Recurrence Rate of Herpes Zoster and Its Risk Factors: a Population-based Cohort Study

BACKGROUND: Herpes zoster (HZ) is generally thought to occur once in a lifetime and recurrence is considered to be limited to immunocompromised individuals. Although HZ recurrence rates seem to be increasing, there have been few studies exploring these rates in the general population. We investigated the recurrence rate and associated risk factors in the general population. METHODS: We used the population-based samples of the National Health Insurance Service database to identify cases of initial HZ episodes from January 1, 2002 to December 31, 2013. We also followed up on these cases through December 31, 2013 to identify recurrence. RESULTS: Overall, the incidence rate of HZ is 5.1 per 1,000 person years and the recurrence rate is 12.0 per 1,000 person years. There were 2,100 recurrent cases out of 39,441 initial episodes with 4.4 years of the mean follow-up period. We identified significant risk factors for recurrence such as old age (51–70 years) (hazard ratio [HR], 1.447; 95% confidence interval [CI], 1.311–1.598), women (1.476; 1.345–1.619), zoster-related pain (ZRP) longer than 30 days (cases of ZRP lasting 31–90 days [1.200; 1.042–1.383], and ZRP lasting longer than 90 days [2.293; 1.990–2.643]). Concurrent hematologic malignancies (2.864; 1.929–4.251), autoimmune diseases (1.466; 1.252–1.715), dyslipidemia (1.390; 1.263–1.530), and hypertension (1.222; 1.107–1.350) were also significant risk factors. CONCLUSION: Our results suggest that the recurrence of HZ is much more common than generally expected, and that the associated risk factors can play an important role in predicting recurrence.

Effect of polyphenol from Cortex Mori on melanogenesis of B16 cells and its mechanism / 中国药理学通报

Aim To investigate the inhibitory effect of polyphenol from Cortex Mori( CMP) on melanogenesis in mouse melanoma B16 cells and its possible mecha- nism. Methods Melanoma B16 cells with high ex-pression melanin were induced by α-melanocyte-stimu-lating hormone ( α-MSH) to establish cell model. Cell viability was detected by MTT assay. The melanin syn-thesis and tyrosinase activity were measured by NaOH and L-Dopa assays, respectively. The tyrosinase (TYR), tyrosinase-related protein-1 (TRP-1), tyrosi-nase-related protein-2 ( TRP-2 ) and microphthalmia associated transcription factor ( MITF ) protein and mRNA levels were measured by Western blot and qRT-PCR, respectively. Results CMP could inhibit the melanin synthesis and tyrosinase activity in α-MSH stimulated B16 cells in a dose-dependent manner ( P<0.05) . The melanin content and tyrosinase activity significantly decreased by 52.95% , 32.85% at 20 mg ·L-1of CMP, respectively. Treatment of 100 mg· L-1of arbutin reduced the melanin content and tyrosi- nase activity by 17.29% , 16.75% , respectively. Based on the results of this study, CMP showed a stronger anti-melanogenesis activity than that of positive control arbutin. After treated by CMP, the protein and mRNA levels of TYR, TRP-1, TRP-2 and MITF were significantly inhibited compared to the α-MSH group ( P<0.05) . Conclusions CMP could suppress the melanogenesis in α-MSH stimulated B16 cells, and its mechanism may be related to its regulation of the pro-tein and mRNA expressions of TYR, TRP-1, TRP-2 and MITF, and the inhibition of tyrosinase activity.

Factors Influencing Posttraumatic Growth in Cancer Survivors

PURPOSE: The purpose of this study was to identify the level of post-traumatic growth (PTG) and the factors affecting the PTG of cancer survivors. METHODS: Data were collected from 147 cancer patients who were admitted to hospital to two hospitals, P and B city during July and September, 2017 using the PTG Inventory, Multidimensional Scale Perceived Social Support, Event-Related Rumination Inventory, Korean Cancer Coping Questionnaire, Resilience Scale, and Self-Esteem Scale. Data were analyzed using t-tests, ANOVA, Pearson-correlation coefficient, and multiple regression. RESULTS: The mean score for PTG in cancer survivors was 3.20 points. PTG had significant correlation with social support, deliberate rumination, coping, and resilience. Factors that had an influence on PTG in multiple regression were social support (β=0.25, p<001), personal coping (β=0.22, p=.008), resilience (β=0.21, p=.006), recognizing the need for religion (β=0.17, p=.015), religion (β=0.17 p=.011), and deliberate rumination (β=.15, p=.022). These factors explained 60.0% of the variance in the PTG of cancer patients. CONCLUSION: In order to effectively promote PTG of cancer survivors, it is necessary to develop and apply programs that can improve social support, coping (personal), resilience, religion, and deliberate rumination.

