Assessment of Punch Elevation Efficacy in Atrophic Scars with Unsatisfactory Results Following Prior Laser Treatment Using Three-Dimensional Image Analysis / 대한피부과학회지

Background@#Various treatments exist for addressing volume loss in atrophic scars. Although laser therapy has gained traction in treating atrophic scars, it is associated with side effects, such as post-inflammatory hyperpigmentation or erythema. Additionally, not all types of atrophic scars respond optimally to laser therapy, even after multiple sessions. @*Objective@#This study aimed to evaluate the efficacy and safety of punch elevation for atrophic scars that yielded unsatisfactory outcomes after repeated laser treatment sessions. @*Methods@#Seven patients with atrophic scars on their facial area underwent punch elevation, concurrently supplemented by fractional CO2 laser application to the scar margins. Improvement in volume restoration of atrophic scars was assessed via investigator evaluation and 3-dimensional (3D) image analysis. @*Results@#After 1 month, median volume (interquartile range) of depression improved from 4.39 mm3 (2.23∼9.90 mm3 ) to 1.97 mm3 (1.46∼7.50 mm3 ), indicating a statistically significant difference post-punch elevation (p=0.018). No serious adverse events were reported during follow-up. @*Conclusion@#The efficacy of the punch elevation was objectively evaluated. Punch elevation is a safe and effective therapeutic avenue for atrophic scars that exhibit resistance to laser or alternative interventions.

Current Status of Q Fever and the Challenge of Outbreak Preparedness in Korea: One Health Approach to Zoonoses

Human Q fever, a zoonosis caused by Coxiella burnetii, presents with diverse clinical manifestations ranging from mild self-limited febrile illnesses to life-threatening complications such as endocarditis or vascular infection. Although acute Q fever is a benign illness with a low mortality rate, a large-scale outbreak of Q fever in the Netherlands led to concerns about the possibility of blood transfusion-related transmission or obstetric complications in pregnant women. Furthermore, a small minority (< 5%) of patients with asymptomatic or symptomatic infection progress to chronic Q fever. Chronic Q fever is fatal in 5–50% of patients if left untreated. In South Korea, Q fever in humans was designated as a notifiable infectious disease in 2006, and the number of Q fever cases has increased sharply since 2015. Nonetheless, it is still considered a neglected and under-recognized infectious disease. In this review, recent trends of human and animal Q fever in South Korea, and public health concerns regarding Q fever outbreaks are reviewed, and we consider how a One Health approach could be applied as a preventive measure to prepare for zoonotic Q fever outbreaks.

Removal of an intraosseous hemangioma of the frontal bone through an anterior hairline incision: a case report

An intraosseous hemangioma of the frontal bone is typically removed via a coronal incision. This procedure, while effective, can be lengthy and may result in complications such as a prominent scar and hair loss. An alternative approach involves a direct incision in the forehead, which leaves a less noticeable scar and allows a quicker recovery. However, in this specific case, the patient declined both coronal surgery and surgery through a direct forehead incision due to cosmetic concerns. Therefore, we proposed an anterior hairline incision. A 35-year-old woman presented with a firm, non-mobile, palpable mass on her right forehead. Preoperative non-contrast computed tomography revealed a heterogeneous osteolytic lesion. We performed an excisional biopsy through the anterior hairline. Postoperative non-contrast computed tomography was conducted 2 and 6 months after surgery. The wound was clean and free of complications, and there was no local recurrence. Partial resection can reduce scarring for patients who are concerned about cosmetic outcomes. However, the potential for recurrence remains a significant concern. We present this case of an anterior hairline incision for a hemangioma located in the forehead, evaluated using serial computed tomography for both preoperative and postoperative imaging.

Micropipette tip intubation in rats as a replacement for conventional endotracheal tube intubation

Endotracheal intubation is often necessary in the course of animal experiments, especially in craniofacial surgery. However, endotracheal intubation can be a major burden in this context. The authors performed simple and cost-saving method using a 200 μL yellow micropipette tip, and the success of this method was demonstrated by X-ray and autopsy. We used a total of 30 rats. After the rats were fixed with a plaster, the trachea and vocal cords were visualized with the tongue pulled back. Under direct visualization of the vocal cords, a curving micropipette tip was advanced into the trachea. This method can be learned quickly and applied successfully by general experimenters. We successfully intubated all 30 rats without any complications. The success rate of micropipette tip intubation was 100%. This procedure was performed by one experimenter within 2 to 3 minutes after induction of anesthesia. We demonstrated its superiority by X-ray and autopsy. Herein, we describe endotracheal intubation of rats using micropipette tips. To the best of our knowledge, this method is novel and represents the simplest and most efficient means of intubation in rats, providing an alternative to conventional endotracheal intubation.

