Stratification of clinical and inflammatory phenotypes according to the urinary leukotriene E4 level in adult asthmatics

Purpose@#Cysteinyl leukotrienes (CysLTs) have been recognized as key mediators associated with type 2 inflammation in the airways of asthmatic patients. CysLTs are associated with airway constriction, eosinophil recruitment/activation, and airway remodeling. The study aimed to understand the role of CysLTs in adult asthmatics in a real-world clinical setting. @*Methods@#One hundred five adult asthmatics who had maintained antiasthmatic medications were enrolled. Asthmatic subjects were classified into 2 groups according to urinary leukotriene E4 (uLTE4) levels, and their clinical parameters and inflammatory mediators, including forced expiratory volume in 1 second (FEV1) %, fractional exhaled nitric oxide (FeNO), blood eosinophil count, serum periostin (sPON), and urinary eosinophil derived neurotoxin (uEDN) were compared between the high-uLTE4 and low-uLTE4 groups. @*Results@#The prevalence of chronic rhinosinusitis (CRS), severe asthma, and aspirin-exacerbated respiratory disease (AERD) were significantly higher in the high-uLTE4 group than in the low-uLTE4 group. The high-uLTE4 group had lower FEV1% and maximal midexpiratory flow %, but higher FeNO levels than the low-uLTE4 group. In addition, blood eosinophil count, sPON, and uEDN levels were significantly higher in the high-uLTE4 group than in the low-uLTE4 group. The presence of AERD and levels of FeNO, sPON, and uEDN were significantly associated with higher uLTE4 levels in asthmatics. @*Conclusion@#CysLTs are associated with type 2 inflammation in the airways of asthmatic patients, contributing to the development of AERD, CRS, and asthma severity. The stratification of clinical phenotypes according to the uLTE4 level could support optimizing anti-inflammatory therapy for better control of asthma.

A Case of Nasopharyngeal Tuberculosis Which Was Difficult to Differentiate From Sarcoidosis / 대한이비인후과학회지

Nasopharyngeal mass is a disease that can cause unilateral or bilateral nasal obstruction. Common diseases that can cause nasal obstruction include antrochoanal polyp, adenoid remnants, juvenile nasopharyngeal angiofibroma, and nasopharyngeal carcinoma. Nasopharyngeal tuberculosis and nasopharyngeal sarcoidosis are two rare diseases that involve the nasopharynx and manifest as nasopharyngeal mass, and they share common histopathologic findings of granulomatous inflammation. We report a case where a patient complaining of nasal obstruction was found with nasopharyngeal mass with smooth surface, which was difficult to differentiate nasopharyngeal tuberculosis from nasopharyngeal sarcoidosis due to similar clinical manifestations and histopathologic findings.

Kikuchi-Fujimoto Disease Masquerading as Bilateral Lymph Node Metastasis in a Patient With Papillary Thyroid Carcinoma: A Case Report and Literature Review / 대한이비인후과학회지

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is common in young Asian women under the age of 30, and is usually characterized by fever, myalgia, fatigue, and cervical lymphadenopathy. Because patients with KFD often present with necrotic lesions that are also features of lymph node metastasis, ipsilateral or bilateral lymph node enlargement in head and neck cancer patients can be disguised as lymph node metastasis. We present an unusual case of KFD mimicking bilateral metastatic papillary carcinoma of the thyroid. This study emphasizes that KFD should be considered when diagnosing lymph nodes with necrotic lesions but without malignant cells in young women.

A Case of Auricular Keloid Resulting from Conchal Cartilage Graft in Asian Rhinoplasty

When planning rhinoplasty, there are several options of grafts for augmentation, especially in relatively short and small Asian noses. Among such grafts, conchal cartilage is one of the most commonly used materials due to its histological similarity to nasal alar cartilage. Keloids and hypertrophic scars are fibroproliferative disorders that can occur after deep cutaneous injury. Since patients who wish to undergo rhinoplasty tend to have a lot of interest in cosmetic appearance, keloid formation can be serious complication to them. This case report presents an 18-year-old man who experienced keloid formation following conchal cartilage graft at 6 months after rhinoplasty. The authors introduce the case and review the considerations in prevention and treatment strategies for keloid scars after conchal cartilage harvest in Asian rhinoplasty.

