Pilot study of fractional microneedling radiofrequency for hidradenitis suppurativa assessed by clinical response and histology.

BACKGROUND: Hidradenitis suppurativa (HS) is a devastating chronic inflammatory skin disease with frequent recurrences. Various systemic treatments and procedures have been used but the efficacy of fractional microneedling radiofrequency (FMR) has not been reported. AIM: To evaluate the clinical and histological efficacy of FMR in the treatment of HS lesions. METHODS: An 8-week, prospective, split-body, unblinded study was conducted, which enrolled 10 adult patients with mild to moderate HS to receive 3 sessions of FMR treatment biweekly. HS severity was assessed using the number and type of lesions, HS Physician Global Assessment (HS-PGA) and the modified Sartorius score (mSS). Skin biopsies were performed on participants to assess change in inflammation before and after FMR. RESULTS: Severity of HS was significantly reduced on the FMR-treated side of the body, but not on the control side. Inflammatory HS lesions were significantly reduced after 4 weeks, while HS-PGA and mSS were significantly decreased after 6 weeks. Immunohistochemistry staining showed decreased expression of inflammatory markers including neutrophil elastases, interleukin (IL)-8 and IL-17, tumour necrosis factor-α, transforming growth factor-ß1 and matrix metalloproteinases. CONCLUSION: FMR may be a viable treatment option for mild to moderate HS.

Association of COVID-19 with skin diseases and relevant biologics: a cross-sectional study using nationwide claim data in South Korea.

BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic has spread, information about COVID-19 and skin disease or related biologics is still lacking. OBJECTIVES: To identify the association between COVID-19 and skin diseases or biologics. METHODS: A nationwide claim dataset relevant to COVID-19 in South Korea was analysed. This dataset included insurance claim data before and during COVID-19 treatment and clinical outcomes. Claim data related to skin diseases and relevant biologics were analysed to determine the association of COVID-19 with skin diseases and relevant biologics. RESULTS: The dataset contained a total of 234 427 individuals (111 947 male and 122 480 female) who underwent COVID-19 testing. Of them, 7590 (3·2%) were confirmed as having COVID-19, and 227 (3·0%) confirmed patients died. Among various skin diseases and biologics, no significant increase in the presence of specific skin diseases or exposure to biologics was observed in the COVID-19-positive group, even after adjusting for or matching covariates. The presence of skin diseases and exposure to biologics also did not seem to affect clinical outcomes including mortality. CONCLUSIONS: Underlying skin diseases did not appear to increase susceptibility to COVID-19 or mortality from COVID-19. Considering the risks and benefits, biologics for dermatological conditions might be continuously used during the COVID-19 pandemic.

Dermatologist-level classification of malignant lip diseases using a deep convolutional neural network.

BACKGROUND: Deep convolutional neural networks (DCNNs) can classify skin diseases at a level equivalent to a dermatologist, but their performance in specific areas requires further research. OBJECTIVE: To evaluate the performance of a trained DCNN-based algorithm in classifying benign and malignant lip diseases. METHODS: A training set of 1629 images (743 malignant, 886 benign) was used with Inception-Resnet-V2. Performance was evaluated using another set of 344 images and 281 images from other hospitals. Classifications by 44 participants (six board-certified dermatologists, 12 dermatology residents, nine medical doctors not specialized in dermatology and 17 medical students) were used for comparison. RESULTS: The outcomes based on the area under curve, sensitivity and specificity were 0·827 [95% confidence interval (CI) 0·782-0·873], 0·755 (95% CI 0·673-0·827) and 0·803 (95% CI 0·752-0·855), respectively, for the set of 344 images; and 0·774 (95% CI 0·699-0·849), 0·702 (95% CI 0·579-0·808) and 0·759 (95% CI 0·701-0·813), respectively, for the set of 281 images. The DCNN was equivalent to the dermatologists and superior to the nondermatologists in classifying malignancy. After referencing the DCNN result, the mean ± SD Youden index increased significantly for nondermatologists, from 0·201 ± 0·156 to 0·322 ± 0·141 (P < 0·001). CONCLUSIONS: DCNNs can classify lip diseases at a level similar to dermatologists. This will help unskilled physicians discriminate between benign and malignant lip diseases. What's already known about this topic? Deep convolutional neural networks (DCNNs) can classify malignant and benign skin diseases at a level equivalent to dermatologists. The lips are a unique feature in terms of histology and morphology. Previous studies of DCNNs have not investigated tumours on specific locations. What does this study add? This study shows that DCNNs can distinguish rare malignant and benign lip disorders at the same rate as dermatologists. DCNNs can help nondermatologists to distinguish malignant lip diseases. What are the clinical implications of this work? DCNNs can distinguish malignant and benign skin diseases even at specific locations such as the lips, as well as board-certified dermatologists. Malignant lip diseases are rare and difficult for less trained doctors to differentiate them from benign lesions. This study shows that in dermatology, DCNN can help improve decision-making processes for rare skin diseases in specific areas of the body.