Validation of Herpes Zoster Diagnosis Code in the Electronic Medical Record: A Retrospective, Multicenter Study

No abstract available.

Repeated Glucose Deprivation/Reperfusion Induced PC-12 Cell Death through the Involvement of FOXO Transcription Factor

BACKGROUND: Cognitive impairment and brain damage in diabetes is suggested to be associated with hypoglycemia. The mechanisms of hypoglycemia-induced neural death and apoptosis are not clear and reperfusion injury may be involved. Recent studies show that glucose deprivation/reperfusion induced more neuronal cell death than glucose deprivation itself. The forkhead box O (FOXO) transcription factors are implicated in the regulation of cell apoptosis and survival, but their role in neuronal cells remains unclear. We examined the role of FOXO transcription factors and the involvement of the phosphatidylinositol 3-kinase (PI3K)/Akt and apoptosis-related signaling pathways in PC-12 cells exposed to repeated glucose deprivation/reperfusion. METHODS: PC-12 cells were exposed to control (Dulbecco's Modified Eagle Medium [DMEM] containing 25 mM glucose) or glucose deprivation/reperfusion (DMEM with 0 mM glucose for 6 hours and then DMEM with 25 mM glucose for 18 hours) for 5 days. MTT assay and Western blot analysis were performed for cell viability, apoptosis, and the expression of survival signaling pathways. FOXO3/4',6-diamidino-2-phenylindole staining was done to ascertain the involvement of FOXO transcription factors in glucose deprivation/reperfusion conditions. RESULTS: Compared to PC-12 cells not exposed to hypoglycemia, cells exposed to glucose deprivation/reperfusion showed a reduction of cell viability, decreased expression of phosphorylated Akt and Bcl-2, and an increase of cleaved caspase-3 expression. Of note, FOXO3 protein was localized in the nuclei of glucose deprivation/reperfusion cells but not in the control cells. CONCLUSION: Repeated glucose deprivation/reperfusion caused the neuronal cell death. Activated FOXO3 via the PI3K/Akt pathway in repeated glucose deprivation/reperfusion was involved in genes related to apoptosis.

Co-Culture of alpha TC-6 Cells and beta TC-1 Cells: Morphology and Function

BACKGROUND: In vitro experiments using only beta-cell lines instead of islets are limited because pancreatic islets are composed of four different types of endocrine cells. Several recent studies have focused on cellular interactions among these cell types, especially alpha- and beta-cells. Because islet isolation needs time and experience, we tested a simple co-culture system with alpha- and beta-cells. Their morphology and function were assessed by comparison to each single cell culture and pancreatic islets. METHODS: alpha TC-6 cells and beta TC-1 cells were maintained in Dulbecco's Minimal Essential Medium containing 5 mM glucose and 10% fetal bovine serum. Cells were mixed at a 1:1 ratio (5x10(5)) in 6-well plates and cultured for 24, 48, and 72 hours. After culture, cells were used for insulin and glucagon immunoassays and tested for glucose-stimulated insulin secretion (GSIS). RESULTS: alpha TC-6 and beta TC-1 cells became condensed by 24 hours and were more strongly compacted after 48 hours. beta TC-1 cells showed both beta-beta and beta-alpha cell contacts. GSIS increased with increasing glucose concentration in co-cultured cells, which showed lower secreted insulin levels than beta TC-1 cells alone. The increase in the secreted insulin/insulin content ratio was significantly lower for co-cultured cells than for beta-cells alone (P=0.04). Compared to islets, the alpha-/beta-cell co-culture showed a higher ratio of GSIS to insulin content, but the difference was not statistically significant (P=0.09). CONCLUSION: alpha TC-6 and beta TC-1 cells in the co-culture system showed cell-to-cell contacts and a similar stimulated insulin secretion pattern to islets. The co-culture system may be used to better mimic pancreatic islets in in vitro assessments.

