Image findings of anti-neutrophil cytoplasmic antibody-associated vasculitis involving the skull base.

AIM: To investigate computed tomography (CT) and magnetic resonance imaging (MRI) features of skull bases involving anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). MATERIALS AND METHODS: A retrospective review was undertaken to identify an institutional historical cohort of 17 patients with confirmed AAV who underwent CT or MRI and had skull base involvement between 2002 and 2021. Two radiologists reviewed the extent and features of the lesions, bone changes, and other MRI findings. RESULTS: A total of 17 patients (12 men; mean age ± standard deviation, 46.5 ± 17.1 years) were selected. AAV presented as infiltrative lesions with involvement at various sites. Most cases involved the paranasal sinuses (PNS; 88%, 15/17), nasopharynx (88%, 15/17), pterygopalatine fossa (82%, 14/17), and parapharyngeal space (82%, 14/17), frequently accompanied by mucosal irregularity of the PNS and nasopharynx (71%, 12/17). Central skull base and temporal bone involvement were seen in 53% (9/17) and 38% (6/16) of cases, respectively. On T1-weighted imaging (WI) and T2WI MRI, all lesions (15/15) showed predominant signal iso-intensity to grey matter. CONCLUSIONS: Although radiological findings of AAV are non-specific and skull base involvement is less common, AAV may be considered if infiltrative lesions predominantly involving the PNS, nasopharynx, pterygopalatine fossa, and parapharyngeal space with combined bone changes of skull base are seen.

An objective skin-type classification based on non-invasive biophysical parameters.

BACKGROUND: Despite the invention of various non-invasive bioengineering tools, skin-type analysis has largely been based on subjective assessments. However, advancements in the functional cosmetic industry and artificial intelligence-assisted dermatology are creating a greater demand for an objective skin-type classification system. OBJECTIVES: To propose an objective skin-type classification system solely based on non-invasive, bioengineering devices; provide reference values applicable to the Korean population; and compare our reference values with those of published studies. METHODS: Biophysical parameter measurements were obtained from the 2018 International Skin Characteristics Data Bank Project conducted by the Foundation of Korea Cosmetic Industry Institute. The participants were 434 healthy South Korean adults. Each participant was assessed using eight bioengineering devices (Tewameter® , pH-meter® , Corneometer® , Sebumeter® , Cutometer® , Spectrophotometer® , PRIMOS® lite, and Janus® ). The measurements were divided into tertiles to determine reference points. RESULTS: Our objective skin-type classification consists of five main categories (sensitivity, hydration, oiliness, elasticity, and skin tone) and five corresponding subcategories (erythema, roughness, pores, wrinkles, and pigmentation, respectively). Each skin type was assigned based on the reference point of the biophysical parameter, which was established as the tertile value associated with 'unfavourable' skin characteristics. Individuals were categorized as having sensitive skin when the TEWL scores were over 18.0 g/m2 /h or the pH was over 5.45; dehydrated skin when the corneometric value measured below 47.17 A.U.; oily skin when the sebumetric value exceeded 70 µg/cm2 ; and loose skin when the cutometric R2 value was below 0.68 E/mm. CONCLUSIONS: This study is the first to provide a comprehensive skin-type classification system based solely on non-invasive biophysical parameters. As measurement data accumulate, the reference points will progress to become more accurate, and they will be subdivided according to gender, age, and ethnic group. Therefore, our classification system serves as a basis for artificial intelligence-based skin-type analysis.

PIN1 is a new therapeutic target of craniosynostosis.