Rabbit model for the study of nasal tip plasty: a comparative cephalometric analysis after rhinoplasty

Background@#Open rhinoplasty and septoplasty have emerged as popular surgical techniques for both functional and aesthetic procedures. To study open rhinoplasty with or without septoplasty, the use of animals is necessary. However, no reports have been published on radiologic methods for evaluating rhinoplasty or nasal tip plasty in animals using cephalometry. In this study, a validated model of open rhinoplasty and septoplasty was utilized in rabbits to establish radiographic guidelines for assessing the degree of tip plasty in these animals. @*Methods@#Eight adult New Zealand rabbits were used to establish an autologous septal extension graft (SEG) model. The rabbits underwent concurrent submucosal septal resection and open rhinoplasty. The SEG was implanted using nasal septal cartilage. To evaluate the results of nasal tip plasty, lateral-view X-ray images were obtained preoperatively, as well as 2 days, 2 months, and 12 months postoperatively. @*Results@#This open rhinoplasty rabbit model appears to be a practical tool for studying open rhinoplasty and tip plasty, demonstrating statistically significant results following SEG implantation. Furthermore, it is suitable for training purposes, specifically for the submucosal resection of septal cartilage. @*Conclusions@#This study presents a statistical analysis of the long-term (1-year) postoperative results of SEG implantation, using experimental procedures like those utilized in humans. Through a cephalometric comparison of rabbit noses, the effect of various SEG and tip plasty methods on the rabbit nose can be objectively measured.

A Case of Cowden Syndrome Presenting with Diverse Cutaneous Manifestations

Cowden syndrome is caused by mutations in the phosphatase and tensin homolog (PTEN) gene and is part of the PTEN hamartoma tumor syndrome. Skin lesions including trichilemmomas, acral keratosis, mucocunateous neuromas and oral paillomas are the most prevalent feature found in patients with Cowden syndrome. It also possesses an increased risk of developing malignancies including breast, thyroid, endometrial, and colorectal cancers.Due to the increased risk of cancer, early diagnosis and regular surveillance are important for Cowden syndrome patients. Herein, we report a case of Cowden syndrome with diverse cutaneous manifestations and thyroid cancer.

A cohort study of incidence of club drug abuse in men who have sex with men in Qingdao / 中华流行病学杂志

Objective: To understand and analyze the incidence of club drug abuse and influencing factors in men who have sex with men (MSM) in Qingdao, and provide reference for the AIDS prevention and intervention in this population. Methods: From March 2017 to July 31, 2022, MSM who did not abuse club drug were recruited by snowball sampling of MSM social organizations in Qingdao, a prospective cohort was established, and a follow-up survey was conducted every 6 months. The survey collected the information about the MSM's demographic characteristics, sexual characteristics, club drug abuse and others. The incidence of club drug abuse was the outcome dependent variable and the interval between the recruitment into the cohort and the incidence of club drug abuse was the time dependent variable. Cox regression analysis was conducted to identify the influencing factors for club drug abuse. Results: A total of 509 MSM were recruited at baseline survey, and 369 eligible MSM were enrolled in this cohort. A total of 62 MSM began to abuse club drug during the study period, and the cumulative follow-up time was 911.54 person-years, the incidence of club drug abuse was 6.80/100 person-years. All the club drug abusers shared drugs with others in the first club drug abuse, and 16.13% (10/62) had mix-use of club drugs. The multivariate Cox proportional risk regression analysis showed that being students (aHR=2.17, 95%CI: 1.15-4.10), receiving no HIV testing or receiving 1 HIV testing during past 6 months (aHR=4.57, 95%CI:1.80-11.60; aHR=5.15, 95%CI: 2.83-9.36), having sex only with regular sexual partners during past 6 months (aHR=4.75,95%CI:2.32-9.75), having more than 4 homosexual partners (aHR=1.70, 95%CI:1.01-2.87) and abuse of club drug of sexual partners during past 6 months (aHR=12.78, 95%CI:3.06-53.35) were significantly associated with club drug abuse in the MSM. Conclusions: The incidence of club drug abuse was at a high level in the MSM cohort in Qingdao, indicating a high risk for HIV infection. Being student, receiving less HIV testing, having sex only with regular sexual partners, having more homosexual partners and abuse of club drug of sexual partners during past 6 months were risk factors for the incidence of club drug abuse in the MSM. Targeted surveillance and intervention measures should be strengthened to reduce the risk of club drug abuse in MSM.

