Skin biopsy findings and clinicopathological correlation are therefore necessary for differential diagnosis. Several histopathological features, such as parakeratosis as well as dermal eosinophil and plasma cell infiltration, can distinguish LPLK from lichen planus.

Cut-Off Scores of an Olfactory Function Test for Mild Cognitive Impairment and Dementia

Objective@#We aimed to find the optimal cut-off scores for screening of odor detection threshold, odor discrimination, and odor identification tests for detection of mild cognitive impairment (MCI) and dementia in Korean elderly. @*Methods@#A total of 195 elderly people were divided into three groups: the normal cognition (NC), MCI, and dementia groups. All participants underwent neurocognitive and olfactory function tests. We used k-means cluster analysis and receiver operating characteristic (ROC) analysis to identify the most appropriate cut-off value. @*Results@#To distinguish the MCI from NC groups, odor identification [area under the curve (AUC)=0.670, p<0.007] with a cut-off point of 7 showed greater validity for screening (sensitivity/specificity=0.462/0.837) than did other olfactory function tests. To distinguish the MCI and dementia from NC as well, odor identification (AUC=0.817, p=0.002) with a cut-off point of 7 showed the highest validity for screening (0.785/0.654). To distinguish MCI from AD, an odor detection threshold (AUC=0.722, p=0.001) with a cut-off point of 2 showed the highest validity for screening (0.785/0.654). @*Conclusion@#Olfactory function tests may be a useful screening tool for cognitive decline before clinical symptoms of dementia have completely developed. This tool can be used as a supplementary tool to enhance the sensitivity of traditional cognitive tests to screen for dementia.

Resilience as a Protective Factor for Suicidal Ideation among Korean Workers

Objective@#This study aimed to investigate resilience as a protective factor for suicidality among Korean workers. @*Methods@#Participants were workers from 26 organizations in Korea, aged 18 to 63 years, who completed a self-reported questionnaire comprising items on sociodemographic factors, job stress, resilience, and suicidality. Completed questionnaires were collected from 4,405 persons, with 4,389 valid responses. Hierarchical logistic regression analyses were performed using suicidality as the dependent variable. @*Results@#Results of the logistic regression analyses indicated that among the sociodemographic factors, older age, being female, and being single were statistically significantly associated with suicidal ideation. A high level of job stress, depressive mood, and anxiety, in addition to a short job duration, were also associated with suicidal ideation. Resilience was a significant protective factor for suicidal ideation after adjusting for all other variables. Older age and high anxiety levels were associated with having a suicide plan among participants with suicidal ideation. The association of resilience with suicide plans and suicide attempts was non-significant. @*Conclusion@#In this study, we found that a high level of resilience was associated with a low incidence of suicidal ideation in Korean workers. Based on these results, we suggest the need to develop and implement interventions to improve resilience in the workplace, thereby protecting workers, especially those with a high level of work stress, from suicidal ideation.

Effects of Repetitive Transcranial Magnetic Stimulation on Improvement of Mental Health and Clinical Parameters in Depressed Hemodialysis Patients: a Pilot Study

Background@#This study aimed to evaluate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) as a nonpharmacologic treatment in depressed hemodialysis patients. @*Methods@#Patients who scored ≥ 5 on the Patient Health Questionnaire-9 were randomized to either the rTMS (n = 7) or sham group (n = 7). The rTMS group was stimulated with a 110% motor threshold and 10 Hz on the left dorsolateral prefrontal cortex for 20 minutes, three times a week, for 4 weeks. In the sham group, the “1-wing 90-degree method” was used. We analyzed clinical indices before and after the intervention, as well as data from quantitative electroencephalography (frontal alpha asymmetry [FAA]), and various psychiatric questionnaires (Beck Depression Inventory-II, Beck Anxiety Inventory [BAI], Symptom Checklist-90-Revised Somatization Subscale [SCL-90R-SOM]), and Perceived Stress Scale. @*Results@#One month after rTMS, the changes in hemoglobin A1c levels in the rTMS group were significantly greater than those in the sham group (F = 6.687, P = 0.032). The changes in BAI scores in the rTMS group were significantly greater than those in the sham group (F = 6.700,P = 0.025), and the changes in SCL-90R-SOM scores in the rTMS group were greater than those in the sham group (F = 4.943, P = 0.048). In addition, the changes in the FAA value at the F7 and F8 electrodes in the rTMS group were greater than those in the sham group (F = 6.468, P = 0.027). @*Conclusion@#In depressed hemodialysis patients, rTMS may improve anxiety and somatization symptoms, which may lead to improvements in clinical measures.

