Dermatofibrosarcoma Protuberans with Diversely Atypical Clinical Presentation:Three Case Reports / 대한피부과학회지

Dermatofibrosarcoma protuberans (DFSP) is a relatively rare, slow-growing dermal spindle cell tumor characterized by high local recurrence rates and a low risk of metastasis. It starts as an erythematous indurated papule or plaque where firm nodules subsequently arise, forming typical ‘protuberant’ morphology. However, atypical DFSP presentations, which are difficult to diagnose clinically, have been reported. In this study, we describe three patients diagnosed with diversely atypical DFSP, which were pigmented, hemangioma-like, and cystic DFSP variants. Among them, two patients were misdiagnosed with other diseases, resulting in delayed treatment, with much larger resections needed to achieve local control or avoid recurrence. Therefore, dermatologists should pay attention to these diverse clinical variants of DFSP.

A Case of Cutaneous Fistula of the Chest Presenting as a Fixed Nodule after Blunt Chest Trauma / 대한피부과학회지

An 83-year-old man presented with an intermittently bleeding fixed nodule on the left side of the chest for 2 months. Due to the clinical suspicion of metastatic cancer or a ruptured epidermal cyst, a punch biopsy was performed, which revealed granulation tissue. During surgical excision, a connection between the granulation tissue and the deeper structure was confirmed. Based on the clinicopathological findings, a cutaneous fistula was suspected;a detailed history revealed that he had experienced blunt chest trauma in a motorcycle accident 2 months before. Subsequent chest computed tomography showed soft tissue infiltration in the left sixth rib. Finally, the patient was diagnosed with a cutaneous fistula and underwent resection of the left sixth rib and costal cartilage. Cutaneous fistulae rarely occur in the chest. In cases where a recalcitrant inflammatory nodule is observed on the chest, the patient’s trauma history and ordinary medical history should be evaluated to rule out a cutaneous fistula.

Participants’ Satisfaction with the Atopic Dermatitis Education Program: Assessing the Impact of Each Content Using Structural Equation Modeling

Background@#Only a few studies have tried to assess factors relevant to the satisfaction of the participants in atopic dermatitis (AD) educational programs. More systematic modeling of this issue is needed. @*Objective@#To examine the benefit of a conjoint educational program for AD on patients and caregivers in a clinical setting. @*Methods@#In a half-day educational program called “AD school”, 831 people (493 patients and 338 family members) participated for 8 years. Various educational and entertaining programs were provided. The on-site survey was administered to measure participants’ satisfaction and perception of the benefit. We applied structural equation modeling to identify the relations among satisfaction and perception. @*Results@#A total of 209 family survey data was obtained and analyzed. The survey items were grouped into four categories. The categories were classified as individual education, group education, fun activity, and overall satisfaction (fun, benefit, intention to re-join and recommend to others). According to the model that we built, comprehensive group education was demonstrated to be the most relevant factor affecting overall satisfaction. @*Conclusion@#Our holistic approach would allow dermatologists to improve the efficacy of the conjoint educational program for AD.

Effect of Red Ginseng Oil on Cultured Sebocytes and Outer Root Sheath Cells after Treatment with Lipopolysaccharide

Background@#Ginseng has been known in Korea as a healthsupportive herbal medicine from time immemorial. Essential oil isolated from fresh ginseng has been shown to display antibacterial and anti-inflammatory activities. @*Objective@#The effects of red ginseng oil (RGO) on the lipopolysaccharide (LPS)-treated sebocytes and outer root sheath (ORS) cells were studied. @*Methods@#The cultured cells were treated with either 0.1% dimethyl sulfoxide, 5 μg/ml LPS, 50 μg/ml RGO, or 5 μg/ml LPS plus 50 μg/ml RGO for 6 and 24 hours.RT-PCR, real-time PCR, enzyme-linked immunosorbent assay, western blot, and immunofluorescence staining were performed for the analysis of inflammatory cytokine. @*Results@#RGO showed the increased gene and protein expression of inflammatory cytokines, including interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-α in the LPS-treated sebocytes and ORS cells. RGO also showed the increased protein expression of p-c-jun and p-JNK in the LPS-treated sebocytes and ORS cells. Gene expression of TLR2 was increased in LPS-treated sebocytes following treatment with RGO. Additionally, RGO resulted in an increased expression of LL-37 in the LPS-treated sebocytes and ORS cells. Moreover, it remarkably increased the production of sebum in LPS-treated sebocytes. @*Conclusion@#RGO might be among the aggravating factors of acne vulgaris. It would be better to stop taking red ginseng in patients with inflammatory acne.