Spatial distribution of mumps in South Korea, 2001-2015: identifying clusters and population risk factors.

In South Korea, the resurgence of mumps was noted primarily among school-aged children and adolescents since 2000. We analyzed spatial patterns in mumps incidence to give an indication to the geographical risk. We used National Notifiable Disease Surveillance System data from 2001 to 2015, classifying into three periods according to the level of endemicity. A geographic-weighted regression analysis was performed to find demographic predictors of mumps incidence according to district level. We assessed the association between the total population size, population density, percentage of children (age 0-19 years), timely vaccination rate of measles-mumps-rubella vaccines and the higher incidence rate of mumps. During low endemic periods, there were sporadic regional distributions of outbreak in the central and northern part of the country. During intermediate endemic periods, the increase of incidence was noted across the country. During high endemic period, a nationwide high incidence of mumps was noted especially concentrated in southwestern regions. A clear pattern for the mumps cluster shown through global spatial autocorrelation analysis from 2004 to 2015. The 'non-timely vaccination coverage' (P = 0·002), and 'proportion of children population' (P < 0·001) were the predictors for high mumps incidence in district levels. Our study indicates that the rate of mumps incidence according to geographic regions vary by population proportion and neighboring regions, and timeliness of vaccination, suggesting the importance of community-level surveillance and improving of timely vaccination.

Clinical applications of next-generation sequencing-based gene panel in patients with muscular dystrophy: Korean experience.

Muscular dystrophy (MD) is a genetically and clinically heterogeneous group of disorders. Here, we performed targeted sequencing of 18 limb-girdle MD (LGMD)-related genes in 35 patients who were highly suspected of having MD. We identified one or more pathogenic variants in 23 of 35 patients (65.7%), and a genetic diagnosis was performed in 20 patients (57.1%). LGMD2B was the most common LGMD type, followed by LGMD1B, LGMD2A, and LGMD2G. Among the three major LGMD types in this group, LGMD1B was correlated with the lowest creatine kinase (CK) levels and the earliest onset, whereas LGMD2B was correlated with the highest CK levels and the latest onset. Thus, next-generation sequencing-based gene panels can be a helpful tool for the diagnosis of MDs, particularly in young children and those displaying atypical symptoms.

Identification of novel mutations in the VPS33B gene involved in arthrogryposis, renal dysfunction, and cholestasis syndrome.

Arthrogryposis, renal dysfunction, and cholestasis (ARC) syndrome is an autosomal recessive disorder caused by mutations in the VPS33B and VIPAS39. Here, we report novel mutations identified in four patients with ARC syndrome. We analyzed the entire coding regions of the VPS33B and VIPAS39 genes by direct sequencing. To detect novel splice site mutations, mRNA transcripts were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and sequencing. All four patients had compound heterozygous variants in the VPS33B gene. One patient had a previously reported splice site variant with unknown significance, c.239+5G>A, and a novel nonsense mutation, c.621G>A. The other three patients had the c.403+2T>A mutation, and each of them carried one of the splice site variants, c.239+5G>A or c.499-11G>A. c.239+5G>A and c.499-11G>A created novel splice sites which resulted in abnormal transcripts. No significant VIPAS39 mutation was detected in all patients. In patients suspected with ARC syndrome, mutation analysis of the VPS33B gene should be employed as a primary diagnostic test before performing invasive testing procedures such as organ biopsies. Performing mRNA analysis can be useful in predicting the pathogenic phenotype when the mutation seems to affect a normal splicing mechanism.

A new surveillance indicator identifying optimal timeliness and accuracy: application to the Korean National Notifiable Disease Surveillance System for 2001-2007.

Although immediate notification of a case is crucial for epidemic control, clinicians may delay notification due to uncertainties in diagnosis, reflecting a trade-off between timeliness and the accuracy of surveillance. We assessed this trade-off for four epidemic-prone diseases that require immediate notification of suspected cases: shigellosis, typhoid fever, paratyphoid fever, and cholera in the Korean National Notifiable Disease Surveillance System data for 2001-2007. Timeliness was measured as the time to registration (T R), being the time interval from symptom onset to notification by the clinician to the local public health centre. We introduced a new index, 'time-accuracy trade-off ratio' to indicate time saved by clinical vs. laboratory-based notifications. Clinical notifications comprised 34.4% of total notifications, and these showed a shorter median T R than laboratory-based notifications (1-4 days). The trade-off ratio was greatest for shigellosis (3.3 days), and smallest for typhoid fever (0.6 days). A higher trade-off ratio provides stronger evidence for clinical notification without waiting for laboratory confirmation.