HIV self-testing and related factors in men who have sex with men in Shijiazhuang / 中华流行病学杂志

Objective: To understand HIV self-testing and related factors in men who have sex with men (MSM) in Shijiazhuang. Methods: From August to September 2020, convenient sampling was used to recruit MSM in Shijiazhuang. Online questionnaires were used to collect information about their demographic characteristics, sexual behaviors and HIV self-testing. logistic regression model was used to analyze the related factors associated with HIV self-testing. Results: In the 304 MSM respondents, 52.3% (159/304) had HIV self-testing in the past 6 months, and 95.0% (151/159) used fingertip blood HIV detection reagent. Self-purchase was the main way to obtain HIV testing reagents (45.9%, 73/159), followed by supply from MSM social organization (44.7%, 71/159). The reasons for having HIV self-testing were non-specific testing time (67.9%, 108/159) and privacy protection (62.9%,100/159), the reasons for having no HIV self-testing included inability of using (32.4%, 47/145), being unaware of HIV self-testing reagent (24.1%, 35/145), and worry about inaccurate self-testing results (19.3%, 28/145). Multivariate logistic regression analysis showed that being 18-29 years old (aOR=2.68, 95%CI: 1.20-5.94), obtaining free HIV self-testing kits in recent 6 months (aOR=8.61, 95%CI: 4.09-18.11) and making friends through Internet and social software (aOR=2.68, 95%CI: 1.48-4.88) were positive factors for having HIV self-testing. Conclusion: HIV self-testing is a more flexible and convenient way to detect HIV in MSM, and the promotion of HIV self-testing in MSM should be strengthened to further increase the HIV detection rate in this population.

Progress in research on HIV self-testing and associated factors among men who have sex with men in China / 中华流行病学杂志

HIV testing is the first step in HIV prevention and control, the rate of HIV infection is high and the rate of HIV testing is low among men who have sex with men (MSM) in China. HIV self-testing provides MSM with a new choice and plays a vital role in expanding the coverage of HIV testing in this population. This paper reviews HIV self-testing and associated factors among MSM in China and provides a reference for promoting HIV self-testing in this population.

Reversible Gait Disturbance Due to Vitamin B12 Deficiency

Vitamin B12 deficiency causes a variety of symptoms in the hematologic, gastrointestinal tract, and neurologic deficit. We report a rare case of progressive gait disturbance, bradykinesia and dysarthria which was that vitamin B12 deficiency was diagnosed as the cause, and symptoms improved after intramuscular cobalamin treatment. Vitamin B12, homocysteine, and methylmalonic acid tests are recommended for patients with progressive gait disturbance, even in the absence of obvious anemia symptoms.

Application and progress of capture-recapture method in population size estimation / 中华流行病学杂志

Capture-recapture method is an economical and straightforward method widely used in fields such as estimating population size and estimating and adjusting incidence or prevalence. This paper reviews the classical capture-recapture method and its improvement and application in population size estimation in referring the subsequent related work.

Progress on application of spatial epidemiology in HIV/AIDS control and prevention / 中华流行病学杂志

Spatial epidemiology focuses on the use of geographic information systems and spatial analysis to study spatial distribution and change tendency of diseases and explore the health status of specific populations. In recent years, spatial epidemiology has been applied in the field of HIV/AIDS prevention and control. This review summarizes the progress in the application of spatial epidemiology in the analysis of spatiotemporal distribution, non-monitoring area data estimation, influencing factors of AIDS and health resource allocation and utilization to provide reference for its application in the prevention and control of AIDS in the future.