Functional Listening Performance of Children with Sequential Bilateral Cochlear Implantation in Daily Life / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to identify whether the sequential bilateral cochlear implantation in children with a long inter-implant interval provides functional benefits in everyday situation. SUBJECTS AND METHOD: Seventeen children with sequential bilateral cochlear implants (BiCIs) (mean age at first implantation, 2.6 years; mean age at second implantation, 8.5 years; mean inter-implant interval, 6.0 years) and 17 children with unilateral cochlear implants (UniCIs) were included in this study. The questionnaire SSQ (The Speech, Spatial, and Qualities of hearing scale for parents of children with impaired hearing, Galvin, 2007) was used to evaluate the performance of two groups by individually interviewing the parents of the subjects. For the BiCIs, anecdotal reports of the performance in everyday listening situation and device use were also collected in interviews. RESULTS: The BiCI group showed significantly better performance in all three areas (speech perception, spatial hearing, and other qualities of hearing) of the SSQ than did the UniCI group. The differences between the two groups were significantly larger in performance on 'spatial hearing' and 'other qualities of hearing' than on 'speech perception'. All subjects with bilateral cochlear implants had a positive attitude on bilateral hearing. Anecdotal reports indicated that bilateral hearing has positive effects such as reduced repeated questions, increased participation in conversation, facilitated language and learning acquisition, and improved concentration. CONCLUSION: Children who received sequential bilateral cochlear implantation with a long inter-implant interval could obtain functional benefits in daily life. Also it turned out that these benefits have positive effects on children's communication, language, learning, and socio-emotional areas.

Population-Based Study of the Epidemiology of Herpes Zoster in Korea

General epidemiological data regarding herpes zoster (HZ) are necessary for treatment and prevention of this disease. In addition, epidemiological data can play an important role in evaluating the efficacy and impact of vaccination. Though several epidemiological studies of HZ in Korea have been conducted, they usually depend on hospital-based data and may not be representative of HZ characteristics all over Korea. The purpose of this study was to evaluate the incidence and other epidemiological features of HZ in the general Korean population. We used population-based medical records from the Health Insurance Review & Assessment Service, which includes 50,908,646 medical insurance subscribers, to calculate the incidence of HZ. Also, we analyzed an age-stratified random sample of 1,375,842 individuals to study descriptive epidemiologic characteristics of HZ in Korea in 2011. We observed that the incidence of HZ was 10.4 per 1,000 person-years and was strongly correlated with age. Sex had a major influence on HZ incidence; overall, there were 12.6 cases per 1,000 person years in women and 8.3 cases per 1,000 person years in men. There was no difference in incidence according to the locality and season.

A1c Variability Can Predict Coronary Artery Disease in Patients with Type 2 Diabetes with Mean A1c Levels Greater than 7

BACKGROUND: Recent studies suggested that the association of acute glucose variability and diabetic complications was not consistent, and that A1c variability representing long term glucose fluctuation may be related to coronary atherosclerosis in patients with type 1 diabetes. In this study, we attempt to determine whether or not A1c variability can predict coronary artery disease (CAD) in patients with type 2 diabetes. METHODS: We reviewed data of patients with type 2 diabetes who had undergone coronary angiography (CAG) and had been followed up with for 5 years. The intrapersonal standard deviation (SD) of serially-measured A1c levels adjusted by the different number of assessments among patients (adj-A1c-SD) was considered to be a measure of the variability of A1c. RESULTS: Among the 269 patients, 121 of them had type 2 diabetes with CAD. In patients with A1c > or =7%, the mean A1c levels and A1c levels at the time of CAG among the three groups were significantly different. The ratio of patients with CAD was the highest in the high adj-A1c-SD group and the lowest in the low adj-A1c-SD group (P=0.017). In multiple regression analysis, adj-A1c-SD was an independent predictor for CAD in subjects with A1c > or =7% (odds ratio, 2.140; P=0.036). CONCLUSION: Patients with higher A1c variability for several years showed higher mean A1c levels. A1c variability can be an independent predictor for CAD as seen in angiographs of patients with type 2 diabetes with mean A1c levels over 7%.

A Case of Systemic Lupus Erythematosus with Myelitis and Recurrent Neuromyelitis Optica

Neuromyelitis optica (NMO) is an idiopathic, severe inflammatory demyelinating disease of the central nervous system targeting optic nerves and the spinal cord. It is characterized by acute bilateral visual loss (optic neuritis), acute transverse myelitis, and tends to spare brain early in the disease course. NMO can occur as an isolated condition or secondary to infection, toxin exposure, and autoimmune disease including systemic lupus erythematosus (SLE), sarcoidosis, and Behcet's disease. We experienced a case of SLE with myelitis and recurrent optic neuritis in a 28-year-old woman who presented with recurrent visual disturbance and sudden onset of paraplegia, and report here on this case along with a review of the relevant literature.

Perforated Mitral Valve Aneurysm in the Posterior Leaflet without Infective Endocarditis

Aneurysm of the mitral valve, although uncommon, occurs most commonly in association with infective endocarditis of the aortic valve and true mitral valve aneurysm is a rare cause of mitral regurgitation. We report a case with perforated mitral valve aneurysm in the posterior leaflet without concurrent infective endocarditis initially mistaken diagnosis of cystic mass, which was confirmed at operation with successful mitral valve annuloplasty.