Radiological dimensions of the Eustachian tube in patients with adhesive otitis media.

OBJECTIVE: This study aimed to analyse the computed tomography parameters for effective ventilation in patients with adhesive otitis media. METHODS: Twenty-six patients with unilateral adhesive otitis media were included in the study. The patients' temporal bone computed tomography images were retrospectively reviewed. Eustachian tube length and diameter were measured. Mastoid pneumatisation and middle-ear size were evaluated by measuring petroclival and Eustachian tube-tympanic cavity ventilation angles. RESULTS: The average Eustachian tube length was 38.4 mm and 38.9 mm in adhesive otitis media and healthy ears, respectively. The Eustachian tube diameter of the adhesive otitis media ears (1.47 mm) was significantly narrower than that of the healthy ears (1.83 mm). There were no significant differences in the angles between adhesive otitis media and healthy ears. CONCLUSION: A narrow Eustachian tube diameter was associated with developing adhesive otitis media. Measuring Eustachian tube diameter is simple and can be routinely performed when examining temporal bone computed tomography images for Eustachian tube function evaluation.

Impact of BMI on the incidence of metabolic abnormalities in metabolically healthy men.

OBJECTIVES: Although the existence of metabolically healthy obese (MHO) individuals has been recognized, little is known regarding metabolic health status in these subjects over time. Thus, we evaluated longitudinal changes in metabolic parameters among MHO subjects compared with metabolically healthy, normal-weight (MHNW) subjects. METHODS: A cohort study was performed on 2599 Korean men, 30-59 years of age, with no evidence of fatty liver disease on ultrasound and no traits of metabolic syndrome at baseline. BMI was categorized based on criteria for Asian population. Study participants were followed annually or biennially between 2002 and 2009. At each visit, the fatty liver on ultrasound was assessed and metabolic abnormalities were measured. Parametric Cox models and a pooled logistic regression models were used to evaluate the relationships of BMI with incident metabolic abnormalities. RESULTS: During 9647.1 person-years of follow-up, 1673 participants developed metabolic abnormalities. After adjusting for age, smoking, alcohol intake and exercise, higher baseline BMI categories predicted increased incidences of metabolic abnormalities in a dose-response manner. The hazard ratios (95% confidence intervals) for hypertriglyceridemia, prediabetes, pre-hypertension, low high-density lipoprotein-cholesterol, fatty liver, elevated high sensitivity-C reactive protein, elevated homeostasis model assessment of insulin resistance, any metabolic abnormality and metabolic syndrome among the MHO subjects compared with the MHNW subjects were 1.51 (1.23-1.85), 1.43 (1.19-1.72), 1.79 (1.45-2.22), 1.80 (1.30-2.49), 2.69 (2.19-3.31), 1.39 (1.16-1.67), 2.90 (2.31-3.62), 1.68 (1.45-1.93) and 1.84(1.02-3.30), respectively. CONCLUSION: In this study, MHO individuals showed higher incidences of metabolic abnormalities compared with MHNW individuals. This suggests that initially MHO individuals undergo adverse metabolic changes associated with obesity over time.

Expression of CCL1 and CCL18 in atopic dermatitis and psoriasis.

BACKGROUND: Recent studies have shown that chemoattractive proteins play an important role in the organization of the innate and adaptive immune responses. There are some reports that chemokine (C-C motif) ligand (CCL)1 and CCL18, members of a family of chemoattractive proteins, have increased expression in atopic dermatitis (AD). AIM: To evaluate the quantity and pattern of CCL1 and CCL18 expression in lesions and blood of patients with AD, and compare them with those of patients with psoriasis. METHODS: Biopsy specimens were taken from atopic skin and normal-appearing skin of patients with AD and from the psoriatic skin only of patients with psoriasis. Quantitative real-time PCR analysis and immunohistochemistry of CCL1 and CCL18 expression were performed, and the quantities of expressed CCL1 and CCL18 in acute AD were compared with those of normal-appearing atopic skin and psoriatic skin. The serum level of CCL1 and CCL18 was assessed by ELISA. RESULTS: Expression of CCL1 mRNA and protein was significantly higher in the acute lesional skin of patients with AD than in their nonlesional skin or in the lesional skin of patients with psoriasis. Both CCL18 mRNA and protein were abundant in acute AD lesions and in psoriatic lesions, but were lower in the nonlesional skin of patients with AD. The serum levels of CCL1 and CCL18 were not different in patients with AD and patients with psoriasis. CONCLUSIONS: CCL1 is a chemokine that is associated with AD. Both CCL1 and CCL18 may play important roles in the initiation and progression of atopic skin inflammation.