Effects of Snoezelen Therapy on Stress, Anxiety, Depression, and Quality of Life of College Students with Game Addiction

Purpose@#Despite the existence of Snoezelen method, there is no case of researching the effects on game addiction. Therefore, this study aims to investigate the effects of Snoezelen therapy on stress, depression, anxiety and quality of life of college students who overuse computer games or mobile phone games. @*Methods@#Eight students who responded to spend more than 30 hours of computer or mobile phone games in the selection questionnaire were recruited (The total respondents were 224 students). Students were randomly assigned to either the study group (4 students) or the control group (4 students). Stress (Korean version of Perceived Stress Scale, K-PSS), depression (Korean Screening Tool for Depression Disorders, K-DEP), Anxiety (Korean Beck Anxiety Inventory, K-BAI) and quality of life (Short Form Health Survey version 2 [SF-36]) were assessed three times (before intervention [pre], post-3 weeks [post 1], post-6 weeks [post 2]). @*Results@#First, the study group (-4.75±3.86) and control group (1.00±2.71) showed significant difference (p<0.05) in the analysis of score changes between pre-test and test at 6 weeks (post 2) for K-DEP. Next, pre-test and test at 3 weeks of intervention (post 1) for K-BAI showed significant difference (p<0.05) in the study group (-2.50±1.91) and control group (2.25±2.99). In addition, pre-test and test at 6 weeks (post 2) showed significant difference (p<0.05) for the study group (-3.00±1.51) and control group (4.75±6.24). @*Conclusion@#The study confirmed the possibility of Snoezelen therapy as a therapy method to induce effective responses in stress, depression, anxiety, and quality of life of college students with game addiction.

Management of allergic patients during severe acute respiratory syndrome coronavirus-2 pandemic

A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 in China. The mutated coronavirus spread worldwide, and some patients infected with SARS-CoV-2 developed coronavirus disease 2019 (COVID-19) manifested with upper respiratory infection, pneumonia, or respiratory distress. Since the SARS-CoV-2 pandemic was declared with surging confirmed cases and mortality of COVID-19 worldwide, it has reshaped our way of living and how to manage patients with allergic diseases. The medical staff, including allergy specialists, has been at the forefront of fighting against the SARSCoV-2 pandemic and is struggling to guarantee safety to themselves and their patients. Thanks to vigorous research into the relationship between SARS-CoV-2 and allergic diseases, we have become able to treat allergic patients with the best of evidence to date. The clinician should make a careful decision on each clinical situation with regard to patient characteristics, local and national circumstances as well as the knowledge we have, since it is still limited. We hope further efforts to identify the nature of SARS-CoV-2 and COVID-19 clearer and effective SARS-CoV-2 vaccination will soon remove the grim picture of the worldwide pandemic and bring us back to normal.

Recent update on the management of anaphylaxis

Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.

Do Patients Maintain Proper Long-Term Cardiopulmonary Fitness Levels After Cardiac Rehabilitation? A Retrospective Study Using Medical Records

Objective@#To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community. @*Methods@#We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home. @*Results@#No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO2max) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO2max at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years. @*Conclusion@#Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.

A Case of Auricular Keloid Resulting from Conchal Cartilage Graft in Asian Rhinoplasty

When planning rhinoplasty, there are several options of grafts for augmentation, especially in relatively short and small Asian noses. Among such grafts, conchal cartilage is one of the most commonly used materials due to its histological similarity to nasal alar cartilage. Keloids and hypertrophic scars are fibroproliferative disorders that can occur after deep cutaneous injury. Since patients who wish to undergo rhinoplasty tend to have a lot of interest in cosmetic appearance, keloid formation can be serious complication to them. This case report presents an 18-year-old man who experienced keloid formation following conchal cartilage graft at 6 months after rhinoplasty. The authors introduce the case and review the considerations in prevention and treatment strategies for keloid scars after conchal cartilage harvest in Asian rhinoplasty.

