A Systematic Review and Meta-Analysis of Nonpharmacological Interventions for Moderate to Severe Dementia

OBJECTIVE: Due to limited efficacy of medications, non-pharmacological interventions (NPI) are frequently co-administered to people with moderate to severe dementia (PWMSD). This systematic review and meta-analysis investigated the effects of NPI on activities of daily living (ADL), behavioral and psychological symptoms of dementia (BPSD), and cognition and quality of life (QoL) of PWMSD. METHODS: A literature search was conducted in the following databases: Cochrane CENTRAL, EMBASE, Medline, CIHNAL, PsycINFO, KoreaMED, KMbase, and KISS. We conducted a meta-analysis on randomized controlled trials and used the generic inverse variance method with a fixed-effects model to calculate the standardized mean difference (SMD). The protocol had been registered (CRD42017058020).

Osteoarthritis Affects Health-Related Quality of Life in Korean Adults with Chronic Diseases: The Korea National Health and Nutritional Examination Surveys 2009–2013 / 가정의학회지

BACKGROUND: Osteoarthritis (OA) is a chronic disease that commonly afflicts the elderly. This disease reduces the health-related quality of life (HRQoL) and causes a significant social burden. Whether the effect of coexisting chronic conditions on HRQoL varies according to the presence of OA remains unclear. Therefore, this study aimed to investigate this notion. METHODS: A total of 13,395 participants were identified from the 2009–2013 Korean National Health and Nutrition Examination Survey for analysis. HRQoL was assessed using the European quality of life-5 dimensions (EQ-5D) index. Patients with OA were defined as those diagnosed by a physician or those who displayed both, symptoms and radiological findings consistent with OA at the time of the survey. Associations between OA and 8 chronic conditions were tested using regression analysis. RESULTS: The EQ-5D index was lower in patients with OA than in those without (mean difference, −0.145; 95% confidence interval [CI], −0.138 to −0.151; P<0.001). Most patients with OA and chronic conditions showed a lower score than those without. EQ-5D was particularly lower in OA patients with hypertension, dyslipidemia, stroke, and renal failure. The estimated β coefficient for the interaction term was significant in renal failure (−0.034; 95% CI, −0.055 to −0.012), after adjusting for demographic and socio-economic variables. CONCLUSION: OA significantly affects HRQoL of Korean elderly individuals alone or when combined with other conditions. OA combined with renal failure is particularly detrimental. These results indicate the importance of managing OA, which is an underestimated disease in public health surveys.

Efficacy of Carboxymethylcellulose and Hyaluronate in Dry Eye Disease: A Systematic Review and Meta-Analysis / 가정의학회지

BACKGROUND: The efficacy of two artificial tears, carboxymethylcellulose (CMC) and hyaluronate (HA), was compared in the treatment of patients with dry eye disease. METHODS: We conducted a systematic review and meta-analysis on randomized controlled trials in the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. The efficacy was compared in terms of the mean change from baseline in tear break-up time. The meta-analysis was conducted using both random and fixed effect models. The quality of the selected studies was assessed for risk of bias. RESULTS: Five studies were included involving 251 participants. Random effect model meta-analysis showed no significant difference between CMC and HA in treating dry eye disease (pooled standardized mean difference [SMD]=-0.452; 95% confidence interval [CI], -0.911 to 0.007; P=0.053). In contrast, fixed effect model meta-analysis revealed significant improvements in the CMC group when compared to the HA group (pooled SMD=-0.334; 95% CI, -0.588 to -0.081; P=0.010). CONCLUSION: The efficacy of CMC appeared to be better than that of HA in treating dry eye disease, although meta-analysis results were not statistically significant. Further research is needed to better elucidate the difference in efficacy between CMC and HA in treating dry eye disease.

HIV-1 Tat Protein-dependent Cytotoxicity is Attenated by 15-deoxy-Delta12,14-Prostaglandin J2 in Rat Hippocampal Slices: Involvement of the ERK1/2 Signaling Pathway

15-deoxy-delta12,14 prostaglandin J2 (15d-PGJ2) may hold promise in treatment of the pathologies associated with human immunodeficiency virus (HIV) infection of the central nervous system. However, its precise role and neuroprotective mechanism in the hippocampus remain poorly understood. In the present study, rat hippocampal slices were stimulated with HIV-1 Tat protein to investigate the protective role of 15d-PGJ2 on the hippocampal cytotoxicity. Full-length HIV-1 Tat protein (Tat1-86), but neither its Tat32-62 nor Tat30-86 fragment, significantly induced cytotoxicity in the hippocampus, the brain region most commonly damaged in HIV-associated dementia. This Tat-induced cytotoxicity was associated with inactivation of MEK/extracellular signal-regulated kinase (ERK) signaling pathway. In contrast, Tat1-86 did not alter Wnt signaling pathway necessary for cell survival. Pretreatment of slices with 15d-PGJ2 markedly reduced Tat-driven cytotxicity. Interestingly, this reduction was accompanied by suppression of ERK inactivation in response to Tat. Moreover, the inhibition of the MEK/ERK pathway with SL327 enhanced the Tat-induced cytotoxicity, confirming the ERK-dependent mechanism of Tat-driven cytotoxicity. Collectively, these data demonstrate that the protective action of 15d-PGJ2 against the hippocampal cytotoxicity upon Tat stimulation is exerted through suppression of Tat-mediated ERK1/2 inactivation.

Granular Parakeratosis of Eccrine Ostia

Granular parakeratosis is a recently recognized disorder of keratinization that is usually confined to intertriginous areas. The histopathologic features are distinctive and diagnostic. Rarely, histopathologic variants such as follicular granular parakeratosis and granular parakeratosis of eccrine ostia have been described. In this report, we describe a rare case of granular parakeratosis mostly confined to eccrine ostia.

Dieticians' Perception of Nutrient Preservation Management Practices during Meal Production by School Food Service in Daegu Area

The purpose of this study was to explore nutrition teachers/dietitians' perception towards production management practices as well as the importance & performance of nutrient preservation during production by school foodservices. A total of 120 school nutrition teachers/dietitians in the Daegu area participated in this study. The data were analyzed by descriptive analysis, t-test, and ANOVA using SPSS/Windows (ver 17.0). A questionnaire consisted of three dimensions with 66 items concerning the general characteristics of schools and respondents, production management practices, and perceived importance and performance of nutrient preservation. Exactly 79.2& of dietitians responded that scheduling of production management is necessary, and 52.5% of respondents perceived that their knowledge for nutrient preservation is of normal/average level. Thirty-eight percent of respondents did not establish scheduling of production management; according to them, cooking stage has priority over other stages of nutrient preservation. Perceived importance score was higher than perceived performance score in all stages of production management. The difference between perceived importance and performance in the production scheduling stage was found to be statistically significant. The results indicate that nutrition control point should be established and managed to prevent nutrient loss in all production stages. Further, dietitians who do not take measures to reduce nutrient loss should be carefully educated on the importance of nutrient control and be motivated to follow guidelines on nutrient preservation.

A Unique Ultrasonographic Finding of Carotid Thrombus in a Patient with Acute Cardiogenic Cerebral Infarction / 대한뇌졸중학회지

In patients with acute ischemic stroke, carotid duplex ultrasonography has been used to assess atherosclerotic lesions at the extracranial carotid artery. We reported a unique sonographic finding of carotid artery thrombus in a patient with acute cardioembolic stroke and atrial fibrillation. An 81-year-old woman with atrial fibrillation was presented with dysarthria and left side hemiparesis. She had undergone surgical thrombectomy and angioplasty for her right brachial artery occlusion four days before the stroke onset. Diffusion-weighted MRI revealed multiple territorial infarctions suggestive of acute cardio-embolic stroke. CT angiography showed an occlusion of the right common carotid artery. On B-mode ultrasonography, longitudinal intraluminal tortuous cylinderic oscillating thrombus was observed on the right distal common carotid artery to the proximal internal carotid artery. This case illustrates a unique ultrasonographic finding of acute cardiogenic thrombus in the extracranial carotid artery.