Necrobiotic Xanthogranuloma Coexists with Diffuse Normolipidemic Plane Xanthoma and Multiple Myeloma

A Case of Granulomatous Pigmented Purpuric Dermatosis / 대한피부과학회지

No abstract available.

Effect of Multidisciplinary Emergency Consultation System for Drug Intoxicated Patients / 정신신체의학

OBJECTIVES@#When a patient who attempts suicide visits the emergency room, it is important that the departments of emergency medicine, internal medicine, and psychiatry communicate with each other and prioritize treatment. This study was conducted to verify the effectiveness of the multidisciplinary emergency consultation system (ECS) for drug intoxicated patients.@*METHODS@#We retrospectively analyzed the data from medical records prior to the ECS, from July 2017 to May 2018, and after the ECS, from July 2018 to May 2019, to verify the effectiveness of the system.@*RESULTS@#After the ECS, admission to open wards was significantly higher than to the intensive care units (χ²=8.567, p=0.014). In addition, the proportion of consultations to the department of psychiatry among patients admitted to other departments tended to increase (χ²=4.202, p=0.053), and the time required for consultation response decreased (Z=−2.031, p=0.042). As a result of the consultation, the proportion of the patients who had been transferred to the department of psychiatry was increased (χ²=4.692, p=0.043), and the time spent to transfer tended to decrease (Z=−1.941, p=0.052).@*CONCLUSIONS@#After implementing the ECS for drug intoxicated patients, unnecessary intensive care unit admissions, consultation response time, and the time spent to transfer were reduced, and the rate of consultation referrals and transfer rates increased. This means that the multidisciplinary consultation system rapidly provided essential medical services to patients at lower medical costs.

Molecular Identification of Human Sporotrichosis in Korea / 대한의진균학회지

BACKGROUND@#Sporotrichosis is a common deep mycosis caused by the Sporothrix schenckii complex. Until 2016, no molecular studies had been conducted on these fungi, and all the included strains were reported as S. schenckii. However, investigations conducted in northeast China, Japan, and India revealed that S. globosa was the most prevalent Sporothrix species, whereas S. schenckii sensu stricto was reported very rarely.@*OBJECTIVE@#To investigate the accurate prevalent causative species of sporotrichosis among strains reported as S. schenckii in Korea.@*METHODS@#We isolated strains of Sporothrix spp. Prevalent in Korea from fungus collection centers or private collections and reviewed the available literature on molecular studies of strains from this region. We found five S. schenckii (1998-2016) and three S. globosa (2016-2018) strains. Ribosomal DNA internal transcribed spacer (ITS) sequences of these strains were compared with those of the S. schenckii complex strains.@*RESULTS@#The ribosomal ITS sequences of the eight strains were 100% identical with that of S. globose. No S. schenckii sensu stricto was found. In addition, a study on the molecular analysis of Korean S. schenckii published by Ishizaki et al. (2004) demonstrated that the eight strains were of the mitochondrial subtype group B (S. globosa). Thus, all the 16 strains examined within the Korean S. schenckii complex were determined to be S. globosa.@*CONCLUSION@#In summary, S. globosa is the causative species within the tested Korean sporotrichosis cases reported between 1998 and 2018. Based on our analyses, S. globosa, and not S. schenckii, may be the predominant species in Korea.

Influence of Major Coping Strategies on Treatment Non-adherence and Severity of Comorbid Conditions in Hemodialysis Patients

BACKGROUND: Non-adherence and comorbidities are prevalent among hemodialysis patients and are associated with increased mortality and financial burden. We aimed to investigate the influence of major coping strategies (CSs) on non-adherence and comorbidities in hemodialysis patients. METHODS: A total of 49 patients were enrolled. We collected participant data including CS measured by a Korean version of the ways of coping questionnaire (K-WCQ), comorbidities measured by age-adjusted Charlson comorbidity index (CCI), and adherence measured by the 8-item Morisky medication adherence scale (MMAS-8). RESULTS: Regarding major CS, 61.2% of participants reported use of support-seeking CS (SUP group), 14.3% reported use of problem-focused CS (PRO group), and 24.5% reported use of hopeful-thinking CS (HOP group). The mean MMAS-8 score was higher in the PRO group than in the HOP group (P = 0.024). The mean CCI score was lower in the PRO group than in the HOP group (P = 0.017). In the HOP group, the severity of somatic symptoms was positively correlated with the scores for the emotion-focused CS subscale (r = 0.39, P = 0.029) and the hopeful-thinking CS subscale (r = 0.38, P = 0.036) of the K-WCQ. The level of life satisfaction positively correlated with the score for the problem-focused CS subscale in the HOP group (r = 0.40, P = 0.027). CONCLUSION: We should pay more attention to the CSs of hemodialysis patients and provide interventions that promote problem-focused CSs, especially for nonadherent patients with high comorbidity rates who mainly use a hopeful-thinking CS.