Effects of Snoezelen Therapy on Stress, Anxiety, Depression, and Quality of Life of College Students with Game Addiction

Purpose@#Despite the existence of Snoezelen method, there is no case of researching the effects on game addiction. Therefore, this study aims to investigate the effects of Snoezelen therapy on stress, depression, anxiety and quality of life of college students who overuse computer games or mobile phone games. @*Methods@#Eight students who responded to spend more than 30 hours of computer or mobile phone games in the selection questionnaire were recruited (The total respondents were 224 students). Students were randomly assigned to either the study group (4 students) or the control group (4 students). Stress (Korean version of Perceived Stress Scale, K-PSS), depression (Korean Screening Tool for Depression Disorders, K-DEP), Anxiety (Korean Beck Anxiety Inventory, K-BAI) and quality of life (Short Form Health Survey version 2 [SF-36]) were assessed three times (before intervention [pre], post-3 weeks [post 1], post-6 weeks [post 2]). @*Results@#First, the study group (-4.75±3.86) and control group (1.00±2.71) showed significant difference (p<0.05) in the analysis of score changes between pre-test and test at 6 weeks (post 2) for K-DEP. Next, pre-test and test at 3 weeks of intervention (post 1) for K-BAI showed significant difference (p<0.05) in the study group (-2.50±1.91) and control group (2.25±2.99). In addition, pre-test and test at 6 weeks (post 2) showed significant difference (p<0.05) for the study group (-3.00±1.51) and control group (4.75±6.24). @*Conclusion@#The study confirmed the possibility of Snoezelen therapy as a therapy method to induce effective responses in stress, depression, anxiety, and quality of life of college students with game addiction.

Recent update on the management of anaphylaxis

Anaphylaxis is a life-threatening systemic allergic reaction presenting various clinical manifestations. Its prevalence has increased in almost all age groups and both sexes. Food, venom, and drugs are major causes in both children and adults; a higher prevalence of food-induced anaphylaxis is noted in children, while a higher prevalence of drug-induced anaphylaxis is noted in adults. The pathogenic mechanism is mediated by immunologic and nonimmunologic mechanisms, where mast cells and basophils are key cells that release mediators. A diagnosis of anaphylaxis is mainly based on clinical symptoms and physical findings; however, an increased serum tryptase level is a useful biomarker. Epinephrine is the first-line drug to treat acute symptoms, and an epinephrine auto-injector should be prescribed for each patient. Antihistamines and systemic corticosteroids are used to relieve symptoms. This review updates current issues in the management of anaphylaxis as well as the new guidelines for proper diagnosis and treatment.

Do Patients Maintain Proper Long-Term Cardiopulmonary Fitness Levels After Cardiac Rehabilitation? A Retrospective Study Using Medical Records

Objective@#To examine whether patients who participated in a cardiac rehabilitation (CR) program after hospitalization for acute coronary syndrome maintained cardiorespiratory fitness (CRF) in the community. @*Methods@#We conducted a retrospective study including 78 patients who underwent percutaneous coronary intervention or coronary artery bypass graft surgery at our hospital’s cardiovascular center and participated in a CR program and a 5-year follow-up evaluation. Patients were divided into a center-based CR (CBCR) group, participating in an electrocardiography-monitored exercise training in a hospital setting, and a home-based CR (HBCR) group, receiving aerobic exercise training and performed self-exercise at home. @*Results@#No significant differences were found between groups (p>0.05), except the proportion of non-smokers (CBCR 59.5% vs. HBCR 31.7%; p=0.01). In both groups, the maximal oxygen consumption (VO2max) increased significantly during the first 12 weeks of follow-up and remained at a steady state for the first year, but it decreased after the 1-year follow-up. Particularly, VO2max at 5 years decreased below the baseline value in the HBCR group. In the low CRF group, the CRF level significantly improved at 12 weeks, peaked at 1 year, and was still significantly different from the baseline value after 5 years. The high CRF group did not show any significant increase over time relative to the baseline value, but most patients in the high CRF group maintained relatively appropriate CRF levels after 5 years. @*Conclusion@#Continuous support should be provided to patients to maintain optimal CRF levels after completing a CR program.

Effects of Slime Program on Hand Function and Problem Behavior of Adults with Intellectual Disabilities

Purpose@#This study examined the effects of training using the slime on the hand function and problem behavior in adults with intellectual disabilities. @*Methods@#Five adults with intellectual disabilities who were judged as Level 1 or Level 2 were selected. The training consisted of one session (50 min)/day, one day/week for 10 weeks (preparatory activities: 5 min, slime activities: 40 min, finishing activities: 5 min) The functions of the hand (Purdue Pegboard Test [PPT], grip strength test [GST]) and problem behavior (Korean Behavior Problems Inventory [K-BPI]) were assessed three times (first assessment; pre, second assessment; post-5 weeks, third assessment; post-10 weeks). Wilcoxon signed-rank tests were used to analyze changes in the subjects’ performance before and after the intervention. @*Results@#In the PPT, the use of the non-dominant hand was increased significantly (p<0.05). No significant differences were observed in the remaining results, but the mean value increased. In addition, although the problem behavior was not statistically significant, an increase in the problem behavior score was noted. @*Conclusion@#The training using the slime for adults with intellectual disabilities is effective in hand function improvement and reducing problem behavior.

