Increased Expression of Interleukin-12 in Lesional Skin of Atopic Dermatitis Patients with Psoriasiform Features on Histopathology: An Immunohistochemical Study

Association between Physical Fitness and Cardiometabolic Risk of Children and Adolescents in Korea / 가정의학회지

BACKGROUND: This study aimed to investigate the association between physical fitness and cardiometabolic health of Korean children and adolescents. METHODS: In total, 168 participants (89 boys and 79 girls) aged 10–16 years were recruited for the Intervention for Childhood and Adolescent Obesity via Activity and Nutrition Study in 2016. The subjects were categorized into two groups using the definition of metabolic syndrome by the International Diabetes Federation: metabolically unhealthy (with at least two of the five criteria) and healthy groups (with less than one criterion). Correlation analysis of the participants' general characteristics was performed. Odds ratios (ORs) of physical fitness for cardiometabolic risk were evaluated via logistic regression. RESULTS: Metabolically unhealthy children showed greater weight, height, and body mass index, higher Children's Depression Inventory score, and longer screen time than did the metabolically healthy children. Metabolically healthy children showed greater upper and lower extremity muscular strength than did the metabolically unhealthy children (P=0.04 and P<0.001, respectively). In the multiple logistic regression analysis, lower extremity muscle strength was inversely related to the clustered cardiometabolic risk of the children and adolescents with or without adjustment for confounders (OR, 4.32; 95% confidence interval [CI], 1.87–9.97; OR, 7.64; 95% CI, 1.55–37.74, respectively). CONCLUSION: Physical fitness, especially lower extremity muscle strength, is significantly inversely associated with individual and clustered cardiometabolic risks in Korean children and adolescents.

Prediction of Obstructive Sleep Apnea Based on Respiratory Sounds Recorded Between Sleep Onset and Sleep Offset

OBJECTIVES: To develop a simple algorithm for prescreening of obstructive sleep apnea (OSA) on the basis of respiratorysounds recorded during polysomnography during all sleep stages between sleep onset and offset. METHODS: Patients who underwent attended, in-laboratory, full-night polysomnography were included. For all patients, audiorecordings were performed with an air-conduction microphone during polysomnography. Analyses included allsleep stages (i.e., N1, N2, N3, rapid eye movement, and waking). After noise reduction preprocessing, data were segmentedinto 5-s windows and sound features were extracted. Prediction models were established and validated with10-fold cross-validation by using simple logistic regression. Binary classifications were separately conducted for threedifferent threshold criteria at apnea hypopnea index (AHI) of 5, 15, or 30. Prediction model characteristics, includingaccuracy, sensitivity, specificity, positive predictive value (precision), negative predictive value, and area under thecurve (AUC) of the receiver operating characteristic were computed. RESULTS: A total of 116 subjects were included; their mean age, body mass index, and AHI were 50.4 years, 25.5 kg/m2, and23.0/hr, respectively. A total of 508 sound features were extracted from respiratory sounds recorded throughoutsleep. Accuracies of binary classifiers at AHIs of 5, 15, and 30 were 82.7%, 84.4%, and 85.3%, respectively. Predictionperformances for the classifiers at AHIs of 5, 15, and 30 were AUC, 0.83, 0.901, and 0.91; sensitivity, 87.5%,81.6%, and 60%; and specificity, 67.8%, 87.5%, and 94.1%. Respective precision values of the classifiers were89.5%, 87.5%, and 78.2% for AHIs of 5, 15, and 30. CONCLUSION: This study showed that our binary classifier predicted patients with AHI of ≥15 with sensitivity and specificityof >80% by using respiratory sounds during sleep. Since our prediction model included all sleep stage data, algorithmsbased on respiratory sounds may have a high value for prescreening OSA with mobile devices.