Extensive Nevus Comedonicus with Inflammatory Nodules and Cysts Controlled with Adalimumab

Nevus comedonicus is a very rare skin disorder characterized by the presence of comedo-like dilated pores with keratinous plugs, rarely resulting in painful recurrent inflammatory nodules or cysts. It presents as localized or extensive form. It displays unilaterally or bilaterally segmental distribution. Histopathologically, it is characterized by keratin-filled epidermal invagination with bulbous proliferation of keratinocytes. The condition may be caused by fibroblast growth factor receptor 2 mutation. Although it may be controlled by a variety of therapeutic modalities, it is difficult to achieve complete resolution. We report a case of extensive nevus comedonicus with inflammatory nodules and cysts controlled with adalimumab.

A Case of Cutaneous Fistula of the Chest Presenting as a Fixed Nodule after Blunt Chest Trauma / 대한피부과학회지

An 83-year-old man presented with an intermittently bleeding fixed nodule on the left side of the chest for 2 months. Due to the clinical suspicion of metastatic cancer or a ruptured epidermal cyst, a punch biopsy was performed, which revealed granulation tissue. During surgical excision, a connection between the granulation tissue and the deeper structure was confirmed. Based on the clinicopathological findings, a cutaneous fistula was suspected;a detailed history revealed that he had experienced blunt chest trauma in a motorcycle accident 2 months before. Subsequent chest computed tomography showed soft tissue infiltration in the left sixth rib. Finally, the patient was diagnosed with a cutaneous fistula and underwent resection of the left sixth rib and costal cartilage. Cutaneous fistulae rarely occur in the chest. In cases where a recalcitrant inflammatory nodule is observed on the chest, the patient’s trauma history and ordinary medical history should be evaluated to rule out a cutaneous fistula.

Participants’ Satisfaction with the Atopic Dermatitis Education Program: Assessing the Impact of Each Content Using Structural Equation Modeling

Background@#Only a few studies have tried to assess factors relevant to the satisfaction of the participants in atopic dermatitis (AD) educational programs. More systematic modeling of this issue is needed. @*Objective@#To examine the benefit of a conjoint educational program for AD on patients and caregivers in a clinical setting. @*Methods@#In a half-day educational program called “AD school”, 831 people (493 patients and 338 family members) participated for 8 years. Various educational and entertaining programs were provided. The on-site survey was administered to measure participants’ satisfaction and perception of the benefit. We applied structural equation modeling to identify the relations among satisfaction and perception. @*Results@#A total of 209 family survey data was obtained and analyzed. The survey items were grouped into four categories. The categories were classified as individual education, group education, fun activity, and overall satisfaction (fun, benefit, intention to re-join and recommend to others). According to the model that we built, comprehensive group education was demonstrated to be the most relevant factor affecting overall satisfaction. @*Conclusion@#Our holistic approach would allow dermatologists to improve the efficacy of the conjoint educational program for AD.

Effect of Red Ginseng Oil on Cultured Sebocytes and Outer Root Sheath Cells after Treatment with Lipopolysaccharide

Background@#Ginseng has been known in Korea as a healthsupportive herbal medicine from time immemorial. Essential oil isolated from fresh ginseng has been shown to display antibacterial and anti-inflammatory activities. @*Objective@#The effects of red ginseng oil (RGO) on the lipopolysaccharide (LPS)-treated sebocytes and outer root sheath (ORS) cells were studied. @*Methods@#The cultured cells were treated with either 0.1% dimethyl sulfoxide, 5 μg/ml LPS, 50 μg/ml RGO, or 5 μg/ml LPS plus 50 μg/ml RGO for 6 and 24 hours.RT-PCR, real-time PCR, enzyme-linked immunosorbent assay, western blot, and immunofluorescence staining were performed for the analysis of inflammatory cytokine. @*Results@#RGO showed the increased gene and protein expression of inflammatory cytokines, including interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor-α in the LPS-treated sebocytes and ORS cells. RGO also showed the increased protein expression of p-c-jun and p-JNK in the LPS-treated sebocytes and ORS cells. Gene expression of TLR2 was increased in LPS-treated sebocytes following treatment with RGO. Additionally, RGO resulted in an increased expression of LL-37 in the LPS-treated sebocytes and ORS cells. Moreover, it remarkably increased the production of sebum in LPS-treated sebocytes. @*Conclusion@#RGO might be among the aggravating factors of acne vulgaris. It would be better to stop taking red ginseng in patients with inflammatory acne.