Precalcaneal Congenital Fibrolipomatous Hamartoma

Precalcaneal congenital fibrolipomatous hamartomas (PCFHs) are characterized clinically by the presence of unilateral or bilateral, asymptomatic nodules in the medial precalcaneal plantar region of the heel. They are skin colored and usually painless nodules. In most patients, the lesions appear within the first few months of life, but they may also be present at birth. Generally PCFHs are benign, but they can grow in proportion to the growth of the infants. Here, we report the case of a 4-month-old boy with a solitary, localized skin-colored nodule on the precalcaneal plantar region of his right heel, diagnosed as a PCFH.

Acantholytic Acanthoma with an Atypical Presentation / 대한피부과학회지

Acantholytic acanthoma is a rare benign neoplasm of epidermal keratinocytes and this commonly displays as a solitary, asymptomatic keratotic papule on the trunk. The histologic features are hyperkeratosis, acanthosis, papillomatosis and prominent acantholysis. Dyskeratotic cells are occasionally present, but prominent dyskeratosis is not a characteristic feature of acantholytic acanthoma. Herein, we report on a case of acantholytic acanthoma with several dyskeratoses, and this occurred in a 54-year-old woman who presented with a keratotic plaque that repeatedly pealed on the umbilicus.

Isolated Epidermolytic Acanthoma in a Renal Transplant Recipient

No abstract available.

A Case of Tumor of the Follicular Infundibulum with Sebaceous Differentiation

Tumor of the follicular infundibulum (TFI) is an uncommon benign adnexal tumor that usually presents as a solitary keratotic papule on the face or scalp of elderly patients. Histopathologically, it typically manifests as a plate-like fenestrated proliferation of monomorphic pale-staining cells. A 76-year-old male presented with about a 2 cm, well-defined, yellowish to brownish, slightly elevated, twisted and bent, interrupted, cord-like plaque on his left lower abdomen. Microscopic examination revealed a sharply demarcated plate-like proliferation of pale cells localized in the papillary dermis with multiple connections to the overlying epidermis. The histopathological features were compatible with TFI, except for foci of sebaceous differentiation. There has been one previous case report of TFI with sebaceous differentiation in the English medical literature. Herein, we report on a singular case of TFI with sebaceous differentiation.

Subcutaneous Panniculitis-Like T-cell Lymphoma: A Clinical and Pathologic Study of 14 Korean Patients

BACKGROUND: Subcutaneous panniculitis-like T-cell lymphoma (SPTL) is a distinctive skin lymphoma characterized by neoplastic T-cell infiltration of the subcutaneous tissue, mimicking panniculitis. OBJECTIVE: To describe the clinical and pathologic features of SPTL in Korean patients. METHODS: Fourteen SPTL patients evaluated over 15 years were retrospectively reviewed. RESULTS: The mean patient age was 35 years (range: 7~73 years), with male predominance (2.5:1). Most patients presented with either nodules or plaques, occurring most commonly on the trunk, with two patients (14%) having hemophagocytic syndrome. Histopathologically, all patients showed infiltrates of small-to-medium pleomorphic cells mimicking panniculitis, with some also showing rimming, bean-bag cells, and fat necrosis. Most patients were positive for CD3 (14/14), CD8 (12/13), TIA-1 (9/9) and betaf1 (5/5), but were negative for CD4 (11/12), CD20 (8/8), CD56 (14/14) and Epstein-Barr virus (8/8). Ten patients (71%) received chemotherapy and 2 (14%) died due to the disease, with an average survival time of 4 months. Survival analysis did not reveal any significant prognostic factors. CONCLUSION: This is the first series of patients with SPTL in Korea. Due to its indolent clinical course and relatively high survival rate, SPTL should be differentiated from cutaneous gammadelta T-cell lymphoma.

Spinal Epidural Metastasis Presenting Atypical Images in Hepatocellular Carcinoma

No abstract available.