Hypothyroidism with Suspected Ovarian Malignancy: A Case Report / 대한내과학회지

We report a 44-year-old woman with massive ascites, elevated serum carbohydrate antigen 125 (CA 125) concentrations, pericardial effusion, and junctional bradycardia. Ascites caused by hypothyroidism are rare, and the pathogenesis is unclear. The ascitic fluid showed elevated total protein concentrations and a high serum-ascites albumin gradient. The massive ascites and increased serum, ascitic, and pericardial CA 125 concentrations led us to make an incorrect presumptive diagnosis of an ovarian malignancy with metastasis. However, there was no evidence of malignancy except the elevated CA 125 level. Similar to ascites, also junctional escape rhythm with marked bradycardia is a very rare feature of hypothyroidism. Following thyroid hormone replacement, the ascites and serum CA 125 gradually decreased, and the heart rhythm returned to sinus bradycardia. We report this case with a brief review of the literature.

COMP-angiopoietin 1 Gene Transfer Enhances Cutaneous Wound Healing by Promoting Angiogenesis

BACKGROUND: Angiogenesis is crucial for wound healing and exogenous supplements of the angiogenic growth factors have been known to promote cutaneous wound healing. Angiopoietin (Ang) 1 is a recently discovered angiogenic factor and there have been few studies of its effect on cutaneous wound healing. OBJECTIVE: We examined the effect of Ang 1 on cutaneous wound healing. METHODS: Cartilage oligomeric matrix protein (COMP)-Ang 1 (Ade-COMP-Ang 1)- was intravenously injected to rats two days before surgery creating full-thickness wounds. The clinical wound healing rate and the number of vessels in the skin samples were evaluated on days 3, 7 and 14 post operation. RESULTS: At post-operation day 3, 7 and 14, the clinical wound healing rate was 38.3%, 59.4% and 92.1%, respectively, in the Ade-COMP-Ang 1-treated group, compared with 20.5%, 47.5% and 87.3%, respectively, in the Ade-LacZ-treated group. There were significant differences in the results of day 3 and day 7 between two groups (p<0.05). Histopathologically, the number of the vessels of the Ade-COMP-Ang 1-treated group was 73.7, 94.1 and 62.7 at day 3, 7 and 14, compared with that of the Ade-LacZ-treated group, 53.5, 83.9, and 56.9. The differences in the results of the two groups were statistically significant (p<0.05). CONCLUSION: These results indicate that Ade-COMP-Ang 1 therapy significantly accelerats wound healing by promoting angiogenesis. However, further study using Ade-COMP-Ang 1 gene therapy for chronic wounds in which the formation of new blood vessels is impaired is needed in the near future.

A Case of Cutaneous Protothecosis / 대한피부과학회지

Protothecosis is an unusual human infection caused by the achlorophyllic algae Prototheca, and most commonly by Prototheca wickerhamii. A 65-year-old man presented with a 2-month history of a painful, erythematous, non-healing, ulcerative plaque on the extensor surface of his left forearm. He was previously diagnosed with diabetes and iatrogenic Cushing syndrome. A skin biopsy specimen revealed characteristic morula-like sporangia in the dermis by PAS positive staining. Prototheca wickerhamii was identified by culture and biochemical studies. Initially, itraconazole was administered for 8 weeks, followed by fluconazole, and the patient's condition was greatly improved.

A Case of Solitary Superficial Angiomyxoma / 대한피부과학회지

Solitary superficial angiomyxoma gap (SSA), sometimes referred to as solitary cutaneous myxoma, is a relatively uncommon benign myxoid tumor of soft tissue. It is characterized clinically by slowly-growing, asymptomatic nodules on the head, neck, and trunk of adults. It is locally recurrent, but there have been no reports of metastatic spread. Histologically, SSA consists of the conglomerate of moderate-to-sparse cellular angiomyxoid nodules with scattered, small to medium-sized blood vessels in the dermis, frequently involving subcutaneous fat. We herein report a case of SSA which developed in the genital area of an 80-year-old woman.

A Case of Solitary Superficial Angiomyxoma / 대한피부과학회지

Solitary superficial angiomyxoma gap (SSA), sometimes referred to as solitary cutaneous myxoma, is a relatively uncommon benign myxoid tumor of soft tissue. It is characterized clinically by slowly-growing, asymptomatic nodules on the head, neck, and trunk of adults. It is locally recurrent, but there have been no reports of metastatic spread. Histologically, SSA consists of the conglomerate of moderate-to-sparse cellular angiomyxoid nodules with scattered, small to medium-sized blood vessels in the dermis, frequently involving subcutaneous fat. We herein report a case of SSA which developed in the genital area of an 80-year-old woman.