A review of global and domestic HIV epidemic estimation / 中华流行病学杂志

Due to the latent characteristics of HIV infection, exceptionality of HIV high-risk population, social discrimination and insufficient awareness of AIDS prevention, timely testing and diagnosis of HIV infection is still a challenge worldwide. Until recently, it is difficult to exactly understand the overall HIV epidemic only using routine surveillance data. Therefore, epidemiological and statistical modeling is widely used to address this issue. Almost at the same time when AIDS was firstly discovered firstly, scientists also began to study the methods for the estimation and prediction of HIV infection epidemic. This article summarizes the development of global and domestic HIV epidemic estimation for the further understanding of its current performance and methods applied to provide reference for the future work.

Eosinophil-mediated lung inflammation associated with elevated natural killer T cell response in COVID-19 patients

Background/Aims@#Coronavirus disease 2019 (COVID-19) is associated with acute respiratory syndrome. The mechanisms underlying the different degrees of pneumonia severity in patients with COVID-19 remain elusive. This study provides evidence that COVID-19 is associated with eosinophil-mediated inflammation. @*Methods@#We performed a retrospective case series of three patients with laboratory and radiologically confirmed COVID-19 pneumonia admitted to Chosun University Hospital. Demographic and clinical data on inflammatory cell lung infiltration and cytokine levels in patients with COVID-19 were collected. @*Results@#Cytological analysis of sputum, tracheal aspirates, and bronchoalveolar lavage fluid (BALF) samples from all three patients revealed massive infiltration of polymorphonuclear cells (PMNs), such as eosinophils and neutrophils. All sputum and BALF specimens contained high levels of eosinophil cationic proteins. The infiltration of PMNs into the lungs, together with elevated levels of natural killer T (NKT) cells in BALF and peripheral blood samples from patients with severe pneumonia in the acute phase was confirmed by flow cytometry. @*Conclusions@#These results suggest that the lungs of COVID-19 patients can exhibit eosinophil-mediated inflammation, together with an elevated NKT cell response, which is associated with COVID-19 pneumonia.

A Case Report of Large Tailgut Cyst Located from the Perirenal to the Perivesical Spaces

Tailgut cysts are known to originate from the remnants of the embryonic hindgut. They occur exclusively in the retrorectal and presacral spaces. There have been limited reports of tailgut cysts occurring in the left perirenal space. The present case features a huge tailgut cyst extending from the right perirenal to the perivesical space. We believe that this case report will help to further elucidate the characteristics of perirenal and perivesical tailgut cysts.

A Case of Primary Cutaneous Extraskeletal Ewing Sarcoma on the Abdomen

Primary cutaneous extraskeletal Ewing sarcoma (EWS) is a primitive neuroectodermal tumor that usually occurs as a small, localized tumor on the trunk or extremities of young adults. The prognosis is typically reported to be quite favorable. It is extremely rare; only three cases of primary cutaneous EWS have been reported in Korea. In the first report, molecular genetic testing was not performed to make a definitive diagnosis. In the second report, reverse transcription polymerase chain reaction (RT-PCR) for EWS-FLI1 gene arrangement was done, but the result was negative. Although RT-PCR and fluorescence in situ hybridization (FISH) were performed in the third report, none of the results were shown in the article. Considering that genetic testing is an essential diagnostic tool for certain diseases, such as some brain tumors, we report a case of primary cutaneous extraskeletal EWS, including the result of RT-PCR. A 36-year-old Korean female presented with a cutaneous mass on the abdomen. Histological evaluation revealed solid sheets of primitive, small, uniform cells with hyperchromatic nuclei and scant cytoplasm. Immunohistochemistry stains were positive for CD99 and FLI1. RT-PCR showed a t(11;22) EWSR1 (Ewing sarcoma region 1)-FLI1 (Friend leukemia virus integration 1) translocation.

Microcystic Adnexal Carcinoma on the Forehead Misdiagnosed as Cylindroma: A Case Report / 대한피부과학회지

Microcystic adnexal carcinoma (MAC) is a rare infiltrative cutaneous malignant tumor that presents as scar-like papules or plaques on sun-exposed skin. MAC can be misdiagnosed as a benign adnexal tumor, owing to its histopathologic similarity and slow growth rate. Nonetheless, MAC can show aggressive local invasion. Therefore, MAC should be treated with surgical excision or radiation therapy. Herein, we report the case of a 51-year-old woman with a flesh-colored plaque on her forehead. The patient was diagnosed with a benign adnexal tumor on the first punch biopsy. Notably, after a second incisional biopsy, the patient was finally diagnosed with MAC. This case demonstrates the difficulty of diagnosing MAC, suggesting that MAC should be considered for the differential diagnosis of slow-growing tumors in the head and neck and that multiple biopsies are needed when histological findings are ambiguous.