Principal Clinical Factors Predicting Therapeutic Outcomes After Surgical Drainage of Postoperative Cheek Cysts: Experience From a Single Center

OBJECTIVES: Postoperative cheek cyst (POCC) is a late postoperative complication of radical maxillary sinus surgery including the Caldwell-Luc (C-L) operation. The present study aimed to evaluate the therapeutic outcomes of surgical treatment for POCC and to assess the clinical factors correlated to these outcomes. METHODS: This study included 57 patients (67 nostrils) diagnosed with POCC who underwent surgical drainage. The medical records of the patients were retrospectively reviewed for radiological findings, treatment modalities, residual symptoms, and recurrences. RESULTS: In total, 30 patients were male and 27 patients were female with a mean age of 55 years, and the patients were usually diagnosed with POCC 28.2 years after radical surgery. Endonasal endoscopic marsupialization was performed via inferior meatal antrostomy, and if possible, middle meatal antrostomy was performed at the same time. In patients with cysts that were difficult to reach using an endonasal endoscopic approach, additional open C-L approaches were performed. The median follow-up period was 19.4 months. Overall, adequate drainage and symptomatic relief were achieved in 91% (61/67) of the patients. The recurrence rate was significantly higher in patients who had anterolateral POCC. Failure to achieve symptomatic relief was correlated to a smaller cyst and the use of the open C-L approach for drainage. CONCLUSION: The location and size of the cyst as well as the use of the open surgical approach were important factors in predicting the therapeutic outcome of POCC. The time point of treatment and surgical approaches should be based on the above-mentioned findings.

A Nutrition Intervention Focused on Weight Management Through Lifestyle Improvements in Prediabetic Subjects

We reported the cases in order to evaluate the effects of individualized nutrition interventions for enhancing self-management abilities of prediabetic subjects. We conducted four nutrition interventions for weight control in two subjects with high-risk of type 2 diabetes. The first subject was a 53-year-old housewife, and the second subject was a 46-year-old male office worker. The subjects visited the medical center 4 times during the study period, and the lifestyle interventions were advised by a clinical team comprised physicians, clinical dietitians, and nurses. In particular, nutrition intervention to achieve weight loss focused on enhancing motivation and problem-solving skills to improve self-management ability. As a result, both subjects achieved weight loss by the time of their last visits. These two case studies, which differed in terms of sex, occupation, and dietary habits showed the importance of individualized nutrition intervention and forming an intimate relationship based on trust centered on prediabetic subjects. In conclusion, systematic collaboration within the clinical team is necessary, and social infrastructure should be prepared to fully realize the benefits of a systematic intervention program.

Validation of the Korean Version of the Abbreviated Profile of Hearing Aid Benefit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The quantification of hearing aid benefit is important in hearing aid fitting. The abbreviated profile of hearing aid benefit (APHAB) is a useful tool for measuring the benefit of using hearing aids. In this study, we developed a Korean version of APHAB (K-APHAB) and determined its validity and reliability. SUBJECTS AND METHOD: An expert panel translated the original version of APHAB into Korean language. Two bilingual translators back-translated the first translated version into English and it was compared with the original version. After cognitive debriefing, the translation of APHAB into the Korean version was completed. One hundred ninety-seven subjects using hearing aids participated in this study and completed K-APHAB. Reliability was assessed using Cronbach's alpha coefficient, and validity was evaluated by factor analysis and criterion validity. RESULTS: K-APHAB had a good internal consistency (α=0.80). Confirmatory factor analysis showed that K-APHAB is comprised of four subsections, namely ‘communication in daily life’, ‘aversiveness’, communication in ‘background noise’ or ‘reverberation’. CONCLUSION: The K-APHAB is a useful tool for evaluating the benefit of hearing aids in Korean hearing-impaired individuals.

Reconstruction of Subtotal Nasal Defect with Radial Forearm Free Flap and Forehead Flap: A Case Report

Reconstructive rhinoplasty is one of the unique areas of rhinoplasty, but its concept and technique have not been widely established in Korea compared to cosmetic rhinoplasty. Nasal reconstruction poses a challenging problem when the defect is large and involves all 3 layers of the nose including the septum. We report a patient who underwent nasal reconstruction due to subtotal, full thickness defect of the nose after repeated failed rhinoplasties including use of a nasolabial flap. A staged operation was planned. First, a radial forearm free flap was used to reconstruct the inner layer. After 4 months, the bulk of the forearm tissue was reduced and used as inner lining at the second operation. In the second operation, the framework of the lower 2/3 of the nose was formed of autologous rib cartilage, and the outer skin defect was covered with a forehead flap. Six weeks later, the forehead flap was divided. One year after the last operation, the patient can breathe well, and his nose has better esthetics than before surgery. We believe this is the first report of nasal reconstruction using a radial forearm free flap and a forehead flap to restore a subtotal, full thickness defect of a nose.