Pressure Relieving Effect of Adding a Pelvic Well Pad to a Wheelchair Cushion in Individuals With Spinal Cord Injury

OBJECTIVE: To identify the pressure relieving effect of adding a pelvic well pad, a firm pad that is cut in the ischial area, to a wheelchair cushion on the ischium. METHODS: Medical records of 77 individuals with SCI, who underwent interface pressure mapping of the buttock-thigh area, were retrospectively reviewed. The pelvic well pad is a 2.5-cm thick firm pad and has a cut in the ischial area. Expecting additional pressure relief, it can be inserted under a wheelchair cushion. Subjects underwent interface pressure mapping in the subject's wheelchair utilizing the subject's pre-existing pressure relieving cushion and subsequently on a combination of a pelvic well pad and the cushion. The average pressure, peak pressure, and contact area of the buttock-thigh were evaluated. RESULTS: Adding a pelvic well pad, under the pressure relieving cushion, resulted in a decrease in the average and peak pressures and increase in the contact area of the buttock-thigh area when compared with applying only pressure relieving cushions (p < 0.05). The mean of the average pressure decreased from 46.10±10.26 to 44.09±9.92 mmHg and peak pressure decreased from 155.03±48.02 to 131.42±45.86 mmHg when adding a pelvic well pad. The mean of the contact area increased from 1,136.44±262.46 to 1,216.99±255.29 cm². CONCLUSION: When a pelvic well pad was applied, in addition to a pre-existing pressure relieving cushion, the average and peak pressures of the buttock-thigh area decreased and the contact area increased. These results suggest that adding a pelvic well pad to wheelchair cushion may be effective in preventing a pressure ulcer of the buttock area.

The Novel Neuroprotective Compound KMS99220 Has an Early Anti-neuroinflammatory Effect via AMPK and HO-1, Independent of Nrf2

We have previously reported a novel synthetic compound KMS99220 that prevented degeneration of the nigral dopaminergic neurons and the associated motor deficits, suggesting a neuroprotective therapeutic utility for Parkinson's disease. Microglia are closely associated with neuroinflammation, which plays a key role in the pathogenesis of neurodegenerative diseases. In this study, we investigated the effects of KMS99220 on the signaling involving AMP-activated protein kinase (AMPK) and heme oxygenase-1 (HO-1), the enzymes thought to regulate inflammation. KMS99220 was shown to elevate the enzyme activity of purified AMPK, and phosphorylation of cellular AMPK in BV2 microglia. It increased the level of HO-1, and this was attenuated by AMPK inhibitors. KMS99220 lowered phosphorylation of IκB, nuclear translocation of NFκB, induction of inducible nitric oxide synthase, and generation of nitric oxide in BV2 cells that had been challenged with lipopolysaccharide. This anti-inflammatory response involved HO-1, because both its pharmacological inhibition and knockdown of its expression abolished the response. The AMPK inhibitors also reversed the anti-inflammatory effects of KMS99220. The induction of HO-1 by KMS99220 occurred within 1 h, and this appeared not to involve the transcription factor Nrf2, because Nrf2 knockdown did not affect the compound's HO-1 inducing- and anti-inflammatory effects in this time window. These findings indicated that KMS99220 leads to AMPK-induced HO-1 expression in microglia, which in turn plays an important role in early anti-inflammatory signaling. Together with its neuroprotective property, KMS99220 may serve as a feasible therapeutic agent against neuroinflammation and neurodegeneration.

Familial Sporotrichosis Due to Human-to-human Infection of Sporothrix globosa: A Case Report / 대한의진균학회지

Typically, sporotrichosis follows an environmental transmission route via traumatic inoculation of contaminated plant or soil matter. Although familial occurrences of sporotrichosis are rare, human-to-human transmission is even rarer. Herein, we report two cases, a father and son, with sporotrichosis caused by Sporothrix (S.) globosa. A 33-year-old male who otherwise appeared healthy presented with a tender, erythematous, ulcerative crusted plaque on the left ala nasi and upper lip. A skin biopsy and mycological study revealed fixed cutaneous sporotrichosis. The patient irregularly received oral itraconazole with a relapsing course. Approximately a year later, his 3-year-old son developed a single plaque on the left leg. When the father carried his son on his shoulder, there was direct contact between the two lesions. Fungal culture results from the father and son's lesions confirmed S. globosa with ribosomal DNA ITS sequencing. In both patients, oral terbinafine exhibited better results than oral itraconazole. These cases are an excellent example of human-to-human transmission of sporotrichosis.