Gain-of-function mutations in fibroblast growth factor receptors (FGFRs) cause congenital skeletal anomalies, including craniosynostosis (CS), which is characterized by the premature closure of craniofacial sutures. Apert syndrome (AS) is one of the severest forms of CS, and the only treatment is surgical expansion of prematurely fused sutures in infants. Previously, we demonstrated that the prolyl isomerase peptidyl-prolyl cis-trans isomerase interacting 1 (PIN1) plays a critical role in mediating FGFR signaling and that Pin1+/- mice exhibit delayed closure of cranial sutures. In this study, using both genetic and pharmacological approaches, we tested whether PIN1 modulation could be used as a therapeutic regimen against AS. In the genetic approach, we crossbred Fgfr2S252W/+, a mouse model of AS, and Pin1+/- mice. Downregulation of Pin1 gene dosage attenuated premature cranial suture closure and other phenotypes of AS in Fgfr2S252W/+ mutant mice. In the pharmacological approach, we intraperitoneally administered juglone, a PIN1 enzyme inhibitor, to pregnant Fgfr2S252W/+ mutant mice and found that this treatment successfully interrupted fetal development of AS phenotypes. Primary cultured osteoblasts from Fgfr2S252W/+ mutant mice expressed high levels of FGFR2 downstream target genes, but this phenotype was attenuated by PIN1 inhibition. Post-translational stabilization and activation of Runt-related transcription factor 2 (RUNX2) in Fgfr2S252W/+ osteoblasts were also attenuated by PIN1 inhibition. Based on these observations, we conclude that PIN1 enzyme activity is important for FGFR2-induced RUNX2 activation and craniofacial suture morphogenesis. Moreover, these findings highlight that juglone or other PIN1 inhibitors represent viable alternatives to surgical intervention for treatment of CS and other hyperostotic diseases.

Diagnostic performance of MRI to detect metastatic cervical lymph nodes in patients with thyroid cancer: a systematic review and meta-analysis.

AIM: To evaluate the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of metastatic cervical lymph nodes. MATERIALS AND METHODS: Ovid-MEDLINE and EMBASE databases were searched up until 12 June 2018. Eleven articles were included in the qualitative systematic review and nine of the 11 in the quantitative analysis. Two radiologists independently performed data extraction and methodological quality assessment using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A qualitative systematic review and quantitative analysis were performed, followed by a meta-regression analysis to determine factors causing heterogeneity. RESULTS: The pooled sensitivity and specificity in the diagnosis of metastatic cervical lymph nodes were 80% (95% confidence interval [CI]: 68-88%) and 85% (95% CI: 63-95%), respectively. The sensitivity and false-positive rate (correlation coefficient, 0.655) showed a positive correlation due to a threshold effect, which was responsible for heterogeneity across the studies, as indicated by a Q-test (p<0.01) and Higgins I2 statistic (sensitivity, I2=90.11%; specificity, I2=92.49%). In the meta-regression analysis, fat-suppressed imaging, and the analysis method were significant factors influencing the heterogeneity in diagnostic performance. CONCLUSIONS: MRI shows moderate diagnostic performance in the diagnosis of metastatic lymph nodes in patients with thyroid cancer in the neck. MRI may be an optional or complementary imaging method to ultrasound or computed tomography (CT) in thyroid cancer patients.

High-resolution MRI using compressed sensing-sensitivity encoding (CS-SENSE) for patients with suspected neurovascular compression syndrome: comparison with the conventional SENSE parallel acquisition technique.

AIM: To retrospectively compare sensitivity encoding (SENSE) and compressed sensing-sensitivity encoding (CS-SENSE) for high resolution (HR) cranial nerve magnetic resonance imaging (MRI) in a clinical population. MATERIAL AND METHODS: Twenty consecutive patients who were clinically suspected of neurovascular compression syndrome (NVCS) were enrolled in this study. HR three-dimensional isotropic T2-weighted fast spin-echo (T2 VISTA) sequences with SENSE or CS-SENSE, and contrast-enhanced three-dimensional T1-turbo field-echo (CE 3D T1 TFE) with SENSE or CS-SENSE, were compared using quantitative and qualitative methods by two board-certified neuroradiologists. RESULTS: For the T2 VISTA, CS-SENSE was significantly superior to SENSE in terms of cerebrospinal fluid homogeneity. For CE 3D T1 TFE, CS-SENSE was significantly superior to SENSE in terms of the existence of ghost artefact and the signal-to-noise ratio (SNR) of the pontine parenchyma. There was no significant difference in overall image quality between the two techniques. Compared with SENSE, CS-SENSE reduced the scan time to 44.2% of that with SENSE on T2 VISTA, and to 66.1% of that with SENSE of the CE 3D T1 TFE, with the differences being statistically significant (p<0.01, both). CONCLUSION: For T2 VISTA and CE 3D T1 TFE imaging of patients with suspected NVCS, CS-SENSE appears to offer superior reductions in motion artefact and scan time relative to SENSE, without a loss of overall image quality.

Are patients with mild to moderate renal impairment on metformin or other oral anti-hyperglycaemic agents at increased risk of contrast-induced nephropathy and metabolic acidosis after radiocontrast exposure?

AIM: To investigate whether the use of metformin during computed tomography (CT) with radiocontrast agents increases the risk of contrast-induced nephropathy (CIN) and metabolic acidosis after CT in type 2 diabetes patients with mild to moderate renal failure. MATERIALS AND METHODS: Patient records from January 2015 to December 2017 were reviewed retrospectively. A total of 374 patients were included in the final analysis. Of them, 157 patients received metformin, and 217 patients were taking other oral hypoglycaemic agents (OHAs) during radiocontrast administration. RESULTS: No significant difference in CIN incidence was observed between the metformin use group and the other OHAs group (p=0.085). Metabolic acidosis after CT was seen in 91 (58%) patients who used metformin and 141 (65%) patients who were taking other OHAs. There was no relationship between metabolic acidosis after CT and the use of metformin (p=0.195). Metabolic acidosis after radiocontrast agent exposure was associated with malignant disease, low serum albumin level, and low serum total CO2 level at baseline. CONCLUSION: These data show that other factors, but not metformin use, are associated with metabolic acidosis after radiocontrast agent exposure in patients with reduced renal function. These data support current recommendations that there is no need to discontinue metformin before CT using radiocontrast agents in patients with mild to moderate renal failure.

Human skin-depigmenting effects of resveratryl triglycolate, a hybrid compound of resveratrol and glycolic acid.

OBJECTIVES: Resveratryl triglycolate (RTG) is a hybrid compound derived by the esterification of resveratrol with glycolic acid. This compound has been previously shown to inhibit cellular melanin synthesis in vitro. This study aimed to examine the in vivo skin-depigmenting efficacy of RTG in human participants. METHODS: In total, 22 women aged between 25 and 49 years with Fitzpatrick skin type III or IV were enrolled. Their forearms were exposed to UV to induce artificial pigmentation. The test product containing 0.4% RTG or the control product was applied twice daily for up to 8 weeks after the artificial pigmentation. The participants visited the research centre every 2 weeks and were subjected to skin assessments. RESULTS: Visual assessment of pigmentation degree and instrumental analysis of melanin index, skin lightness (L* value) and skin colour (individual typology angle, ITAo ) indicated enhanced depigmentation of the skin in the test group, compared with the control group, in Weeks 6 and 8 (P < 0.05). No adverse skin reactions were observed in any of the participants during the entire test. CONCLUSION: This study demonstrated the skin-depigmenting effects of RTG in human participants.

Interobserver reproducibility of maximal axial diameter and tumour volume measurements from CT of patients with head and neck squamous cell carcinoma.

AIM: To evaluate the interobserver reproducibility of computed tomography (CT) measurements of maximum tumour diameter and tumour volume for head and neck squamous cell carcinoma. MATERIALS AND METHODS: Eighty consecutive patients who underwent neck CT for the initial evaluation of head and neck squamous cell carcinoma were included in this retrospective study. Two radiologists independently measured the maximal axial diameter and volume of tumours. The reproducibility between the two observers was assessed using 95% Bland-Altman limits of agreement, reproducibility coefficient, within-subject coefficient of variation, and intraclass correlation coefficient with subgroup analysis according to tumour location. Logistic regression analysis was performed to identify the risk factors for high variability in tumour volume. RESULTS: The 95% limits of agreement for maximal axial diameter and tumour volume were ±22.3% and ±42.8%, respectively. The within-subject coefficient of variation and reproducibility coefficient were 7.9% and 0.564 for maximal axial diameter and 22.9% and 5.069 for tumour volume. All intraclass correlation coefficients for maximal axial diameter and tumour volume demonstrated excellent agreement (all intraclass correlation coefficients >0.9). Peritumoural infiltration (odds ratio: 7.189; confidence interval: 1.815-28.469; p=0.005) was an independent risk factor for high interobserver variability. CONCLUSION: Changes in maximum axial diameter and tumour volume of <22.3% and 42.8%, respectively, were in the range of measurement error on CT. The presence of peritumoural infiltration on CT increases the error in tumour volume measurement.