Exploratory Study on Guide Wire-Guided Tongue Resection under Ultrasonography for Adequate Safe Margins in Tongue Cancer Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The adequate safety margin in tongue cancer is the most important prognostic factor for local recurrence and survival. This study aimed to evaluate the resection margins using a new technique of tongue resection under the guidance of guide wire under ultrasonography in patients with tongue cancer. SUBJECTS AND METHOD: In this prospective study, 10 patients with presurgical, biopsy-proven, clinical T1 or T2 tongue squamous cell carcinomas underwent resection under the guidance of guide wire inserted using ultrasonography. The data of resection margins of 37 patients who underwent partial glossectomy using the conventional method of palpation were used as control data. RESULTS: The mean safety margins (mm) of the experimental group were 7.59±4.30 (anterior), 8.56±4.69 (posterior), 5.25±3.01 (superior), 5.93±3.66 (inferior), 13.00±13.29 (medial), 5.78±2.64 (deep), and 6.67±3.06 (lateral). There were no differences in the safety margins between the two groups. CONCLUSION: Using guide wire under ultrasonography was not superior to the conventional method for partial glossectomy for having adequate resection margins.

Alopecia Areata in the Elderly: A 10-Year Retrospective Study

BACKGROUND: Alopecia areata (AA) is an organ-specific autoimmune disease that typically occurs in young adults. AA in the elderly is relatively rare, thus little data have been reported. OBJECTIVE: This study aimed to understand the clinical characteristics of AA in the elderly. METHODS: We performed a 10-year retrospective study of AA in the elderly who visited our dermatologic clinic from January 2002 to December 2011. A clinical review of medical records and telephone interviews were performed by two dermatologists. RESULTS: Among 1,761 patients with newly diagnosed AA, 61 (3.5%) were older than 60 years at the first visit. Among those who completed a telephone interview, 74.3% (26/35) had less than 50% of scalp-localized hair loss. There was no association between the extent of AA and hair graying (p=0.679). Favorable therapeutic response was observed in 62.9% (22/35) of cases. CONCLUSION: AA in the elderly shows mild disease severity and favorable treatment response. There is no association between graying and the extent of AA. However, the influence of aging on the pathogenesis of AA in the elderly deserves further investigation.

Two Concurrent Facial Epidermal Nevi without Systemic Abnormalities: Nevus Sebaceus and Nevus Comedonicus

Epidermal nevi (EN) are hamartomatous lesions derived from epidermal components originating from pluripotent cell mutations. They have been categorized according to their predominant component. The existence of >2 types of EN concurrently within a single area or within contiguous areas has been rarely reported. This report describes the case of simultaneous presence of a yellowish plaque on the left medial canthus and an aggregation of closed comedo-like papules on the right side of the cheek of a 15-year-old girl.

Potential Immunoinflammatory Role of Staphylococcal Enterotoxin A in Atopic Dermatitis: Immunohistopathological Analysis and in vitro Assay

BACKGROUND: The underlying mechanism of atopic dermatitis (AD) exacerbated by Staphylococcus aureus has not been established. However, we demonstrated recently that the majority of S. aureus strains colonized in the skin of Korean AD patients carried genes encoding staphylococcal enterotoxin A (SEA) and/or toxic shock syndrome toxin-1 (TSST-1). OBJECTIVE: To clarify the role of staphylococcal superantigen, SEA in AD. METHODS: With the lesional skin of 9 AD patients and normal looking skin of one healthy adult, we examined first the expression of SEA, staphylococcal enterotoxin B (SEB), and TSST-1 using immunohistochemical analysis. In addition, we investigated the effects of SEA on the expression of inflammation-related adhesion molecules and cytokines in human HaCaT keratinocytes and Human Umbilical Vein Endothelial Cells (HUVECs) by reverse transcriptase-polymerase chain reaction (RT-PCR) analysis and enzyme-linked immunosorbent assay. RESULTS: Staphylococcal protein A (SPA) and SEA were detected with increased immunoreactivity in AD patients. However, TSST-1 showed mild-to-moderate immunoreactivity in AD patients, whereas SEB was minimally detected. In the double immunofluorescence investigation, SEA and SPA were well co-localized. SEA induced upregulation of adhesion molecules and elicited inflammatory responses in HaCaT keratinocytes and HUVECs. CONCLUSION: This study demonstrates the importance of SEA as an immunoinflammatory triggering factor of AD in Koreans.

The Efficacy of Complete Surgical Excision of Keloid and Piercing Sinus Tract on Earlobe Keloid

No abstract available.