Can manipulation under anesthesia alone provide clinical outcomes similar to arthroscopic circumferential capsular release in primary frozen shoulder (FS)?: the necessity of arthroscopic capsular release in primary FS

Background@#We evaluated the need for arthroscopic capsular release (ACR) in refractory primary frozen shoulder (FS) by comparing clinical outcomes of patients treated with ACR and manipulation under anesthesia (MUA). @*Methods@#We assessed patients with refractory primary FS, 54 patients (group A) who were treated with MUA and 22 patients (group B) who were treated with ACR. In group A, manipulation including a backside arm-curl maneuver was performed under interscalene brachial block. In group B, manipulation was performed only to release the inferior capsule before arthroscopic circumferential capsular release, which was carried out for the unreleased capsule after manipulation. Pain, range of shoulder motion, and American Shoulder and Elbow Society score were recorded at 1 week, 3 months, 6 months, and 1 year after surgery. We compared outcome variables between treatment groups and between diabetics and non-diabetics and also evaluated the numbers of patients receiving additional intra-articular steroid injection. @*Results@#Outcome variables at 3 months after surgery and improvements in outcome variables did not differ between groups. Group A showed significantly better results than group B in the evaluation of pain and range of motion at 1 week. Diabetics showed comparable outcomes to non-diabetics for most variables. Eleven patients required additional steroid injections between 8 to 16 weeks after surgery: 12.2% in group A, 18.2% in group B. Additional injections were given three times more often in diabetics compared to non-diabetics. @*Conclusions@#MUA alone can yield similar clinical outcomes to ACR in refractory FS.

Can manipulation under anesthesia alone provide clinical outcomes similar to arthroscopic circumferential capsular release in primary frozen shoulder (FS)?: the necessity of arthroscopic capsular release in primary FS

Background@#We evaluated the need for arthroscopic capsular release (ACR) in refractory primary frozen shoulder (FS) by comparing clinical outcomes of patients treated with ACR and manipulation under anesthesia (MUA). @*Methods@#We assessed patients with refractory primary FS, 54 patients (group A) who were treated with MUA and 22 patients (group B) who were treated with ACR. In group A, manipulation including a backside arm-curl maneuver was performed under interscalene brachial block. In group B, manipulation was performed only to release the inferior capsule before arthroscopic circumferential capsular release, which was carried out for the unreleased capsule after manipulation. Pain, range of shoulder motion, and American Shoulder and Elbow Society score were recorded at 1 week, 3 months, 6 months, and 1 year after surgery. We compared outcome variables between treatment groups and between diabetics and non-diabetics and also evaluated the numbers of patients receiving additional intra-articular steroid injection. @*Results@#Outcome variables at 3 months after surgery and improvements in outcome variables did not differ between groups. Group A showed significantly better results than group B in the evaluation of pain and range of motion at 1 week. Diabetics showed comparable outcomes to non-diabetics for most variables. Eleven patients required additional steroid injections between 8 to 16 weeks after surgery: 12.2% in group A, 18.2% in group B. Additional injections were given three times more often in diabetics compared to non-diabetics. @*Conclusions@#MUA alone can yield similar clinical outcomes to ACR in refractory FS.

Effects of Slime Program on Hand Function and Problem Behavior of Adults with Intellectual Disabilities

Purpose@#This study examined the effects of training using the slime on the hand function and problem behavior in adults with intellectual disabilities. @*Methods@#Five adults with intellectual disabilities who were judged as Level 1 or Level 2 were selected. The training consisted of one session (50 min)/day, one day/week for 10 weeks (preparatory activities: 5 min, slime activities: 40 min, finishing activities: 5 min) The functions of the hand (Purdue Pegboard Test [PPT], grip strength test [GST]) and problem behavior (Korean Behavior Problems Inventory [K-BPI]) were assessed three times (first assessment; pre, second assessment; post-5 weeks, third assessment; post-10 weeks). Wilcoxon signed-rank tests were used to analyze changes in the subjects’ performance before and after the intervention. @*Results@#In the PPT, the use of the non-dominant hand was increased significantly (p<0.05). No significant differences were observed in the remaining results, but the mean value increased. In addition, although the problem behavior was not statistically significant, an increase in the problem behavior score was noted. @*Conclusion@#The training using the slime for adults with intellectual disabilities is effective in hand function improvement and reducing problem behavior.