Clinical manifestation and outcome of alagille syndrome in Korea: a study of 30 patients / 소아과

PURPOSE: The purpose of this study was to examine the clinical courses and long-term outcomes of children with Allagille syndrome in Korea, and to evaluate the prognostic potentials of identified variables. METHODS: We reviewed the clinical manifestations and outcomes of 30 children with Alagille syndrome, investigated from 1984 to 2006 until the end of this study (defined as death or last visit; mean follow-up : 5 years). RESULTS: Cholestasis occurred in 100 percent, cardiovascular abnormalities in 83.3 percent, butterfly vertebrae in 30.0 percent, posterior embryotoxon in 43.3 percent, and a characteristic facial appearance in 100 percent. At study conclusion, of these 30 patients, eight had died (26.7 percent); six related to Alagille syndrome. Five patients died of a liver disease complication. Liver transplantation was carried out in five of the 30 patients (16.7 percent) and one of these died due to hyperacute rejection. At age two, cholestasis improved in 17 of the 30 patients. Those who had severe cholestasis at 2 years of age tended to have a complication, such as liver cirrhosis or liver transplantation, or to have died. CONCLUSION: Hepatic complications account for the most mortalities in patients with Alagille syndrome. Careful and complete assessments should be made in children who have cholestasis at 2 years of age. Further investigations of more cases are required.

Clinicopathological Study of Actinic Keratoses in Korea / 대한피부과학회지

BACKGROUND: Actinic keratosis is one of the most common precancerous lesions, and its incidence in Western society has been reported to be up to 40%. However, few clinical and histopathologcial studies of actinic keratosis have been conducted in Korea. OBJECTIVE: The purpose of this study was to investigate clinical and histopathological features of actinic keratosis in Koreans. METHODS: We reviewed the medical records and biopsy specimens of 63 cases previously diagnosed as actinic keratosis at St.Vincents hospital of Catholic Medical Center from January 1999 to June 2003. RESULTS: We were able to compile clinical data and histologic information on 63 cases of actinic keratosis 1. The mean age at diagnosis was 72.6 years, and all the patients were over 50 years old. Actinic kerotosis developed predominantly in females at the sex ratio of 1: 3.8. 2. The disease duration was more than 1 year in 69.8% of patients, and there were few associated cutaneous malignancies, except two basal cell carcinoma. 3. Half of the patients was asymptomatic, however, 34.9% and 15.9% of the patients complained of pruritus and pain, respectively. The lesions were usually solitary, less than 1cm, and erythematous. 4. Actinic keratosis was involved mostly in face, especially cheek, forehead, chin, and nose by decreasing order. 5. Histopathologically, hypertrophic type was noted in 30.2% of the cases, atrophic type in 44.4%, bowenoid type in 19.0%, acantholytic type in 3.2%, and pigmented type in 3.2%. The histopathological scores according to subtype were 5.00(1.76) in hypertrophic type, 3.54(1.82) in atrophic type, and 6.83(1.03) in Bowenoid type. 6. The most common treatment modality was cryotherapy with liquid nitrogen, and surgical resection, electrodessication, and CO2 Laser were also used for the treatment of actinic keratosis. The recurrence was observed in one patient treated by cryotherapy and two patients by electodessication. CONCLUSION: Actinic keratosis in Koreans was precancerous lesion usually present on the face of female patients over 50 years old. Various histopathologic types including hypertrophic, atrophic, Bowenoid, acantholytic and pigmented type were noted, and the most common type was atrophic type. Actinic keratosis could be treated by cryotherapy with liquid nitrogen, surgical resection, eletrodessication and CO2 laser. However, because of the possibility of recurrence, close follow-up is needed.

Rheumatoid Nodules on the Scalp

No abstract available.

Acrodermatitis Enteropathica-like Eruption Associated with Combined Nutritional Deficiency

We present here a case of acrodermatitis enteropathica-like eruption associated with essential free fatty acid and protein deficiencies as well as borderline zinc deficiency that occurred after Whipple's operation in a 31-yr-old woman. Her eruptions were improved not by zinc supplements alone, but her condition was improved by total parenteral nutrition including amino acids, albumin, lipid and zinc. Although we could not exactly decide which of the nutrients contributed the most to her manifestations, we inferred that all three elements in concert caused her dermatoses. This case shows that even though the patient's skin manifestations and laboratory results are suggestive of acrodermatitis enteropathica, the physicians should keep in mind the possibility that this disease can be associated with other nutritional deficiencies such as free fatty acid or protein deficiency.