The Efficacy of Complete Surgical Excision of Keloid and Piercing Sinus Tract on Earlobe Keloid

No abstract available.

Active Sensitization of Para-tertiary-butylphenol after TRUE Test(R) / 대한피부과학회지

Active sensitization of contact allergen is an uncommon complication of patch test. Para-tertiary-butylphenol (PTBP) is a component of neoprene-based adhesives used in glued leather goods such as shoes, handbags, belts and watchstraps. Contact allergy to PTBP is frequently seen when the patch test is performed. However, active sensitization to PTBP after the patch test is rare. A 23-year-old female patient came to our clinic with a brownish hyperpigmented patch on the belt position of her belly. Pruritic erythematous papules and vesicles developed on the abdomen when she wore new pants 4 months ago. Under the clinical diagnosis of allergic contact dermatitis, the patient was patch tested with the Thin-layer Rapid Use Epicutaneous Test (TRUE Test(R)). The result showed strong positive reaction to nickel sulphate and thiomersal both on day 2 and 3 after application. Twenty-nine days after the test, the patient noticed pruritus on the TRUE Test(R) area. Thirty-four days after the test, an erythematous square-shaped plaque studded with tiny vesicles developed at the PTBP patch test site. This strongly suggests that the reaction to PTBP is occurred. She was diagnosed with an active sensitization to PTBP. We report a rare and interesting case of active sensitization to PTBP after TRUE Test(R).

The Clinical Significance of Tumor-Infiltrating Lymphocytes and Microscopic Satellites in Acral Melanoma in a Korean Population

BACKGROUND: There are various histological prognostic parameters of cutaneous malignant melanoma, including tumor thickness and ulceration. Tumor-infiltrating lymphocytes (TIL) are among these parameters and can be further classified into three categories: 'absent', 'non-brisk' and 'brisk'. Brisk TIL usually indicates better clinical prognosis. Microscopic satellite (Ms) is defined as a nest of tumor cells that is greater than 0.05 mm in diameter and definitely separated from the main tumor. Even though the incidence of Ms varies according to Breslow thickness, the presence of Ms generally indicates poor prognosis. OBJECTIVE: Clinical significance of both TIL and Ms has been extensively studied in western populations but much less so in Asian countries, including Korea, where acral melanoma is the most common subtype. METHODS: We reviewed 90 patients with acral melanoma diagnosed at Kyungpook National University Hospital in Korea. Tissue specimens were examined using hematoxylin-eosin and HMB45 immunohistochemical staining. They were also evaluated by the presence and categorization of TIL (absent, non-brisk and brisk) and the presence of Ms. We further evaluated their impact on survival events (recurrence, distant metastasis and death). RESULTS: The number of survival events by TIL type was 22 in the absent category (22/64, 34.4%), 3 in the non-brisk category (3/25, 12.0%) and 0 in the brisk category. For Ms, survival events were present in 7 patients in Ms-present group (7/11, 63.6%) and 21 patients in Ms-absent group (21/79, 26.6%). CONCLUSION: We suggest the possibility of TIL and Ms as prognostic indicators for acral melanoma in Korean population.

Study on the qualities of diet and life in Parkinson's disease patients according to their nutritional status

Assessment regarding the nutritional status of Parkinson's disease (PD) patients is important because their nutritional status influences the outcome of disease. The purpose of this study investigated the dietary habits, dietary quality, and quality of life for Korean PD patients according to their nutritional status. Seventy PD patients were recruited from K University Hospital (KMC IRB#0918-07) from February 2010 to October 2011. To diagnose PD, the United Kingdom Parkinson's Society Brain Bank standards were used by a neurology physician. The participants were interviewed and assessed using various tools, including a general questionnaire, anthropometrics, questionnaires for dietary habits, dietary diversity score (DVS), dietary variety score (DVS), diet quality index-international (DQI-I), beck depression inventory (BDI), the Korean version of mini mental state examination (K-MMSE), and 36-item short-form health survey (SF-36). The results of the study were as follows: 1) Most of the PD patients (69.0%) were at risk of malnutrition, and 8.5% and 22.5% of the subjects were malnourished and well-nourished, respectively. 2) Clinical symptoms (swallowing and chewing difficulties) were obvious, and the quality of diet (DDS, DVS, DQI-I) was low in the malnourished group (p < 0.01). 3) The malnourished group had significantly lower scores regarding SF-36 (quality of life) as well as that of cognitive function (p < 0.05). 4) The nutritional status of PD patients was significantly correlated with their depression (p < 0.05) and quality of life (p < 0.01). These results indicate that appropriate nutritional management will improve the nutritional status and quality of life as well as the cognitive function in Parkinson's disease patients.