Extensive Nevus Comedonicus with Inflammatory Nodules and Cysts Controlled with Adalimumab

Nevus comedonicus is a very rare skin disorder characterized by the presence of comedo-like dilated pores with keratinous plugs, rarely resulting in painful recurrent inflammatory nodules or cysts. It presents as localized or extensive form. It displays unilaterally or bilaterally segmental distribution. Histopathologically, it is characterized by keratin-filled epidermal invagination with bulbous proliferation of keratinocytes. The condition may be caused by fibroblast growth factor receptor 2 mutation. Although it may be controlled by a variety of therapeutic modalities, it is difficult to achieve complete resolution. We report a case of extensive nevus comedonicus with inflammatory nodules and cysts controlled with adalimumab.

Clinical Characteristics of Early Onset Cutaneous Malignant Melanoma in Korea / 대한피부과학회지

Background@#Cutaneous malignant melanoma (CMM) develops mainly in the elderly, although it is often seen in young patients and in clinical practice. However, there are few studies on the clinical features of young patients with CMM in Korea. @*Objective@#To investigate the clinical characteristics of young Korean patients with CMM. @*Methods@#We retrospectively reviewed the medical records of patients with CMM between January 2009 and June 2019 and compared the clinical features of CMM in patients aged 10∼39 and 50∼79 years. @*Results@#Of the 341 patients with CMM, only 22 (6.5%) were between the age of 10∼39 and 250 (73.3%) were aged 50∼79. Acral lentiginous melanoma (ALM) was the most common clinical subtype in both groups (45.5% and 71.2%, respectively). Subungual melanoma was more common in age 10∼39 years (27.3% vs. 17.2%), whereas ALM except subungual melanoma was more common in age 50∼79 years (18.2% vs. 54.0%). Superficial spreading melanoma (31.8%) was also a significant subtype observed in age 10∼39 years (p＜0.001). Frequently involved locations in age group 10∼39 were fingers (27.3%) and trunk (22.7%), but feet (40.8%) were common in age group 50∼79 (p=0.009). There were no differences in mean Breslow thickness, lymph node metastases, or staging of CMM (p＞0.05). @*Conclusion@#Compared with elderly patients, CMM in patients aged 10∼39 showed differences in the location of the lesion and clinical subtype. Therefore, a misdiagnosis can be prevented when a young patient has suspected CMM on the finger or trunk.

Comparison of different criteria for the definition of insulin resistance and its relationship to metabolic risk in children and adolescents

Purpose@#Childhood obesity frequently persists into adulthood and is associated with insulin resistance (IR) and increased long-term morbidity and mortality. We compared IR criteria concerning 'age-specific cutoff point' (ACOP) and ‘fixed cutoff point’ (FCOP) for the identification of IR and investigated their correlation with metabolic syndrome (MS). @*Methods@#Data were acquired from the 5th Korea National Health and Nutrition Examination Survey (2010–2011). Participants ranged from 10 to 17 years of age and underwent fasting plasma glucose, insulin concentration, and lipid panel measurements. High fasting plasma insulin levels or increased homeostatic model assessment insulin resistance (HOMA-IR) were defined as IR. We analyzed MS and IR frequencies according to FCOP or ACOP. @*Results@#Among 719 participants, 165 (22.9%) were overweight or obese based on their body mass index. We found no prevalence of MS in underweightormal weight participants and 12.7% prevalence rate in overweight or obese participants. IR according to ACOP was more closely associated with MS than IR according to FCOP. No differences were found in predicting the frequency of MS using FCOP or ACOP in both fasting plasma insulin and HOMA-IR. @*Conclusion@#The frequency of MS in participants with IR defined using ACOP and FCOP was similar. However, IR using ACOP was more closely associated with MS than IR using FCOP.

Discriminatory performance of insulin-like growth factor 1 and insulin-like growth factor binding protein-3 by correlating values to chronological age, bone age, and pubertal status for diagnosis of isolated growth hormone deficiency

Purpose@#The discriminatory performance of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) was investigated by correlating their values with chronological age (CA), bone age (BA), and pubertal status (PS) for diagnosis of isolated growth hormone deficiency (IGHD). @*Methods@#We evaluated IGF-1 and IGFBP-3 levels in 310 short-stature subjects subdivided into 2 groups: IGHD (n=31) and non-IGHD (n=279). IGF-1 and IGFBP-3 were assayed using immune-radiometric assay and transformed into standard deviation score (SDS) according to CA, BA, and PS. @*Results@#The highest sensitivity was found in IGF-1-SDS for CA and IGFBP-3-SDS for CA (22.6% and 30.0%, respectively). The highest specificity was found in IGF-1-SDS for PS and IGFBP-3-SDS for PS (98.2% and 94.4%, respectively). Groups with the highest positive predictive values were IGF-1-SDS for BA and IGFBP-3-SDS for BA (10.9% and 5.1%, respectively). Highest negative predictive values were seen in IGF-1-SDS for CA and IGFBP-3-SDS for CA (98.4% and 98.4%, respectively). @*Conclusion@#IGF-1-SDS for CA, instead of IGF-1-SDS for BA or PS, could be used as a standard variable for IGHD screening. The sufficiently high specificity of IGF-1-SDS for PS suggests that this value is a useful tool for identification of IGHD.