Comparison of the Size of the Posterior Malleolar Fragment in Trimalleolar Ankle Fractures Measured Using Lateral Plain Radiography and Three-Dimensional Computed Tomography

Purpose@#This study aimed to evaluate and compare the accuracy of the size of the posterior malleolar fragment measured using lateral plain radiography and three-dimensional computed tomography (3DCT) in patients with ankle trimalleolar fractures. @*Materials and Methods@#This study enrolled 80 patients (80 ankles) with ankle trimalleolar fractures and analyzed the size of the posterior malleolar fragments using plain radiography and 3D-CT. The articular involvement of the posterior malleolar fragments was measured as a percentage of the articular surface in the sagittal length of the tibial plafond using lateral plain radiography, and the articular surface area was directly measured using 3D-CT. In addition, we classified the patients into three groups based on the morphology of the posterior malleolar fracture, according to the Haraguchi classification method, and evaluated and compared the accuracy of the size of the posterior malleolar fragments. @*Results@#The mean articular involvement of the posterior malleolar fragments on plain radiography was 27.6% (range, 6.0%-53.1%), which was significantly higher than the mean of 21.9% (range, 4.7%-47.1%) measured using 3D-CT (p=0.004). In the analysis, according to the fracture morphology, the mean difference between the two methods was the largest for type I fractures at 9.1% (range, 1.8%-19.5%) and the smallest for type II fractures at 1.1% (range, –7.7% to 8.8%). @*Conclusion@#The articular involvement of posterior malleolar fragments measured using plain radiography showed low accuracy and significantly higher values than the actual articular involvement. Therefore, careful evaluation using 3D-CT is crucial for accurate analysis and optimal treatment in patients with ankle trimalleolar fractures.

Is Age-Predicted Maximal Heart Rate Applicable in Patients With Heart or Lung Disease?

Objective@#To compare the predicted and actual maximal heart rate (HRmax) values in the cardiopulmonary exercise test (CPET). @*Methods@#We retrospectively investigated 1,060 patients who underwent a CPET between January 2016 and April 2020 at our institution’s cardiopulmonary rehabilitation center. The following patients were included: those aged >20 years, those tested with a treadmill, and those who underwent symptom-limited maximum exercise testing— reaching ≥85% of the predicted HRmax (62% if taking beta-blockers) and highest respiratory exchange ratio ≥1.1. Ultimately, 827 patients were included in this study. Data on diagnosis, history of taking beta-blockers, age, body mass index (BMI), and CPET parameters were collected. Subgroup analysis was performed according to age, betablockers, BMI (low <18.5 kg/m2, normal, and high ≥25 kg/m2), and risk classification. @*Results@#There was a significant difference between the actual HRmax and the predicted value (p<0.001). Betablocker administration resulted in a significant difference in the actual HRmax (p<0.001). There were significant differences in the moderate-to-high-risk and low-risk groups and the normal BMI and high BMI groups (p<0.001). There was no significant difference between the elderly and younger groups. We suggest new formulae for HRmax of cardiopulmonary patients: estimated HRmax=183-0.76×age (the beta-blocker group) and etimated HRmax=210-0.91×age (the non-beta-blocker group). @*Conclusion@#Age-predicted HRmax was significantly different from the actual HRmax of patients with cardiopulmonary disease, especially in the beta-blocker group. For participants with high BMI and moderate-tosevere risk, the actual HRmax was significantly lower than the predicted HRmax.

A Case of African Tick-Bite Fever in a Returning Traveler from Southern Africa

African tick-bite fever (ATBF), caused by Rickettsia africae, is the second most frequent cause of fever after malaria in travelers returning from Southern Africa. As the Korean outbound travelers are increasing every year, tick-borne rickettsial diseases as a cause of febrile illness are likely to increase. We describe a febrile Korean returning traveler who showed two eschars after visiting the rural field in Manzini, Swaziland. We performed nested polymerase chain reaction using the eschar and diagnosed the patient with ATBF. He was treated with oral doxycycline for 7 days, and recovered without any complications. We believe that the present case is the first ATBF case diagnosed in a Korean traveler.