Age-associated changes in nicotine dependence.

OBJECTIVES: Nicotine is the primary factor responsible for tobacco dependence among individuals who smoke. Nicotinic receptors and nicotine-associated metabolism, two significant aspects of nicotine dependence, are influenced by age. To date, however, the relationship between age and nicotine dependence has not been investigated. STUDY DESIGN: Cross-sectional. METHODS: Data were obtained from the national smoking cessation programme for South Korea. Data obtained from current smokers in 2008 (n = 338,566) were used as baseline measures. Nicotine dependence was determined by the Fagerström Test for Nicotine Dependence (FTND). Cigarettes per day (CPD) and FTND were the dependent variables. As CPD is a major component of FTND, scores on the FTND minus scores related to CPD were also used as a dependent variable. The relationships between age and the dependent variables (FTND, CPD, partial FTND) were investigated. Quadratic regression models were used to test the non-linear relationship between age and nicotine dependence after adjusting for other covariates. RESULTS: Analyses relying on nicotine dependence (FTND and partial FTND scores) and CPD produced similar results in relation to age. Specifically, the values of all three dependent variables increased with age until approximately 50 years of age, at which point they decreased. Additionally, nicotine dependence and CPD were associated with age of smoking initiation, smoking duration, alcohol-related problems, body mass index and residential area. After adjusting for other nicotine-dependence-related factors, the linear and quadratic terms of age were statistically significant in the multiple regression models. CONCLUSIONS: In the present study, both nicotine dependence and CPD displayed an inverse U-shaped relationship with age, with a significant peak at 50 years of age. The results suggest that tobacco control policies should target issues related to nicotine dependence according to age group.

Clinical analysis of acute peripheral facial palsy in older adults.

OBJECTIVE: Acute facial palsy is a consequence of various diseases, with the number of patients increasing with advancing age. This study aimed to analyse the clinical characteristics of acute peripheral facial palsy in older adults. METHODS: A total of 30 patients with a mean age of 68.4 ± 9.1 years were included in the study. All patients received a standardised investigation and follow up. The hospital charts of the patients with acute facial palsy were reviewed retrospectively. RESULTS: The predominant causes of acute facial palsy in older adults were: Bell's palsy, Ramsay Hunt syndrome, trauma, otitis media and malignancy. At baseline, complete and incomplete facial palsies were seen in 26.7 per cent and 73.3 per cent of patients, respectively. The overall rates of good recovery, partial recovery and no recovery were 66.7 per cent, 10 per cent and 23.3 per cent, respectively. Increased age led to a significantly lower level of recovery in older adults. CONCLUSION: Bell's palsy and Ramsay Hunt syndrome were the most common aetiologies of acute facial palsy in older adults, and such patients are likely to have incomplete recovery. Active early treatment is necessary for achieving good outcomes in older adults.

Metabolic syndrome and cancer-related mortality among Korean men and women.

BACKGROUND: We examined the association between the metabolic syndrome and cancer mortality in Koreans. MATERIALS AND METHODS: This study included 42 336 men and 32 168 women aged > or =20 years who took health examination and were followed up for 5.6 years. Mortality data were analyzed according to the metabolic syndrome. RESULTS: The relative risk (RR) and 95% confidence interval (CI) of cancer mortality in subjects with metabolic syndrome compared with subjects without metabolic syndrome was 1.41 (1.08-1.84) after adjustment for possible confounding factors. The association is significant only among men [RR 1.52 (1.10-2.10)], but not among women. The RRs and 95% CIs for cancer deaths in subjects with elevated body mass index, blood pressure, fasting glucose, and triglycerides were 1.36 (1.07-1.71), 1.34 (1.07-1.69), 1.45 (1.14-1.86), and 1.60 (1.26-2.02) after mutual adjustment, respectively. Upon increasing the number of metabolic risk factors to 1, 2-3, and 4-5, the RRs and 95% CIs of death from cancer were 1.32 (0.83-1.48), 1.47 (1.10-1.96), and 2.42 (1.25-4.68), respectively, with a graded fashion (P for trend < 0.005). CONCLUSION: Our results indicate that metabolic syndrome is a risk factor for cancer-related death in Korean adults. Prevention and management of the metabolic syndrome would be needed to reduce cancer mortality.

