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Background@#Psoriasis is a complex and heterogeneous disease that widely affects a patient’s life. Biological therapy is usually prescribed in patients with severe psoriasis that do not respond to conventional treatment. However, data on the specific patient characteristics receiving biologics are still unavailable. @*Objective@#To classify patients with psoriasis into subgroups with distinct phenotypes through cluster analysis, and to evaluate the differences between the clusters to predict disease prognosis by examining the response to biological therapy. @*Methods@#The clinical characteristics of the patients with psoriasis were investigated and categorized using hierarchical cluster analysis. After clustering, the clinical characteristics of the patients were compared and the initiation of treatment with biologics according to the clusters were evaluated. @*Results@#A total of 361 patients with psoriasis were classified into two clusters using 16 distinct clinical phenotypes. Group 1 (n=202) consisted of male smokers and alcohol users with higher psoriasis area and severity index (PASI), older age of onset, higher body mass index, and comorbidities including psoriatic arthritis, hypertension, and diabetes when compared to group 2 (n=159). Group 1 had a significantly higher probability of biological treatment initiation than group 2 (p=0.039). The measured risk factors for the initiation of biologics compared were PASI (p<0.001) and nail involvement (p=0.022). @*Conclusion@#Cluster analysis classified patients with psoriasis into two subgroups according to their clinical characteristics. Predicting the disease prognosis using a combination of specific clinical parameters may aid in the management of the disease.
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Background@#Pediatric alopecia areata (AA) can affect the quality of life (QoL) of patients and their family members. Research on the QoL and burden on family members in pediatric AA is limited. @*Objective@#This nationwide multicenter questionnaire study described the QoL and burden of the family members of patients with pediatric AA. @*Methods@#This nationwide multicenter questionnaire study enrolled AA patients between the ages of 5 and 18 years from March 1, 2017 to February 28, 2018. Enrolled patients and their parents completed the modified Children’s Dermatology Life Quality Index (CDLQI) and the modified Dermatitis Family Impact (mDFI). The disease severity was measured using the Severity of Alopecia Tool (SALT) survey scores. @*Results@#A total of 268 patients with AA from 22 hospitals participated in this study. Our study found that the efficacy and satisfaction of previous treatments of AA decreased as the severity of the disease increased. The use of home-based therapies and traditional medicines increased with the increasing severity of the disease, but the efficacy felt by patients was limited. CDLQI and mDFI scores were higher in patients with extensive AA than those with mild to moderate AA. The economic and time burden of the family members also increased as the severity of the disease increased. @*Conclusion@#The severity of the AA is indirectly proportional to the QoL of patients and their family members and directly proportional to the burden. Physicians need to understand these characteristics of pediatric AA and provide appropriate intervention to patients and their family members.
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BACKGROUND: Exposure to secondhand smoke (SHS) has been shown to cause health problems. Recent studies demonstrated an association of SHS with depression and poor mental health. The urinary cotinine concentration (Ucot) is an objective indicator of exposure to SHS. In this study, we evaluated the association between depression and Ucot in adult non-smokers adults in Korea. METHODS: We analyzed the data of 3,417 adults, aged ≥19 years, who participated in the seventh Korea National Health and Nutrition Examination Survey (2016). The eligible subjects were non-smokers. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9). The subjects were dichotomized into two groups: the high depressive symptom group (PHQ-9 ≥10 [n=185]) and the low depressive symptom group (PHQ-9 <10 [n=3,232]). The demographic, socioeconomic, and clinical characteristics of the subjects were retrieved from the survey data. Ucot was dichotomized into high-Ucot (≥10 ng/mL) and low-Ucot (<10 ng/mL). The Ucot and other characteristics were compared between the two groups. To adjust for confounding variables, we conducted a logistic regression analysis and determined the difference in Ucot between the two groups. RESULTS: After adjusting for confounders, the high depressive symptom group was found to be associated with high-Ucot (odds ratio, 1.824; 95% confidence interval, 1.020–3.262). Sex, education, socioeconomic status, marital status, occupational status, limitation of activity, and the presence of an underlying diseases (diabetes and dyslipidemia) had a significant effect on depression. CONCLUSIONS: This concluded that depression was associated with high urine cotinine level in adult non-smokers.
Subject(s)
Adult , Humans , Cotinine , Depression , Education , Employment , Korea , Logistic Models , Marital Status , Mental Health , Nutrition Surveys , Social Class , Nicotiana , Tobacco Smoke PollutionABSTRACT
BACKGROUND@#Exposure to secondhand smoke (SHS) has been shown to cause health problems. Recent studies demonstrated an association of SHS with depression and poor mental health. The urinary cotinine concentration (Ucot) is an objective indicator of exposure to SHS. In this study, we evaluated the association between depression and Ucot in adult non-smokers adults in Korea.@*METHODS@#We analyzed the data of 3,417 adults, aged ≥19 years, who participated in the seventh Korea National Health and Nutrition Examination Survey (2016). The eligible subjects were non-smokers. Depression was evaluated using the Patient Health Questionnaire-9 (PHQ-9). The subjects were dichotomized into two groups: the high depressive symptom group (PHQ-9 ≥10 [n=185]) and the low depressive symptom group (PHQ-9 <10 [n=3,232]). The demographic, socioeconomic, and clinical characteristics of the subjects were retrieved from the survey data. Ucot was dichotomized into high-Ucot (≥10 ng/mL) and low-Ucot (<10 ng/mL). The Ucot and other characteristics were compared between the two groups. To adjust for confounding variables, we conducted a logistic regression analysis and determined the difference in Ucot between the two groups.@*RESULTS@#After adjusting for confounders, the high depressive symptom group was found to be associated with high-Ucot (odds ratio, 1.824; 95% confidence interval, 1.020–3.262). Sex, education, socioeconomic status, marital status, occupational status, limitation of activity, and the presence of an underlying diseases (diabetes and dyslipidemia) had a significant effect on depression.@*CONCLUSIONS@#This concluded that depression was associated with high urine cotinine level in adult non-smokers.
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BACKGROUND/AIMS: The most commonly used immunosuppressant therapy after liver transplantation (LT) is a combination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the most appropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated. METHODS: Ninety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants were included. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was added to reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 +/- 1.3 ng/mL (mean +/- SD). RESULTS: The 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulative steroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alpha fetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels, and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, and positive 18fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05). CONCLUSIONS: Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients.