Effects of Particulate Matter on Healthy Skin: A Comparative Study between High- and Low-Particulate Matter Periods.

BACKGROUND: The influence of airborne particulate matter (PM) on skin has primarily been studied in patients with skin diseases such as atopic dermatitis. Recently, the effect of PM on healthy human skin has gained attention. OBJECTIVE: To evaluate the relationship between PM concentration and objective skin changes in healthy subjects. METHODS: This prospective study enrolled 25 healthy volunteers without any skin disease. Data regarding daily meteorological parameters and air pollution were collected during a high-PM period and a low-PM period for 14 days. Environmental and lifestyle factors that might influence skin conditions of subjects were also collected during the study period. Biophysical parameters of the skin such as transepidermal water loss (TEWL), hydration, erythema index, and melanin index were measured. Pores, wrinkles, sebum, and skin tone were evaluated using a facial analysis system. RESULTS: Mean TEWL value during the high-PM period was significantly higher than that during the low-PM period (10.16 g/m2/h vs. 5.99 g/m2/h; p=0.0005). Mean erythema index was significantly higher in the high-PM period than that in the low-PM period (4.3 vs. 3.42; p=0.038). For facial analysis system indices, uniformity of skin tone was higher in the low-PM period than that in the high-PM period (p<0.0001). In addition, with increasing PM10 and PM2.5, TEWL also showed increase when other environmental components were constant (regression coefficient [RC]=0.1529, p<0.0001 for PM10; RC=0.2055, p=0.0153 for PM2.5). CONCLUSION: Increased PM concentrations may contribute to disturbed barrier function, increased facial erythema, and uneven skin tone even in healthy human skin.

Clinical profile of cutaneous adverse events of immune checkpoint inhibitors in a single tertiary center.

Programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) inhibitors have demonstrated their efficacy in the treatment of various malignancies. Despite their benefits, their immunomodulatory activities can cause unpredictable cutaneous adverse events (CAE). This study aimed to identify characteristics of CAE in patients treated with PD-1/PD-L1 inhibitors through the medical records, photographs, and pathology reports. Fifty CAE occurred in 47 (2.75%) of 1711 patients treated with PD-1/PD-L1 inhibitors. Pruritic, psoriasiform, urticarial, and acneiform eruptions were the four most common types. Melanoma patients showed CAE more frequently than other malignancies. Acneiform eruption occurred more often at ages under 60 years. Urticarial eruption appeared earlier, while keratoacanthoma appeared later after immunotherapy. The overall survival times were not significantly different between the two groups with and without CAE by Kaplan-Meier analysis (p = 0.055). Studies on CAE may provide more information to understand these drugs and to help manage the patients.

A Case of Cutaneous Leukocytoclastic Vasculitis Associated with Granulocyte Colony-Stimulating Factor: An Unusual Presentation.

Drug-induced vasculitis is an inflammation of small-sized blood vessel caused by the use of drugs. It accounts for approximately 10% of acute cutaneous vasculitis. Propylthiouracil, hydralazine, and allopurinol have been widely known as causative agents. The most common clinical feature of drug-induced vasculitis is palpable purpura on lower extremities. A 66-year-old Korean female presented with erythematous nodules on upper chest and back. She had been on medication for multiple myeloma. Laboratory results showed neutropenia. After a single injection of filgrastim (recombinant granulocyte colony-stimulating factor), she developed cutaneous lesions with concurrent increase in absolute neutrophil count. A skin biopsy revealed leukocytoclastic vasculitis. After discontinuation of filgrastim injection, her skin lesions disappeared spontaneously.

Economic impact of epilepsy in the United States.

PURPOSE: To assess differences in medical care expenditures and informal care received for adults and children by individuals' self-reported epilepsy status and to estimate the total economic impact of epilepsy in the United States. METHODS: Pooled medical expenditure panel survey data from 1996-2004 were used. Children's regression analyses were adjusted for race, sex, general self-reported health status, family size, and age. Adults' analyses were also adjusted for income and education. The national annual economic impact was estimated by multiplying the average individual differences by previously published national prevalence data. RESULTS: The results of regressions appropriately weighted to account for study design indicate excess medical expenditures for those with epilepsy of $4,523 [95% confidence interval: $3,184-$5,862]. Excess expenditures were similar for adults and children. Adults with epilepsy received 1.2 extra days of informal care [95% confidence interval: 0.2-2.3]. The national impact included $9.6 billion of medical expenditures and informal care. DISCUSSION: Epilepsy has significant impact on individual medical expenditure and generates a national impact in the billions of dollar.

The relationship between gamma-glutamyltransferase and adiponectin in nonalcoholic women.

The relationship between adiponectin and gamma-glutamyltransferase (GGT) has yet to be clearly demonstrated especially in women. Among the parameters of the liver function test (LFT), it has become increasingly evident that GGT is associated with metabolic disease. The objective of this study was to characterize the relationship between adiponectin and GGT in nonalcoholic women without liver disease. The subjects in this study were recruited from participants in routine health examinations during February of 2004. Among the total of 115 subjects considered for recruitment, we ultimately included 86 patients without liver disease in the study after performing LFT and abdominal sonography. After a 12-hour overnight fast, levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, GGT, total cholesterol, high-density lipoprotein cholesterol, triglycerides, fasting plasma glucose, fasting insulin, and adiponectin were measured in all subjects. We found a significant negative correlation between adiponectin and GGT (r=-0.35, P<.001) and a significant positive correlation between GGT and homeostasis model assessment (HOMA) (r=0.29, P<.01) after controlling for the confounding influences of age and fat mass. Although GGT is clearly related to adiponectin and HOMA, we determined aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase were not significantly associated with adiponectin and HOMA. The present study suggests that only GGT among the LFTs is related to adiponectin in nonalcoholic women without liver disease.

Hypoadiponectinemia and insulin resistance are associated with nonalcoholic fatty liver disease.

We investigated the association between nonalcoholic fatty liver disease (NAFLD) and plasma adiponectin levels and insulin resistance. We recruited study subjects among one hundred and eighty one persons who were examined abdominal ultrasound at routine screening tests. A standard interview (consumption of alcohol and medical history), physical examination (height, weight, waist circumference, and blood pressure), and biochemical study (lipid parameters, aminotransferases, fasting plasma glucose, fasting insulin, and plasma adiponectin) were performed. Subjects who consumed alcohol more than moderate, evidence of viral hepatitis, toxic hepatitis, and serious cardiac, renal, or hepatic disease were excluded. Thirty-eight NAFLD patients and 53 control subjects diagnosed by ultrasound were finally analyzed. The plasma adiponectin level was significantly correlated with HDL-cholesterol (r=0. 38, p<0.001), triglycerides (r=-0.22, p=0.04), fasting insulin (r=-0.37, p<0.01), and insulin resistance by homeostasis model of assessment-insulin resistance (HOMAIR) (r=-0.39, p<0.01), after adjusting for age, sex, and adiposity. Multiple logistic regression analysis indicated that HOMA-IR was a significant predictor of having NAFLD (odds ratio [OR]=2.38; 95% confidence interval [CI]: 1.52-5.74), while adiponectin had a protective effect against NAFLD (OR=0.22; 95% CI: 0.09-0.55). We demonstrated that hypoadiponectinemia and insulin resistance are associated with NAFLD independent of obesity.

Medical needs of tsunami disaster refugee camps.

BACKGROUND AND OBJECTIVES: In response to the massive tsunami disaster in South Asia, two Korean medical relief teams provided emergency medical care in the southern coastal area of Sri Lanka. Their findings are reported here to provide a realistic picture of medical needs created by the tsunami disaster and to enable a better-prepared medical response to future disasters of this type. METHODS: All victims of the tsunami in the area of operation of the two medical relief teams were encouraged to receive medical care. Care provided to each victim was documented in individual medical records. All medical records were reviewed and classified by age, gender, and diagnosis. RESULTS: A total of 4,710 people were treated by the two Korean medical relief teams for 9 days of operation in southern Sri Lanka. Respiratory problems were common, but diarrhea was diagnosed in an average of only 4.3 patients per day. Minor skin trauma and wound infection in the extremities were frequent as long as 3 weeks after the disaster. The proportion of skin trauma in relation to total trauma decreased as days elapsed from the disaster. CONCLUSIONS: Because of the provision of adequate quantities of potable water, the likelihood of waterborne diarrhea was low. Acute respiratory problems and chronic problems were prevalent in tsunami refugee camps. Despite concerted international relief efforts, inadequate treatment of minor skin trauma and skin infections was evident.

Low serum cholesterol is correlated to suicidality in a Korean sample.

OBJECTIVE: The aim of this study was to examine further the association between low total serum cholesterol and suicidal behaviour. METHOD: We measured the serum cholesterol levels in 231 patients admitted to an emergency room following a suicide attempt, in 231 age-,sex- and diagnosis-matched non-suicidal psychiatric controls, and in 231 age- and sex-matched normal controls. The suicide attempt patients were divided into five grades according to the degree of injury. RESULTS: The mean total cholesterol level of the suicide attempt patients was significantly lower than that of the psychiatric and normal controls. When the suicide attempt patients and non-suicidal psychiatric controls were divided by diagnosis, this significant relationship held true for major depressive disorders and personality disorders, but not for schizophrenia and bipolar disorders. Cholesterol level and the severity of suicide attempt were inversely correlated. CONCLUSION: The results suggest that cholesterol level may serve as a marker for suicide risk. Possible explanations are discussed.