The efficacy and safety of low- versus high-fluence fractional picosecond Nd:YAG 1064-nm laser in the treatment of acne scars: A randomized split-face comparison study.

BACKGROUND: Differences in clinical efficacy based on the fluence of fractional picosecond laser treatment for acne scars are unknown. OBJECTIVE: To compare the efficacy and safety of low-fluence versus high-fluence fractional picosecond Nd:YAG 1064-nm laser treatment in acne scar patients. METHODS: In this 12-week, investigator-blinded, randomized, split-face study, 25 patients with moderate-to-severe acne scars received three sessions of high-fluence laser treatment (1.0 J/cm2 ) on one side of their face and low-fluence (0.3 J/cm2 ) on the other side every 4 weeks. Patients were assessed using acne scar counts, the scar global assessment (SGA), and the ECCA scar grading scale every 4 weeks. The histological analysis compared the acne scars obtained before and 4 weeks after treatment. RESULTS: At their last visit, 88.00% and 92.00% of the subjects achieved >30% reduction in scar counts on the low- and high-fluence sides, respectively, without a significant difference between the two sides. On both sides, the scar counts, SGA, and ECCA score significantly improved 4 weeks after the last treatment. Although the high-fluence side showed a greater reduction in scar counts (-66.73%) than the low-fluence side (-62.13%), the two sides had no significant difference in the grading scores. The high-fluence side showed significantly more severe pain and higher side-effect scores immediately and 4 weeks after treatment. Histological analysis revealed a significantly increased collagen, elastin, and vimentin expression after treatment on the low-fluence side. CONCLUSIONS: The low-fluence setting demonstrated comparable efficacy and superior safety in treating acne scars compared with the high-fluence setting.

Pigmented contact dermatitis and hair dyes: A retrospective case-control multicentre study in Korea.

BACKGROUND: Pigmented contact dermatitis (PCD), a rare variant of non-eczematous contact dermatitis, is clinically characterized by sudden-onset brown or grey pigmentation on the face and neck. It is hypothesized to be caused by repeated contact with low levels of allergens. OBJECTIVES: This study evaluated the risk of using hair dyes in patients with PCD in Korea. METHODS: A total of 1033 PCD patients and 1366 controls from 31 university hospitals were retrospectively recruited. We collected and analysed the data from the patient group, diagnosed through typical clinical findings of PCD and the control group, which comprised age/sex-matched patients who visited the participating hospitals with pre-existing skin diseases other than current allergic disease or PCD. RESULTS: Melasma and photosensitivity were significantly more common in the control group, and a history of contact dermatitis was more common in the PCD group. There were significantly more Fitzpatrick skin type V participants in the PCD group than in the control group. There was no significant difference in sunscreen use between the groups. Using dermatologic medical history, Fitzpatrick skin type and sunscreen use as covariates, we showed that hair dye use carried a higher PCD risk (odds ratio [OR] before adjustment: 2.06, confidence interval [CI]: 1.60-2.65; OR after adjustment: 2.74, CI: 1.88-4.00). Moreover, henna users had a higher risk of PCD (OR before adjustment: 5.51, CI: 4.07-7.47; OR after adjustment: 7.02, CI: 4.59-10.74), indicating a significant increase in the risk of PCD with henna dye use. Contact dermatitis history was more prevalent in henna users than in those using other hair dyes in the PCD group (17.23% vs. 11.55%). CONCLUSION: Hair dye use is a risk factor for PCD. The risk significantly increased when henna hair dye was used by those with a history of contact dermatitis.

Dasatinib Attenuates Fibrosis in Keloids by Decreasing Senescent Cell Burden.

Keloids are skin tumours caused by aberrant growth of dermal fibroblasts. Cellular senescence contributes to aging and various pathological conditions, including cancer, atherosclerosis, and fibrotic diseases. However, the effects of cellular senescence and senolytic drugs on keloids remain largely unknown. This study investigated senescent fibroblasts in keloids and assessed the effects of dasatinib on these cells. Tissues acquired from keloid removal surgery were analysed for senescence-associated ß-galactosidase-positive cells, p16 expression, and the effects of dasatinib treatment on keloids. Keloid tissue was xenotransplanted into mice, and the effect of intralesional dasatinib injection on keloid growth was observed. The results showed that the numbers of ß-galactosidase-positive and p16-expressing cells were higher in the keloids compared with in the controls. Dasatinib induced selective clearance of senescent cells and decreased procollagen expression in cultured keloid fibroblasts. In this xenotransplant keloid mouse model, intralesional injection of dasatinib reduced gross keloid tissue weight and the expression of both procollagen and p16. In addition, dasatinib-treated keloid fibroblasts conditioned medium reduced procollagen and p16 expression in cultured keloid fibroblasts. In conclusion, these results suggest that an increased number of senescent fibroblasts may play an important role in the pathogenesis of keloids. Therefore, dasatinib could be an alternative treatment for patients with keloids.