Idiopathic Pterygium Inversum Unguis: Response to Topical Retinoid / 대한피부과학회지

No abstract available.

Biologic Maggot Therapy in Cutaneous Wounds and Postoperative Defects / 대한피부과학회지

BACKGROUND: Maggots are larva of Phaenicia Sericata, the Green Blowfly, and treatments with maggot have recently become widespread revealing their effectiveness in the treatment of chronic wounds, such as diabetic ulcers and pressure sores, by removing necrotic tissue selectively and avoiding damage of healthy tissue. OBJECTIVE: The aim of this study was to evaluate the usefulness and the adverse effects of maggot therapy in dermatology for the treatment of chronic wounds and rapid granulation tissue formation at postoperative defects before reconstruction. METHODS: Fourteen patients with various kinds of skin wounds were included and applied a biobag containing therapeutic maggots on their wounds. RESULTS: Four cases were included for treatment of acute and chronic skin wounds; 10 cases of surgical defects were included for reduction of the treatment period. Maggot therapy periods ranged from 4 to 17 days (mean: 8.3 days). Complete elimination of necrotic tissue was achieved in 7 cases (50%) and partial elimination was achieved in 7 cases (50%). There weren't any cases of incomplete elimination or no response. Eight cases (57.1%) were in the 'excellent' group which had shown rapid granulation tissue formation and 3 cases (21.4%) were in the 'good' group, which had shown relatively rapid granulation tissue formation. But, there were 3 cases (21.4%) which had shown no difference from the previous time. Acute complications such as pain and bleeding had occurred in a few cases after maggot therapy. CONCLUSION: We suggest that the maggot therapy is a useful and effective method to use in the field of dermatology.

Physical Therapists' Recognition about Home-Based Rehabilitation Therapy Services

BACKGROUND: We were interested in getting feedback from physical therapists practicing in individualized home health programs about the present situation and the problems of home-based rehabilitation therapy services. METHODS: We recruited 110 physical therapists practicing in individualized home-visiting health programs offered at health centers. They each completed a 15-item self-administered questionnaire including personal information, therapy environments, characteristics of patients, treatment outcomes and suggestions. RESULTS: Of the 110 respondents, 66 (60%) were engaged in home-based rehabilitation therapy services with other duties. Sixty (54.5%) indicated that >25% of patients improved with home-based therapy and 90% of patients were satisfied with the services they received. Eighty-three (75.5%) respondents indicated that the amount of therapy provided was insufficient, 82 (74.5%) thought that there were no measurement tools to use except for the rehabilitation therapy services records and 27 (24.6%) had evaluation meetings with other medical service members for >50% of their patients. CONCLUSION: The majority of the physical therapists in our study indicated that the home-based rehabilitation therapy services satisfied the needs of patients and improved their functional abilities. However, amount of therapy, use of measurement tools for outcome evaluations and comprehensive team approach were indicated as insufficient. We conclude that increasing the number of physical therapists and systematizing the home-based rehabilitation therapy services would improve the present situation.

Efficacy of Piroxicam Patch Compared to Lidocaine Patch for the Treatment of Postherpetic Neuralgia

BACKGROUND: The lidocaine patch has been effectively used as a first-line therapy to treat neuropathic pain such as postherpetic neuralgia (PHN). OBJECTIVE: To evaluate the safety and efficacy of the topical piroxicam patch as a treatment option for the treatment of PHN. METHODS: Eighteen patients completed a 3-session study, applying three different patches (lidocaine, piroxicam and control) in random order. A maximum of three patches were applied to the most painful area for three consecutive days (12 hours on followed by 12 hours off). Each session was conducted at least seven days apart. The changes in visual analog scale (VAS) scores based pain intensity, quality of sleep and adverse effects were recorded. RESULTS: When compared to the control, both the lidocaine and piroxicam patches significantly reduced the mean VAS scores of pain intensity of all different types. However, the lidocaine patch was better at reducing allodynia, whereas the piroxicam patch was more effective for dull pain. The lidocaine patch worked faster than the piroxicam patch for the response to overall pain relief. CONCLUSION: The results of this study suggest the use of the piroxicam patch for dull pain and in patients where the lidocaine patch is contraindicated.