A Clinical and Histopathological Review on 18 Cases of Lupus Erythematosus Tumidus / 대한피부과학회지

BACKGROUND: Lupus erythematosus tumidus (LET) is a rare subset of chronic cutaneous lupus erythematosus, and LET is clinically characterized by erythematous, succulent, urticarial plaques on the sun-exposed areas and LET is histopathologically characterized by the presence of perivascular and periadnexal lymphocytic infiltrates with interstitial mucin deposition. OBJECTIVE: We investigated the clinical and histopathological features of LET in Korean patients. METHODS: A retrospective study was conducted on 18 patients who were diagnosed with LET between 1993 and 2010. The clinical characteristics, histopathological and laboratory findings, association with other subsets of lupus and the course of disease were analyzed. RESULTS: LET occurred predominantly in females, with the gender ratio being 1 : 8. The mean age at diagnosis was 31.3 years. Two of 18 patients (11.1%) were previously diagnosed with systemic lupus erythematosus (SLE) or they had discoid lupus erythematosus (DLE) simultaneously. The most common clinical features were erythematous patches, nodules or plaques and the most common site was the face. Eight of eighteen patients (44.4%) had photosensitivity and this value was lower than that of the previous reports. The antinuclear antibody (ANA) was negative or weakly positive in 13/15 (86.7%) cases. The main histopathological characteristics were perivascular and/or periadnexal lymphocytic infiltrates, and interstitial mucin deposition. Epidermal changes were absent or there were minimal changes. The treatments included antimalarial drugs, dapsone and topical and systemic corticosteroid. The patients showed a good response to the treatments without scarring. CONCLUSION: A clinicopathological review of 18 LET cases revealed results that were similar to those of the previous reports, although there were some differences in the gender ratio and frequency of photosensitivity. Further studies are needed to elucidate the cause of such differences.

A Case of Erythrodermic Mycosis Fungoides Treated with Gemcitabine / 대한피부과학회지

Erythrodermic mycosis fungoides (MF) denotes a condition in which erythroderma occurs in patients with otherwise typical clinical features of MF. Gemcitabine is a novel treatment regiment for MF. A 16-year-old boy presented in the hospital with skin lesions that showed generalized erythema with scaling, several plaques, and nodules with ulceration on the extremities and trunk. He was diagnosed with erythrodermic MF. His lesions did not improve with methotrexate (7.5 mg/week) and PUVA for 6 months, so his treatment regimen was changed to systemic gemcitabine therapy (1,000 mg/m2 per week). After 6 cycles of gemcitabine, his skin lesions disappeared. We report a case of erythrodermic MF treated by gemcitabine.

Toxoplasmosis Showing Atypical Brain Lesion in an Immunocompetent Patient With Complex Partial Seizure

Toxoplasma gondii is a protozoan parasite that typically manifests as multiple brain lesions of varying sizes. Toxoplasmosis usually causes neurological complications in immunocompromised patients while it is mostly asymptomatic in healthy subjects. A 19-year-old Peruvian woman presented with seizure, and MRI of the brain disclosed a nodular lesion in the left parietal lobe. This case of toxoplasmosis in an immunocompetent patient required extensive differential diagnoses and treatments.

A Case of Cutaneous and Systemic Plasmacytosis with an Unusual Clinical Presentation / 대한피부과학회지

Cutaneous and systemic plasmacytosis is a rare disorder that's characterized by a cutaneous plasma cell infiltrate accompanied by polyclonal hypergammaglobulinemia. Clinically, it appears as multiple red-brown plaques that mainly occur on the trunk, and this is sometimes associated with variable extracutaneous involvement. All the cases of cutaneous and systemic plasmacytosis reported in Korea have shown the typical skin manifestations on the trunk of the patients. Herein, we report on a case of cutaneous and systemic plasmacytosis and the patient presented with multiple erythematous to brownish patches on the face, neck and both axillary areas.

A Case of Rudimentary Meningocele / 대한피부과학회지

Rudimentary menigocele is a developmental anomaly in which menigothelial elements are present in the skin and subcutaneous tissue. A 9-year-old boy presented with a well-circumscribed, central atrophic and alopecic patch on the midline of the occipital area, and this lesion had been present at birth. Histological examination showed dense collagen bundles with pseudovascular spaces lined by oval, spindle shaped cells in the dermis and the subcutaneous layer. Collagen bodies and psammoma body were also detected. On the immunohistochemistry, these oval, spindle shaped cells were positive for vimentin, but negative for CD31, EMA and S100 protein.

A Case of Childhood Granulomatous Periorificial Dermatitis / 대한피부과학회지

Childhood granulomatous periorificial dermatitis is a granulomatous disease that's characterized by monomorphous, small papular eruptions around the mouth, nose and eyes. The condition is benign and self-limiting and it is not associated with systemic involvement. We recently encountered a 7-year-old Korean boy with multiple, discrete, monomorphic, papular eruptions of 4-week duration on the perioral, periocular and perinasal areas. Histopathological examination revealed an upper dermal and perifollicular granulomatous infiltrate. He was treated with oral erythromycin and the condition resolved without leaving any scar.

Effect of Hydroxychloroquine on the Progression of Renal Injury in Chronic Uremic Rats / 대한신장학회잡지

BACKGROUND: Hydroxychloroquine(HCQ) is known to inhibit proinflammatory cytokine production from stimulated mononuclear cells and to have anti-fibrotic effect. The aim of this study was to investigate if HCQ could ameliorate renal injury in chronic uremic rats. METHODS: Using Sprague-Dawley rats, chronic uremia was induced by 5/6 nephrectomy. The rats were divided into 4 groups : normal control rats(NC), uremic control rats(UC) and uremic rats treated with HCQ 10 mg/kg/day(HCQ10) and 20 mg/kg/day (HCQ20). Blood pressure, renal functions, proteinuria and histological changes were followed up for 12 weeks. The glomerular monocyte/macrophage infiltration was evaluated by immunohistochemistry and mRNA expression of MCP-1 and TGF-beta1 was analyzed by RT-PCR. RESULTS: Blood pressure was higher in UC than that in NC from 4 to 12 weeks, and it was lower in HCQ10(from 4 to 12 weeks) and HCQ20(at 4 week) than that in UC. BUN and serum creatinine levels were significantly higher in UC than those in NC from 4 to 12 weeks, and those were significantly decreased in HCQ10 and HCQ20 compared to UC. Creatinine clearance was significantly lower in UC than that in NC from 4 to 12 weeks, and it was increased in HCQ10 and HCQ20 compared to UC. 24 hour proteinurea was significantly increased in UC from 4 to 12 weeks compared to NC, and it was decreased in HCQ10 at 4 and 12 weeks compared to UC. Glomerulosclerosis score was minimal in NC, but was significantly increased in UC from 4 to 12 weeks. It was significantly decreased in HCQ10 and HCQ20 at 8 and 12 weeks compared to UC. Interstitial fibrosis score was also significantly increased in UC from 4 to 12 weeks compared to NC, and it was significantly decreased in HCQ10 and HCQ20 only at 4 weeks compared to UC. The number of glomerular infiltrated monocyte/macrophage in UC was higher than that in NC from 4 weeks, and was peak at 8 weeks. But it was comparable among NC, HCQ10 and HCQ20. MCP-1 mRNA expression were significantly increased in UC compared to NC at 4 and 8 weeks, and it was significantly decreased in HCQ10 at 8 weeks compared to UC. TGF-beta1 mRNA expression were significantly increased in UC compared to NC at 4 and 8 weeks, and it was significantly decreased in HCQ20 at 4 and 8 weeks compared to UC. CONCLUSIONS: Our results suggest that HCQ inhibits MCP-1 and TGF-beta1 mRNA expression in renal cortical tissue and attenuates progression of glomerulosclerosis and interstitial fibrosis in chronic uremic rats, which lead to amelioration of renal function and decrease in proteinuria in chronic uremic rats.