Risk of malignancy according to sub-classification of the atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS) category in the Bethesda system for reporting thyroid cytopathology.

OBJECTIVE: According to the Bethesda System for Reporting Thyroid Cytopathology, atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a heterogeneous category that includes cases with architectural and/or nuclear atypia insufficient to warrant classification as malignant neoplasms. The ambiguous and descriptive characteristics of the AUS/FLUS category mean that the impact of the present guidelines on repeat fine needle aspiration (FNA) is unclear. The present study reclassified AUS/FLUS cases into four sub-categories and then correlated them with histological or cytological follow-up data to clarify the risk of malignancy. METHODS: Ninety-four cases of AUS/FLUS with available follow-up data were reviewed and assigned to one of four sub-categories: (i) AUS-N (nuclear atypia); (ii) AUS-A (architectural atypia); (iii) AUS-O (predominant oncocytic changes); and (iv) AUS-N/A (both nuclear and architectural atypia). The four sub-categories were correlated with subsequent histological or cytological follow-up data, including core needle biopsy, resection, or repeat FNA. RESULTS: Malignancy was identified in 34 of 94 cases (36.2%). The upper limit estimate for malignancy was 43.6%, and the lower limit estimate was speculated as 9.8%. The malignancy rate was highest in cases within the AUS-N sub-category (65.8%, range 16.6%-78.1%). CONCLUSIONS: The present study suggests that cases in the AUS/FLUS category have a higher risk of malignancy than previously thought. Because of the heterogeneous nature of the AUS/FLUS category, further sub-classification might be more effective in achieving appropriate risk stratification and better clinical management.

The association between use of metformin and change in serum CO2 level after administration of contrast medium.

AIM: To evaluate the changes in serum creatinine and total CO2 levels in patients receiving metformin during administration of contrast medium. MATERIALS AND METHODS: Patient records from January 2012 to December 2012 after the administration of contrast medium were reviewed retrospectively. A total of 924 patients were included for the final analysis. Of them, 105 received metformin during contrast medium administration, 112 were taking other oral hypoglycaemic agents, and 707 patients were not diabetic (controls). RESULTS: No significant change in total CO2 levels was detected (p=0.678). Metabolic acidosis was present in 33 (31.4%) metformin users, 31 (28.6%) other oral hypoglycaemic agent users, and 153 (21.6%) control patients. In the present logistic regression analysis, age, baseline levels of creatinine, and total CO2 levels were associated with metabolic acidosis after contrast medium exposure. CONCLUSION: These data indicate the presence of a coexisting risk factor, other than metformin use, associated with metabolic acidosis after contrast medium exposure. No relationship was found between the use of metformin and metabolic acidosis during contrast medium exposure.

Ethanol and/or radiofrequency ablation to treat venolymphatic malformations that manifest as a bulging mass in the head and neck.

AIM: To evaluate the efficacy of ultrasound (US)-guided ethanol ablation (EA) and radiofrequency ablation (RFA) for treating venolymphatic malformations (VLM) of the head and neck. MATERIALS AND METHODS: US-guided EA and/or RFA were performed on 17 patients with VLM of the head and neck. Computed tomography (CT) or magnetic resonance imaging (MRI) was used to locate the cranial nerves and salivary gland ducts that were close to targets, and these were avoided during the procedures. Treatment response was assessed using volume reduction and cosmetic grading scoring. RESULTS: Nine VLMs were located close to the functional structures: Stensen's duct (n=3), cranial nerve branch (n=3), or both (n=3). All patients demonstrated >50% volume reduction, except one patient with a microcystic lymphatic malformation that was abutting the facial nerve. Median cosmetic grading scores improved from 4 to 1 (p<0.001). CONCLUSION: US-guided EA and/or RFA are effective and safe treatment methods in patients with VLMs of the head and neck. Treatment selection of EA and/or RFA could be performed based on the composition of VLMs as assessed at CT and MRI.

Interobserver reproducibility of cervical lymph node measurements at CT in patients with head and neck squamous cell carcinoma.

AIM: To determine the interobserver reproducibility of measuring cervical lymph nodes at computed tomography (CT) in patients with head and neck squamous cell carcinoma (HNSCC) and to investigate the influence of finding extracapsular spread (ECS) at CT on measurement reliability. MATERIALS AND METHODS: The institutional review board approved the study protocol, and informed consent was obtained. A total of 146 patients with 224 suspicious lymph nodes underwent CT before treatment. Two observers independently measured the diameters (minimal axial, maximum axial, and maximum longitudinal diameter) and assessed the ECS using CT. The greatest diameter was defined as the largest among the three measured diameters. Interobserver variability was determined by the within-subject coefficient of variation, and interobserver agreement was determined by the intraclass correlation coefficient (ICC). RESULTS: The within-subject coefficients of variation were 7.8%, 7.6%, and 11.4% for the minimal axial, maximum axial, and greatest diameters, respectively. The ICC values for interobserver agreement were excellent for all diameter measurements (i.e., ICC >0.9). Minimum and maximum axial diameter measurements were statistically more reliable than the greatest diameter measurement (p=0.008 and p=0.0001, respectively). The presence of ECS on CT does not significantly affect the reliability of lymph node diameter measurements (p>0.05). CONCLUSION: Lymph node diameter measurement on CT is a highly reproducible and robust method. Additionally, imaging features of ECS do not affect reliability. Therefore, the measurement of lymph node diameter can be confidently performed in daily clinical practice or clinical trials.

Twelve-point scale grading system of scanning electron microscopic examination to investigate subtle changes in damaged hair surface.

BACKGROUND: To assess the hair surface condition, scanning electron microscope (SEM) is commonly used and it remains an indispensable hair morphology characterization technique. Yet, the technique is criticized for having subjective viewpoints and limitations in distinguishing the appearance of cuticle layers. OBJECTIVES: The aim of this study is to establish an objective classification system and also to subdivide by detailed description of damaged cuticle layers. METHODS: Hair samples were collected from female subjects (n = 500) who participated in hair efficacy study and Asian hair bunches (n = 180) that were previously collected. Damage to hair was initiated by chemical, heat stress and ultraviolet irradiation. We suggested the grading criterion on a 12-point scale and compared with a wide range grading system on a 5-point scale. We evaluated other hair surface-related parameters such as hair luster-ring and combing load to verify the validity and efficacy of our new grading system. RESULTS: The grading criterion on our 12-point scale revealed an improved discrimination compared to the wide range grading system. Hair surface-related parameters were significantly improved after hair care product, and these tendencies were likely to be determined to be similarly improved using the 12-point scale grading system. CONCLUSION: The 12-point scale classification system was demonstrated to be a more precise standardization and appropriate evaluation method to investigate the subtle distinction of the hair shaft after hair care product application.

Analysis of comedone, sebum and porphyrin on the face and body for comedogenicity assay.

BACKGROUND/PURPOSE: Many ingredients used in cosmetics evoke a comedogenic response. Rabbit ear model (REM) is a useful method that can replace human in examining materials and products in early developmental stage. However, a number of studies pointed out its disadvantage that it overreacts to comedogenic materials. The purpose of this study was to find the most appropriate region for evaluating comedogenicity in human skin. METHODS: Sixty-six female subjects (age 32.48 ± 10 years; range 20-52 years) with mild to moderate facial acne lesions were included in this study. The whole face, upper chest, and back of volunteers were photographed. Lesion (closed and open comedones) counting, instrumentation of sebum secretion level, and analysis of porphyrin number were performed. The entire study was performed under environmental conditions of specific relative temperature and humidity, controlled and maintained identically for each volunteer. RESULTS: In case of closed comedone, forehead showed a significant correlation with frontal cheek, lateral cheek, chin, and upper back. Meanwhile, significant correlations were observed between frontal cheek and chin as well as lateral cheek and chest. As for open comedone, forehead showed a significant correlation with chin site. A significant correlation was also observed between front cheek and lateral cheek as well as between upper chest and back. Analyzing the correlation between the occurrence of comedones and sebum in each region, a significant correlation between closed comedone and sebum was observed in frontal and lateral cheek. Analyzing the correlation between the occurrence of comedones and porphyrine in each region, a significant correlation between open comedone and porphyrin was observed in chin. CONCLUSION: When evaluating the comedogenicity of cosmetics ingredients or products, this study recommends using both of the methods of testing on back and directly testing on face according to the characteristics of the materials. In case of mild potent ingredients or products in particular, verification through usability test that the directly test on face will help securing reliability.