Comparison of different criteria for the definition of insulin resistance and its relationship to metabolic risk in children and adolescents

Purpose@#Childhood obesity frequently persists into adulthood and is associated with insulin resistance (IR) and increased long-term morbidity and mortality. We compared IR criteria concerning 'age-specific cutoff point' (ACOP) and ‘fixed cutoff point’ (FCOP) for the identification of IR and investigated their correlation with metabolic syndrome (MS). @*Methods@#Data were acquired from the 5th Korea National Health and Nutrition Examination Survey (2010–2011). Participants ranged from 10 to 17 years of age and underwent fasting plasma glucose, insulin concentration, and lipid panel measurements. High fasting plasma insulin levels or increased homeostatic model assessment insulin resistance (HOMA-IR) were defined as IR. We analyzed MS and IR frequencies according to FCOP or ACOP. @*Results@#Among 719 participants, 165 (22.9%) were overweight or obese based on their body mass index. We found no prevalence of MS in underweightormal weight participants and 12.7% prevalence rate in overweight or obese participants. IR according to ACOP was more closely associated with MS than IR according to FCOP. No differences were found in predicting the frequency of MS using FCOP or ACOP in both fasting plasma insulin and HOMA-IR. @*Conclusion@#The frequency of MS in participants with IR defined using ACOP and FCOP was similar. However, IR using ACOP was more closely associated with MS than IR using FCOP.

Discriminatory performance of insulin-like growth factor 1 and insulin-like growth factor binding protein-3 by correlating values to chronological age, bone age, and pubertal status for diagnosis of isolated growth hormone deficiency

Purpose@#The discriminatory performance of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) was investigated by correlating their values with chronological age (CA), bone age (BA), and pubertal status (PS) for diagnosis of isolated growth hormone deficiency (IGHD). @*Methods@#We evaluated IGF-1 and IGFBP-3 levels in 310 short-stature subjects subdivided into 2 groups: IGHD (n=31) and non-IGHD (n=279). IGF-1 and IGFBP-3 were assayed using immune-radiometric assay and transformed into standard deviation score (SDS) according to CA, BA, and PS. @*Results@#The highest sensitivity was found in IGF-1-SDS for CA and IGFBP-3-SDS for CA (22.6% and 30.0%, respectively). The highest specificity was found in IGF-1-SDS for PS and IGFBP-3-SDS for PS (98.2% and 94.4%, respectively). Groups with the highest positive predictive values were IGF-1-SDS for BA and IGFBP-3-SDS for BA (10.9% and 5.1%, respectively). Highest negative predictive values were seen in IGF-1-SDS for CA and IGFBP-3-SDS for CA (98.4% and 98.4%, respectively). @*Conclusion@#IGF-1-SDS for CA, instead of IGF-1-SDS for BA or PS, could be used as a standard variable for IGHD screening. The sufficiently high specificity of IGF-1-SDS for PS suggests that this value is a useful tool for identification of IGHD.

119 Rescue team's awareness of anaphylaxis and asthma exacerbation in Gyeonggi-do province of Korea: Before and after education

PURPOSE: Anaphylaxis and asthma exacerbation could be life-threatening medical emergencies. The 119 (911 in the United States) rescue teams are at the forefront of such emergency conditions. Early recognition and proper prehospital management by 119 rescuers are important. We evaluated the awareness of 119 rescuers of anaphylaxis and asthma exacerbation in Korea. METHODS: Between May 17 and June 28 of 2018, a total of 180 rescuers were recruited from Gyeonggi-do province, Korea. The 90-minute educational sessions on anaphylaxis and asthma exacerbation were provided by an allergy specialist, which included some lectures and a hands-on workshop on self-injectable epinephrine autoinjector. A questionnaire survey with the same content was performed before and after education to assess the improvement in awareness. It had 2 domains: anaphylaxis awareness and asthma awareness. RESULTS: After education, awareness score for anaphylaxis increased from an average of 3.1 (51.7%) to 5.5 (91.7%). Particularly, the effect of education on the use of epinephrine, the most crucial treatment for anaphylaxis, was greatest. The awareness score for asthma after education increased from an average of 21.3 (78.9%) to 25.1 (93%). The effect of education on treatment and management of asthma was greatest. CONCLUSION: The 119 rescuers could be the first medical personnel at the forefront of anaphylaxis and asthma exacerbation. Hence, it is important to increase their awareness of anaphylaxis and asthma exacerbation. A simple educational activity can dramatically change the level of awareness.