Association between breakfast frequency and insulin resistance in Korean adults with prediabetes: A nationwide population-based cross-sectional study.

AIMS: This study aimed to investigate the association between breakfast frequency and insulin resistance using the triglyceride and glucose (TyG) index in Korean adults with prediabetes. METHODS: This study used data from the 2016-2018 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 16,925 participants were included in this study. Breakfast frequency was classified as 0 times, 1-4 times, and 5-7 times per week. High insulin resistance was defined as a TyG index of ≥8.5. A multivariate logistic regression analysis was performed. RESULTS: Compared with the group whose breakfast frequency was 5-7 times per week, the odds ratio for high insulin resistance was 1.39 times (95% confidence interval (CI), 1.21-1.59) and 1.17 times (95% CI, 1.04-1.32) higher in the group whose breakfast frequency was 0 times and 1-4 times per week, respectively. CONCLUSIONS: This study revealed that a lower frequency of breakfast consumption was significantly associated with a higher risk of insulin resistance in Korean adults with prediabetes. In the future, a large-scale prospective longitudinal study is required to establish the causal relationship between breakfast frequency and insulin resistance.

Comparison between predicted and measured resting energy expenditures in Korean male collegiate soccer players.

PURPOSE: This study aimed to evaluate the differences between predicted resting energy expenditure (REE), using fat-free mass (FFM)-based prediction equations, and measured REE in Korean male collegiate soccer players. METHODS: Fifteen male collegiate soccer players (18-21 years) participated in this study. The REE measurements were conducted using the Douglas bag method. Body composition was measured by dual-energy X-ray absorptiometry (DXA). The differences between the measured REE and predicted REE, using the five FFM-based REE equations, were analyzed using the t-test, calculation of errors, regression analysis, and the Bland-Altman method. RESULTS: The Cunningham (1980) and ten Haaf and Weijs (2014) equations showed significantly overestimated REE (1,808 ± 99 kcal/d, p <0.01; 1,838 ± 103 kcal/d, p <0.01; respectively), but the Owen (1988), Taguchi (2011), and Kim (2015) equations' estimations were not significantly different from the measured REE (1,589 ± 106 kcal/d, 1,640 ± 124 kcal/d, and 1,622 ± 68 kcal/d, respectively). The Taguchi equation gave the best prediction of REE with the lowest constant error (-6 ± 125) and effect size (-0.05), and a non-significant proportional bias (p = 0.95). CONCLUSION: The Taguchi equation is recommended for predicting REE in Korean collegiate soccer players. The selection process of a REE-prediction equation must take into consideration the target population's characteristics. Future studies are recommended to evaluate the validity of the different FFM-based REE-prediction equations in various Korean athletes.

Effects of Forest Therapy on Psychological Improvement in Middle-aged Women in Korea.

OBJECTIVES: Women experience more stress in middle age than in other periods of their lives. Therefore, health management programs that enable middle-aged women to cope with and manage stress are needed. This study investigated the psychological effects of a meditation-focused forest therapy program among 53 middle-aged women living in urban areas in Korea. METHODS: Participants were divided into 2 groups: one group underwent the program for 3 days in a forest, followed by 3 days in an urban environment, and the other group underwent the program for 3 days in the urban environment, followed by 3 days in the forest. The psychological effects of the forest therapy program were evaluated using the Profile of Mood States-Brief (POMS-B). Differences in mood state before and after the program conducted in the forest (experimental group) and in the urban environment (control group) were evaluated using the paired-samples t-test. RESULTS: The program in the forest significantly reduced tension, depression, anger, fatigue, and confusion among the domains of the POMS-B. The program in the urban area significantly reduced tension, but not depression, anger, fatigue, or confusion. CONCLUSIONS: Meditation-focused forest therapy programs are expected to contribute to promoting psychological health and enhancing the quality of life of middle-aged women.