Flexor Carpi Radialis Tendon Rupture due to Repetitive Golf Swing

Flexor carpi radialis (FCR) muscle is located in the forearm anteriorly that runs through a synovial fibro-osseous tunnel in the forearm. We described a case of FCR tendon rupture due to repetitive overuse injury. A 55-year-old man, right-hand dominant, presented with right forearm pain and swelling which started 3 days ago while playing amateur golf. Focal tenderness and bruising over volo-ulnar region of the right forearm were examined. Plain radiographs showed soft tissue edema around lesion area and no detectable fracture. Ultrasonography showed multiple hypoechoic lesions suspected as hematoma of the flexor muscle group. After done magnetic resonance imaging, he was diagnosed with rupture of FCR tendon at proximal origin and strain of flexor digitorum superficialis and palmaris longus muscle. He received compressive dressing and restriction of wrist range of motion for three weeks. Two months later, remaining traces of lesions were observed at the follow-up ultrasonography and the pain disappeared.

Study on the Usage of Acne Patches in Patients with Acne / 대한피부과학회지

BACKGROUND: Patients with acne are at risk of using various over-the-counter drugs (OTCs). In addition, several OTCs are introduced in pharmacies in Korea. However, only few drugs are supported by well-established data. Among the treatments, acne patches are easy to purchase and use. Thus, they are widely used by patients. OBJECTIVE: This study aimed to investigate the patient's perception and usage of acne patches. METHODS: A questionnaire survey was conducted on 80 patients with acne who visited the outpatient department of the National Medical Center for 2 months. RESULTS: A total of 42 (52.5%) patients answered that they had used acne patches, and 38 (47.5%) patients stated that they had never used patches. Moreover, 27 (64.29%) patients responded that they used the patches on inflammatory lesions. Moreover, several patients were using acne patches after pricking themselves. There was only one response to confirm the ingredient when purchasing acne patch. Moreover, 14 (33.33%) participants responded that they noted side effects after using acne patches. Overall, the satisfaction score for the use of acne patches was 5.05. CONCLUSION: Patients often use acne patches because they can be easily purchased and used. However, they do not know how to properly choose and use the product that fits their skin. Therefore, doctors must educate patients on how to properly select and use the products.

Kearns-sayre Syndrome Treated with Permanent Pacemaker Insertion for Complete Atrioventricular Block / 고신대학교의과대학학술지

Kearns-Sayre syndrome (KSS) is a rare multisystem mitochondrial disorder associated with progressive external ophthalmoplegia, atypical pigmentary degeneration of the retina, and complete heart block. KSS can lead to a risk of sudden death because of the potential progression of conduction abnormalities such as right or left bundle branch block or complete atrioventricular (AV) block. Here we describe the case of a KSS patient with type I diabetes who experienced syncope in the presence of complete AV block, confirmed by muscular biopsy.

Status of Occupational Therapists on Unilateral Neglect Test Tools Usage and Symptom Classification

PURPOSE: The aim of this study was to investigate the current status of the use of neglect test tools and the awareness for egocentric neglect (EN) and allocentric neglect (AN). METHODS: A survey questionnaire was distributed to occupational therapists attending continuing education at the Daegu-Gyeongbuk branch on April 16. A total 143 responses were collected, and with the exception of 5 incomplete responses, 138 of them were analyzed. RESULTS: The most commonly used unilateral neglect test tools were the line bisection test (86 responses, 62.3%), cancellation test (35 responses, 25.4%), copy and drawing test (7 responses, 5.1%). In a follow-up survey of 86 respondents who used line bisection tests as the most commonly used test, the majority (82 responses, 95.3%2) were found to use the 20-line test paper. In question about the familiarity and education experience for test manual, only 20 responses (23.2%) and 3 responses (3.5%) answered ‘Yes’. In a question about the experience of a manual and the article for the manual, 25 responses (29.1%) answered ‘Yes’. In the question regarding the separation of EN and AN on the unilateral neglect test, 44 responses (31.9%) were ‘distinction’ and 94 responses (68.1%) were ‘no distinction’. CONCLUSION: Information on the guidance and interpretation of the line bisection test is lacking and the concept of EN and AN was insufficient.