Weight gain within the normal weight range predicts ultrasonographically detected fatty liver in healthy Korean men.

OBJECTIVES: We performed a prospective study to determine whether weight gain predicts future ultrasonographically detected fatty liver (USFL) in a lean adult population. METHODS: Among 15,347 Korean male workers, aged 30-59 years, who participated in a health check-up programme in 2002, a USFL-free cohort of 4246 non-diabetic men was followed until September 2007. Alcohol consumption was assessed by a questionnaire. Weight change for each subject was calculated as the difference between baseline and subsequent measurements. Biochemical tests for liver and metabolic function were done. The primary outcome was ultrasound-diagnosed fatty liver. A standard Cox proportional hazards model and time-dependent Cox model were performed. RESULTS: During 16,829.7 person-years of follow-up, 622 participants developed USFL. After adjusting for age, the period from visit 1 to visit 2, BMI, HDL-C, triglyceride, uric acid, alanine aminotransferase, and HOMA-IR, the risk for USFL increased with increasing quartiles of weight change (p for trend <0.001). This association remained significant when weight change and covariates, except age and the period from visit 1 to visit 2, were modelled as time-dependent variables. Subjects in the fourth quartile (weight gain > or =2.3 kg) were at significantly elevated risk for USFL (adjusted hazard ratio (aHR), 1.26; 95% CI, 1.01 to 1.58). These associations did not change, even in normal weight men with a baseline BMI between 18.5 and 22.9 kg/m(2) (n = 2186). CONCLUSION: Weight gain per se appears to increase the risk for developing USFL. Thus, avoiding weight gain, even among lean adult individuals, can be helpful in preventing this disease.

Secular trends in adult male smoking from 1992 to 2006 in South Korea: age-specific changes with evolving tobacco-control policies.

OBJECTIVES: For years, South Korea has had one of the highest levels of tobacco use among males in the world, but a steady decline has been observed recently. This study examined how the smoking behaviour of male adults changed with age after the implementation of national tobacco control policies in 1995. STUDY DESIGN: Repeated cross-sectional study using a national survey. METHODS: Data were obtained from the 1992, 1995, 1999, 2003 and 2006 results of a repeated cross-sectional survey, the Social Statistics Survey. The smoking status of adult men was compared before (1992 and 1995 surveys) and after (1999, 2003 and 2006 surveys) the implementation of government-directed tobacco control policies using graphical methods and logistic regression analysis. RESULTS: After the implementation of tobacco control policies, the percentage of current male smokers decreased while the percentage of former smokers increased markedly. Smoking prevalence among older men (aged 50 years or more) reduced initially, and this decline was more pronounced after the tobacco control policies were implemented. Smoking prevalence in younger men (aged 30-49 years) declined in 2003 when more comprehensive tobacco control policies were implemented. CONCLUSIONS: This study suggests that comprehensive tobacco control policies in South Korea reduced smoking prevalence among males, initially among older men and later among both older men and younger men.

Changes in metabolic syndrome of Korean children and adolescents in the period 1998 to 2001.

The aim of this study was to compare the prevalence and pattern of metabolic syndrome in children and adolescents in the interval between the Korean National Health and Nutrition Examination Surveys (KNHANES) in 1998 and 2001. Two nationwide surveys (KNHANES) were conducted in Korea in 1998 and 2001. A stratified multistage probability sampling design was used to ensure representation of the entire Korean population. The National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III)-derived definition was used for the definition of metabolic syndrome. A total of 1763 (mean age+/-SD of 14.6+/-2.8 yr) and 1245 (14.1+/-2.8 yr) Korean children and adolescents in the age range 10-19 yr participated in the studies of 1998 and 2001, respectively. The prevalence of metabolic syndrome in male children and adolescents increased significantly from 5.7% in 1998 to 9.0% in 2001. However, there was no increase in females (5.1% in 1998 and 4.9% in 2001). Of the 5 components of metabolic syndrome, low HDL-cholesterolemia showed the highest increase in males and females during the 3 yr. Hypertriglyceridemia increased next in both genders. In contrast, the proportion of female subjects meeting the fasting glucose criterion decreased over the same period. As dyslipidemia was the principal contributor to the increase in metabolic syndrome in Korean male children and adolescents during the 3 yr, a strategy of dietary pattern change and the encouragement of physical activity should be introduced to these groups at a national level.