Inhibition of matrix metalloproteinase expression by selective clearing of senescent dermal fibroblasts attenuates ultraviolet-induced photoaging.

Photoaging mainly occurs due to ultraviolet (UV) radiation, and is accompanied by increased secretion of matrix metalloproteinases (MMPs) and degradation of collagen. UV radiation induces cell senescence in the skin; however, the role of senescent cells in photoaging remains unclear. Therefore, to elucidate the role of senescent cells in photoaging, we evaluated the effect of senolytics in a photoaging mouse model and investigated the underlying mechanism of their antiaging effect. Both UV-induced senescent human dermal fibroblasts and a photoaging mouse model, ABT-263 and ABT-737, demonstrated senolytic effects on senescent fibroblasts. Moreover, we found that several senescence-associated secretory phenotype factors, such as IL-6, CCL5, CCL7, CXCL12, and SCF, induced MMP-1 expression in dermal fibroblasts, which decreased after treatment with ABT-263 and ABT-737 in vivo and in vitro. Both senolytic drugs attenuated the induction of MMPs and decreased collagen density in the photoaging mouse model. Our data suggest that senolytic agents reduce UV-induced photoaging, making strategies for targeting senescent dermal fibroblasts promising options for the treatment of photoaging.

Clinical features and natural course of pediatric longitudinal melanonychia: A retrospective cohort study in Korea.

BACKGROUND: Large studies on the clinical features and natural course of pediatric longitudinal melanonychia (LM) are lacking. OBJECTIVE: To investigate the clinical features and natural course of pediatric LM. METHODS: Retrospective cohort analysis of pediatric patients (age ≤ 18 years) with LM. RESULTS: We examined 703 LM lesions in 381 children. Single, narrow, and homogeneously pigmented fingernail lesions were most frequently observed. Our results suggested that within 3, 4.5, and 9.5 years after onset, approximately 3%, 5%, and 10% of LM lesions, respectively, will completely regress and that single, left-sided, and homogeneously pigmented lesions are more likely to disappear completely. The age of onset, sex, finger/toe position, Hutchinson's sign, and nail dystrophy were not associated with complete regression. During follow-up, most cases demonstrated no change in color or width between the first and last visit, and early darkening/widening before stabilization or lightening/narrowing was common. The lightning of pigmentation was associated with complete regression, whereas change in width was not. LIMITATIONS: Retrospective study at a tertiary center. CONCLUSION: Our results suggest that clinicians ought to follow pediatric patients with LM without intervention for several years even if lesions grow darker or wider. Single, left-sided, and homogeneously colored lesions are more likely to regress.

Smart Roads for Autonomous Accident Detection and Warnings.

An increasing number of vehicles on the roads increases the risk of accidents. In bad weather (e.g., heavy rainfall, strong winds, storms, and fog), this risk almost doubles due to bad visibility as well as road conditions. If an accident happens, especially in bad weather, it is important to inform approaching vehicles about it. Otherwise, there might be another accident, i.e., a multiple-vehicle collision (MVC). If the Emergency Operations Center (EOC) is not informed in a timely fashion about the incident, fatalities might increase because they do not receive immediate first aid. Detecting humans or animals would undoubtedly provide us with a better answer for reducing human fatalities in traffic accidents. In this research, an accident alert light and sound (AALS) system is proposed for auto accident detection and alerts with all types of vehicles. No changes are required in non-equipped vehicles (nEVs) and EVs because the system is installed on the roadside. The idea behind this research is to make smart roads (SRs) instead of equipping each vehicle with a separate system. Wireless communication is needed only when an accident is detected. This study is based on different sensors that are used to build SRs to detect accidents. Pre-saved locations are used to reduce the time needed to find the accident's location without the help of a global positioning system (GPS). Additionally, the proposed framework for the AALS also reduces the risk of MVCs.

Current Status and Future Direction of Physician-Scientists Training in Korea.

In their new JID Innovations article, "Training Physician-Scientists for Careers in Investigative Dermatology," Li et al. (2021) describe the difficulties of nurturing physician-scientists in the United States and their causes. In Korea, the importance of physician-scientists is also being emphasized, and medical schools and the government are making great efforts to foster physician-scientists as well. As a result of these efforts, the number of those obtaining a doctoral degree after residency training in clinical departments, including dermatology, is increasing in Korea. However, more systematic support from the government, medical schools, and their affiliated hospitals is needed so that more physician-scientists can conduct research to identify the causes of diseases and develop new treatments while practicing medicine. In this commentary, we would like to comment on the situation of physician-scientists in Korea.