Cytohesin-2 Is Upregulated in Malignant Melanoma and Contributes to Tumor Growth

No abstract available.

Intake-related factors and educational needs regarding energy drinks in female high school students in the Incheon area / 한국영양학회지

PURPOSE: The purpose of this cross-sectional study was to investigate intake-related factors of energy drinks and educational needs regarding energy drinks in female high school students. METHODS: Subjects were 340 female high school students in Incheon, and data were collected using self-administered questionnaires. Statistical analysis was performed using the SPSS 20.0 program. RESULTS: Subjects who had drunk energy drinks were 74.3% (249 subjects) of all subjects. The first time they drank an energy drink was significantly associated with grade (p < 0.05). In 75.1% of 249 subjects who had drunk energy drinks, the places for buying energy drinks were supermarkets and convenience stores near their homes. For the effects of energy drink intake, sleeplessness (44.6%) and no effect (41.7%) were cited, and 24.5% experienced side effects such as palpitation, tremors, etc. The scores for self-diagnosis of caffeine addiction were significantly higher in the low weight group compared to the overweight group (p < 0.05). The degree of caffeine addiction was significantly associated with effects of energy drink intake (p < 0.001) and type of side effects (p < 0.001). Willingness to stop consuming energy drinks (p < 0.001) and necessity of nutrition education about energy drinks (p < 0.05) were significantly lower in the caffeine addiction group compared to the general group. About 75.0% of subjects wanted to be educated about the side effects of energy drinks and caffeine. CONCLUSION: This study shows that female high school students need proper education about the effects of intake of energy drinks. Therefore, guidelines and a nutrition education program right intake of energy drinks should be provided as well as campaigns concerning the side effects of energy drinks and caffeine in female high school students.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms / 가정의학회지

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to uncover the effects of POPs on the endocrine and nervous systems and on cancer, few focus on the relationship between low-dose POPs and public health. Here, we attempt to determine the relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Medical Center for health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls (PCBs) and 23 types of organochlorine pesticides (OCP). Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Based on our results, abdominal discomfort showed an inverse relationship with several PCBs and an inverted U-shaped relationship with several other OCPs including pp-DDD and pp-DDT. The effects of pp-DDD and pp-DDT on abdominal discomfort were similar to those of OCPs on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear causes could be related to POP levels.

The Relationship between the Blood Level of Persistent Organic Pollutants and Common Gastrointestinal Symptoms / 가정의학회지

BACKGROUND: Persistent organic pollutants (POPs) are toxic materials that cannot be broken down naturally and that easily accumulate in the body. Although several studies have attempted to uncover the effects of POPs on the endocrine and nervous systems and on cancer, few focus on the relationship between low-dose POPs and public health. Here, we attempt to determine the relationship between the level of POPs and common gastrointestinal symptoms, including abdominal discomfort, diarrhea, and constipation. METHODS: We recruited 121 subjects who visited Kyungpook National University Medical Center for health screening. Plasma concentrations were evaluated for 40 kinds of POPs including 17 types of polychlorinated biphenyls (PCBs) and 23 types of organochlorine pesticides (OCP). Furthermore, the Korean version of the Rome III criteria was used to identify gastrointestinal symptoms. RESULTS: Based on our results, abdominal discomfort showed an inverse relationship with several PCBs and an inverted U-shaped relationship with several other OCPs including pp-DDD and pp-DDT. The effects of pp-DDD and pp-DDT on abdominal discomfort were similar to those of OCPs on obesity and metabolic syndrome. CONCLUSION: Our results suggest that mild and unspecified gastrointestinal symptoms with no clear causes could be related to POP levels.

A Case of Rotavirus Infection Presenting with Direct Hyperbilirubinemia / 대한주산의학회잡지

Rotavirus is the most common cause of infectious gastroenteritis in infants and young children and estimated to cause more than 111 million cases of diarrhea annually. Most patients show no specific symptom or experience mild fever, vomiting, non-bloody diarrhea and symptoms often resolve within several days. However, some of patients suffer from severe complication such as necrotizing enterocolitis, intussusception, seizure, encephalitis, and cholestasis. We report a neonatal case of rotavirus infection presenting with reversible direct hyperbilirubinemia with a brief review of associated literatures.