Facial skin physiology recovery kinetics during 180 min post-washing with a cleanser.

BACKGROUND/PURPOSE: Facial cleansing is important to clean and exfoliate the skin while maintaining optimal physiologic function. However, there is insufficient data on the very early stage of skin change after applying soap or cleansing foam. We investigated the recovery kinetics of facial skin physiology during 180 min after exposure to the cleanser. METHODS: For the study, 22 Korean female subjects with normal and dry to oily skin type were recruited in this study. Study subjects were required to have face washing done within the 12 hours prior to visiting the research center, with only toner, lotion, or cream applied. The next day, the subjects visited the research center without face washing. We evaluated the skin hydration (Corneometer(®) CM 825), sebum (Sebumeter(®) SM 815), transepidermal water loss (Tewameter(®) TM 300), and pH (Skin-pH-Meter(®) PH 905) to define recovery kinetics of facial skin physiology during 180 min exposure post-cleansing. RESULTS: Skin hydration, sebum, and TEWL were significantly decreased at 20 min after washing, as compared to the baseline (P < 0.05). And skin hydration returned at 40 min, and skin sebum and TEWL returned at 120 min after washing. However, skin pH did not show significant differences at all times points. CONCLUSIONS: This study indicated that each of the skin parameters was restored at defined time points post-cleansing. Our result could be a useful reference to set the resting time in the estimation of skin bioengineering parameters.

Spinal Accessory Nerve: Ultrasound Findings and Correlations with Neck Lymph Node Levels.

Purpose: To evaluate the ultrasound characteristics of the spinal accessory nerve (SAN) and correlate nerve location with neck lymph node level. Materials and Methods: 50 participants with 100 SANs were enrolled in this study. The SAN was traced from the trapezius muscle to the upper neck and was identified by a hypoechoic linear structure without color Doppler flow. The ultrasound characteristics of the SAN, such as visibility, diameter, relationship with adjacent structures, and its correlation with lymph node levels, were evaluated. Results: The SAN was identified in 96 %-100 % of segments. The mean diameter of the SAN was 0.54 ±â€Š0.09 mm. The SANs was located between the trapezius and levator scapulae muscles and 90.8 % were traced into the trapezius muscle. In the upper neck, the SAN passed deep into the sternocleidomastoid (SCM) muscle in 38 % of cases and between the two heads of the SCM muscle in 62 % of cases. The SAN was found at neck lymph node levels II, III, IV, and V, but not I or VI. Conclusion: Continuous ultrasound monitoring of the SAN and its correlation with lymph node levels is possible in most patients. Our current findings may assist in the future prevention of SAN injury during ultrasound-guided procedures.

Impact of chemical peeling combined with negative pressure on human skin.

OBJECTIVE: In vivo changes in skin barrier function after chemical peeling with alpha hydroxyacids (AHAs) have been previously reported. However, the additional effects of physical treatment with chemical agents on skin barrier function have not been adequately studied. This study measured the degree of acute skin damage and the time required for skin barrier repair using non-invasive bioengineering methods in vivo with human skin to investigate the additional effect of a 4% AHA chemical jet accelerated at supersonic velocities. METHODS: Thirteen female subjects (average age: 29.54 ± 4.86 years) participated in this study. The faces of the subjects were divided into half according to the block randomization design and were then assigned to receive AHA peeling alone or AHA peeling combined with pneumatic pressure on each side of the face. Transepidermal water loss (TEWL), skin colour and skin blood flow were evaluated at baseline and at 30 min, 2, 5 and 7 days after treatment. RESULTS: The TEWL and skin blood flow were significantly increased after 30 min in chemodermabrasion compared with chemical peeling alone (P < 0.05). The TEWL and skin blood flow recovered to baseline after 2 days, and TEWL was significantly decreased at 7 days compared with chemical peeling alone (P < 0.05). CONCLUSIONS: Chemodermabrasion can temporarily impair skin barriers, but it is estimated that it can enhance the skin barrier function after 7 days compared to the use of a chemical agent alone. In addition, chemodermabrasion has a more effective impact in the dermis and relatively preserves the skin barrier.