Within-Day Energy Balance and Metabolic Suppression in Male Collegiate Soccer Players.

Metabolic suppression due to relative energy deficiency can cause various physiological impairments in athletes. The purpose of this study was to evaluate within-day energy balance (WDEB) and the ratio between measured and predicted resting energy expenditure (REEratio) and to investigate the relationships between the markers of metabolic suppression. Ten male collegiate soccer players completed a 7-day food diary, physical activity, and heart rate records during the training and rest days. Energy intake (EI) and energy expenditure (EE) were analyzed to evaluate WDEB components. Body composition was measured using dual-energy X-ray absorptiometry (DXA), and blood sampling was conducted for hormonal analysis. The REE was measured using the Douglas bag method and predicted using the DXA-predicted method to calculate the REEratio. Participants were categorized into the normal (REEratio ≥ 0.94, n = 5) and suppressed (REEratio < 0.94, n = 5) groups. There were no group differences in the components of WDEB, except diet-induced thermogenesis (DIT), but EI was significantly higher in the normal group than in the suppressed group (7-day total: 3660 ± 347 vs. 3024 ± 491 kcal/day, p = 0.046 and rest days: 3772 ± 463 vs. 2796 ± 800 kcal/day, p = 0.046). Analysis of hormonal markers of metabolic suppression only showed a significant positive association between insulin-like growth factor-1 (IGF-1) and REEratio (r = 0.771, p = 0.009). The relationships between metabolic suppression and the markers of energy deficiency were inconclusive. There are possible associations of insufficient EI and IGF-1 levels with metabolic suppression, and further study is required to understand energy deficiency in male soccer players.

Low hemoglobin levels and an increased risk of psoriasis in patients with chronic kidney disease.

Chronic diseases, such as chronic kidney disease (CKD), are frequently accompanied by various comorbidities, including anemia, which is considered a surrogate marker of systemic inflammation. Psoriasis is a chronic inflammatory skin disease prevalent in patients with chronic disease. Psoriasis risk in patients with CKD, however, especially in patients with low hemoglobin levels, has never been investigated. In this study, we investigated associations between low hemoglobin levels and psoriasis in patients with CKD using data from the National Health Insurance Service of Korea. During a mean follow-up period of 6.16 ± 1.02 years, psoriasis was recorded in 13,803 patients with CKD (2.39% of CKD patients). The cumulative incidence of psoriasis was significantly higher in CKD patients with anemia (hemoglobin levels < 13 g/dL in men and < 12 g/dL in women) than those without. In multivariate-adjusted Cox proportional hazards regression models, the risk of psoriasis was significantly higher in anemic CKD patients than nonanemic CKD patients (hazard ratio [HR] 1.136, 95% CI 1.089-1.185, p < 0.001). Additionally, we noted that the incidence of psoriasis decreased with increasing hemoglobin levels in CKD patients (HR 0.953, 95% CI 0.942-0.965, p < 0.001). Altogether, our findings indicate that low hemoglobin levels are significantly related to psoriasis risk in patients with CKD. Further study is required to elucidate whether low hemoglobin levels have an impact on the development of psoriasis or are merely a surrogate marker of psoriasis risk in patients with CKD.

Interplay between electrochemical reactions and mechanical responses in silicon-graphite anodes and its impact on degradation.

Durability of high-energy throughput batteries is a prerequisite for electric vehicles to penetrate the market. Despite remarkable progresses in silicon anodes with high energy densities, rapid capacity fading of full cells with silicon-graphite anodes limits their use. In this work, we unveil degradation mechanisms such as Li+ crosstalk between silicon and graphite, consequent Li+ accumulation in silicon, and capacity depression of graphite due to silicon expansion. The active material properties, i.e. silicon particle size and graphite hardness, are then modified based on these results to reduce Li+ accumulation in silicon and the subsequent degradation of the active materials in the anode. Finally, the cycling performance is tailored by designing electrodes to regulate Li+ crosstalk. The resultant full cell with an areal capacity of 6 mAh cm-2 has a cycle life of >750 cycles the volumetric energy density of 800 Wh L-1 in a commercial cell format.

Invasive Cutaneous Squamous Cell Carcinoma Arising from Chronic Hidradenitis Suppurativa: A Case Report of Treatment by Slow Mohs Micrographic Surgery.

Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory condition presenting with painful, deep-seated abscesses and sinus tracts in multifocal locations. Rarely, long-standing inflammation in HS may lead to serious complications, such as cutaneous squamous cell carcinoma (SCC) (also termed Marjolin ulcer). Herein, we report a case of invasive cutaneous SCC arising from chronic ulcers of a HS patient. A 40-year old Korean male, a current smoker with 20 pack-year history, presented with a history of painful, recurrent, deep-seated abscesses and ulcers on the buttocks since his late teens, thus classified as Hurley stage III. A large purulent ulcer developed on the right buttock several months ago. Initial treatment was focused on controlling infection and facilitating wound healing. The lesion showed 50% reduction of size in 6 weeks, but also developed foul odor and showed fungating margins. Multiple skin biopsies were consistent with invasive SCC. Magnetic resonance imaging revealed a few enlarged lymph nodes on the right inguinal area, which was confirmed as metastasis on frozen biopsy. Slow Mohs micrographic surgery and radical right inguinal lymph node dissection was done. Incidence rates of SCC arising from HS have been reported up to 4.6%. To our knowledge, this is the first report of cutaneous SCC arising from HS in Korea. Our case emphasizes that the diagnosis of cutaneous SCC in HS should not be delayed, and early surgical intervention is crucial for better outcomes.

The long-term risk of lymphoma and skin cancer did not increase after topical calcineurin inhibitor use and phototherapy in a cohort of 25,694 patients with vitiligo.

BACKGROUND: Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial. OBJECTIVE: To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy. METHODS: A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports. RESULTS: During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer. LIMITATIONS: Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races. CONCLUSION: The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.

Association of Low Energy Availability and Suppressed Metabolic Status in Korean Male Collegiate Soccer Players: A Pilot Study.

Low energy availability (EA) can impair physiological function in athletes. The purpose of this study was to investigate EA status, metabolic status, and bone metabolism with biochemical analysis in Korean male soccer players. Twelve male athletes (18-20 years) completed the study. Body composition and bone mineral density were measured using dual energy X-ray absorptiometry (DXA), while VO2 max was determined by an incremental exercise test. Blood samples were taken for bone marker and hormone analyses. Resting energy expenditure (REE) was measured using the Douglas bag method and predicted using the DXA method. Food diaries and heart rates (HR) during training were recorded, and the Profile of Mood States 2 and Eating Attitude Test 26 were completed. Group differences between low EA (LEA <30 kcal/kg FFM/d, n = 5) and high EA (HEA ≥30 kcal/kg FFM/d, n = 7) were evaluated. The mean EA of the all participants was 31.9 ± 9.8 kcal/kg FFM/d with only two participants having an EA above 45 kcal/kg FFM/d. LEA showed suppressed REE (LEA: 26.0 ± 1.7 kcal/kg/d, HEA: 28.8 ± 1.4 kcal/kg/d, p = .011) with a lower REEratio (LEA: 0.91 ± 0.06, HEA: 1.01 ± 0.05, p = .008) as well as a lower insulin-like growth factor 1 (IGF-1) level (LEA: 248.6 ± 51.2 ng/mL, HEA: 318.9 ± 43.4 ng/mL, p = .028) compared to HEA. There were no group differences in bone markers or other hormone levels. Korean male athletes exhibited low EA status with suppressed metabolism, but there was limited evidence on the effect of EA on bone metabolism, endocrine system, and psychological parameters.

Effects of Forest Therapy on Health Promotion among Middle-Aged Women: Focusing on Physiological Indicators.

Women experience more stress in middle age than in other life stages, and health in middle age is vital, because it influences the quality of life in old age. In this study, the effects of a forest therapy program on physiological changes in 53 middle-aged women (divided into two groups) who lived in the city were examined. One group participated in a three-day program in the forest, followed by three days in the city; the other group participated in a three-day program in the city, followed by three days in the forest. Forest experiments were conducted in a "healing forest," and urban experiments were conducted near a university campus. Blood tests were performed to evaluate the physiological effects of forest therapy. Differences in serotonin levels and vitamin D levels were verified before and after the forest (experimental group) and urban (control group) programs through paired t-tests. Statistically significant increases in serotonin levels were noted for participants in the forest program; vitamin D levels also increased, but not by statistically significant values. The findings of this study verify that forest therapy programs promote health among middle-aged women, and may prevent disease and improve quality of life.