Ethanol ablation of predominantly cystic thyroid nodules: evaluation of recurrence rate and factors related to recurrence.

AIM: To evaluate recurrence rate and associated risk factors for recurrence after ethanol ablation (EA) in patients with predominantly cystic thyroid nodules. MATERIALS AND METHODS: This observational study was approved by the Ethics Committee of the Institutional Review Board and informed consent for procedures was obtained. From April 2009 to April 2013, 107 consecutive patients with predominantly cystic nodules were treated using EA. Recurrence was defined as nodules showing a residual solid portion with internal vascularity, cosmetic problems remaining, or persistent symptoms, and patients who requested additional therapy to resolve their symptomatic or cosmetic problems. Delayed recurrence was defined as treated nodules that showed no recurrent features at 1 month, but showed newly developed recurrent features during the longer follow-up period. Multivariate analysis was used for variables to demonstrate the independent factors related to volume reduction. RESULTS: One month after EA, 18.7% of patients (20/107) showed recurrence. Among 87 patients with non-recurrence, 24.1% (21/87) showed delayed recurrence. The total recurrence rate was 38.3% (41/107). Patients with recurrence (n = 41) were treated using radiofrequency ablation (n = 28), second EA (n = 4), and refused further treatment (n = 9). These patients responded well to repeat EA and radiofrequency ablation. Multivariate analysis demonstrated that the initial nodule volume (>20 ml; p < 0.036) and vascularity (grade >1; p < 0.049) were independent predictors of volume reduction at last follow-up. CONCLUSIONS: The results revealed that although EA seemed to be effective during the initial period, delayed recurrence should be considered during longer-term follow-up. The independent predictors of recurrence were initial volume (>20 ml) and vascularity.

The seasonal variation in skin hydration, sebum, scaliness, brightness and elasticity in Korean females.

BACKGROUND/PURPOSE: Age, gender, regional, and ethnic differences influence skin conditions. The purpose of this study was to observe the effects of environments, especially the air temperature, relative humidity, air pressure, duration of sunshine, and precipitation on skin, and the seasonal variation in skin hydration, sebum, scales, brightness, and elasticity in Korean females. METHODS: The study included 89 Korean subjects, aged 29.7 ± 6.2 years. The five skin biophysical parameters (skin hydration, sebum, scales, brightness, and elasticity) were measured at six sites: forehead, under the eye, frontal cheek, crow's foot, lateral cheek, and inner forearm. Skin hydration was measured using the Corneometer® CM 825. Skin sebum was measured with Sebumeter® SM 815. Skin scaliness was measured with Visioscan® VC 98. Skin brightness (L* value) was measured by using Spectrophotometer. A suction chamber device, Cutometer® MPA 580, was used to measure the skin elasticity. The measurements were performed every month for 13 months, from April 2007 to April 2008. RESULTS: There were significantly seasonal variations in environmental factors. The air temperature was the lowest in January (-1.7°C), and the highest in August (26.5°C). The relative humidity was the lowest in February (46%), and the highest in July and August (75%). There was a negative correlation between skin scaliness and three environmental factors such as air temperature, relative humidity, and highest precipitation. There was a positive correlation between skin scaliness and two environmental factors such as air pressure and duration of sunshine. Elasticity was correlated with air temperature positively and with air pressure negatively. CONCLUSION: The correlations shown between the skin biophysical parameters and environmental factors demonstrate that the skin biophysical parameters are affected by environmental factors.

Dermal matrix affects translucency of incident light on the skin.

BACKGROUND/AIMS: The age-dependent changes in the optical reflection characteristics have been studied about skin hydration, melanin index, or skin color. However, the age-dependent changes in the optical reflection have little attention on inner skin structures. To control the factors affecting the optical reflection except for dermal matrix, subjects were selected as our guideline and we evaluated the optical reflection of subsurface on skin layers of two age groups. METHOD: Young and old healthy volunteers were recruited after signing a written informed consent form. Facial skin was measured by means of noninvasive measurements: skin hydration, color, epidermis and dermis thickness, dermal density, subsurface reflectance, and transmittance. RESULT: Compared to young group, old group showed that dermal density and thickness was decreased significantly although epidermis thickness was not changed. CONCLUSION: In conclusion, dermal density is one of the major factors which affects the subsurface reflectance in skin.