Good Clinical Responders to Topical Timolol in Patients with Infantile Hemangiomas: A 7-Year Retrospective Study of 328 Korean Patients.

BACKGROUND: Topical timolol is widely used for treatment of superficial infantile hemangioma (IH). However, little is known about factors that affect the response to topical timolol treatment. OBJECTIVE: This study aimed to investigate the efficacy, safety, and predictive value for good response to topical timolol for IH. METHODS: A retrospective review of medical records and clinical photos of 328 patients with IH treated with topical timolol 0.5% solution was conducted. Serial clinical photographs were compared with those at the initial visit using a 100-mm visual analogue scale (VAS). Treatment response was defined as an improvement of at least 75% from baseline in IH lesions within 12 months of treatment. RESULTS: Overall, IH patients treated with topical timolol showed significant improvement from baseline, showing that the final VAS score within 12 months of treatment was 69.7±20.4. The multivariable logistic regression analysis showed age at initiation of treatment (p=0.007), length of gestation and fetal growth (p=0.03), depth (p=0.01), and flexural area (p=0.007) were significantly associated with treatment response. Only four patients (1.1%) reported local irritation. CONCLUSION: This study demonstrated that topical timolol treatment was an effective and well-tolerated treatment for IHs. Physicians are encouraged to consider several patient- or lesional factors that might affect treatment response to achieve better clinical outcomes.

Sleep during Mohs micrographic surgery: A prospective study.

Mohs micrographic surgery (MMS) is a highly specialized technique for treating skin cancer. Drawbacks of MMS are the multi-step procedure and long surgery time. Some patients sleep during surgery and involuntary movements during sleeping can interfere with surgery, which increases the risk of a fall injury. However, to our knowledge, there have been no studies regarding the characteristics of patients' sleep during MMS. This study aimed to investigate the prevalence and characteristics of sleeping patients during MMS. We performed a prospective study and included patients with skin cancers impending MMS. All patients rated their anxiety levels and sleep status using the State-Trait Anxiety Inventory, an anxiety visual analog scale, the Pittsburgh Sleep Quality Index, and the Leeds Sleep Evaluation Questionnaire. Our data showed that 21.9% of patients were asleep during MMS. Multivariable analysis showed that older age (odds ratio [OR], 1.142; p=0.003), lesion size >150 mm2 (OR, 7.904; p=0.031), and multi-stage MMS (OR, 12.201; p=0.011) were significantly associated factors of sleep. This study is the first to report the prevalence and associated factors of sleep during MMS. Physicians should monitor patients with risk factors during MMS to prevent possible medical accidents.

Tunable Color Coating of E-Textiles by Atomic Layer Deposition of Multilayer TiO2/Al2O3 Films.

We successfully fabricated a conductive E-textile and color-coated E-textile by depositing multilayer Al2O3/TiO2 on a conductive E-textile through atomic layer deposition (ALD). Pt was deposited on an E-textile as a conductive layer via low-temperature ALD. The color of the coated conductive E-textile could be tuned to violet, green, or pink by simply varying the thickness of the Al2O3 and TiO2 layers. Both experimental and simulation results revealed that seven different colors can be obtained with single-layer TiO2 and multilayer Al2O3/TiO2, depending on the film thickness and their refractive indices. This method is highly effective for enhancing the fastness of structural color on conductive E-textiles. Furthermore, the mechanical properties and chemical stability of the color-coated E-textiles were investigated. The color-coated E-textiles could withstand acidic and basic solutions, with almost negligible changes in their morphology; this in turn indicates their excellent chemical stability. These switchable stable color-based conductive E-textiles can be used as a platform to directly integrate future wearable electronics in textiles.

Surface Energy Change of Atomic-Scale Metal Oxide Thin Films by Phase Transformation.

Fine-tuning of the surface free energy (SFE) of a solid material facilitates its use in a wide range of applications requiring precise control of the ubiquitous presence of liquid on the surface. In this study, we found that the SFE of rare-earth oxide (REO) thin films deposited by atomic layer deposition (ALD) gradually decreased with increasing film thickness; however, these changes could not be understood by classical interaction models. Herein, the mechanism underlying the aforesaid decrease was systematically studied by measuring contact angles, surface potential, adhesion force, crystalline structures, chemical compositions, and morphologies of the REO films. A growth mode of the REO films was observed: layer-by-layer growth at the initial stage with an amorphous phase and subsequent crystalline island growth, accompanied by a change in the crystalline structure and orientation that affects the SFE. The portion of the surface crystalline facets terminated with (222) and (440) planes evolved with an increase in ALD cycles and film thickness, as an amorphous phase was transformed. Based on this information, we demonstrated an SFE-tuned liquid tweezer with selectivity to target liquid droplets. We believe that the results of this fundamental and practical study, with excellent selectivity to liquids, will have significant impacts on coating technology.

Schwannoma Presenting as a Scalp Mass: A Case Report with Magnetic Resonance Imaging Findings.

A schwannoma can develop anywhere along the course of nerves. However, a schwannoma presenting as a scalp nodule is rare. Here, we present a rare case of schwannoma on the scalp with a review of magnetic resonance imaging (MRI) findings, which was initially misdiagnosed as an epidermal cyst or vascular malformation despite various radiologic examinations. Recognition of characteristic MRI features of schwannomas, such as low signal margin, target, entering-and-exiting-nerve, and fascicular signs, may result in an accurate diagnosis and proper management of tumors. In this report, we summarized differential characteristics of a schwannoma with an epidermal cyst and a lipoma.

Pruritus in Patients Under Targeted Anticancer Therapy: A Multidimensional Analysis Using the 5-D Itch Scale.

Pruritus is a very common symptom in patients, undergoing targeted anticancer therapy. However, the characteristics of pruritus, according to the targeted anticancer agents, are still unclear. The objective of this study was to determine the characteristics of pruritus, induced by targeted anticancer agents, using a questionnaire-based survey. The survey was administered to cancer patients currently receiving anticancer agents. Medical records were also reviewed. A total of 374 cancer patients completed the survey, of which 108 were treated with the targeted therapy. A total of 205 patients had pruritus, of which 66 were under the targeted therapy. Epidermal growth factor receptor inhibitor (EGFRI) users showed the highest prevalence rate of itching and numeric rating scale score for itching. The 5-D itch score was also highest among users of EGFRIs. In conclusion, patients receiving EGFRIs suffer from severe pruritus frequently. They not only experienced long lasting and intense itching, causing sleep discomfort, but also developed itching at specific body sites.

Changes in Tear Meniscus Height Following Lower Blepharoplasty as Measured by Optical Coherence Tomography.

PURPOSE: The lower eyelid serves important roles in tear distribution and drainage. The purpose of this study was to measure the tear meniscus height (TMH) with anterior segment optical coherence tomography after lower blepharoplasty. METHODS: A total of 52 eyes from 26 patients treated between July 2012 and June 2015 were included in the study. A transcutaneous or transconjunctival approach was performed, depending on whether (1) the supportive lower lid orbicularis oculi muscle was tightened, (2) the middle lamella was elongated, (3) minimal fat was removed or transpositioned, and (4) lateral canthal support was established. Marginal reflex distance 2 and marginal nose distance were analyzed with Image J software. TMH was measured with anterior segment optical coherence tomography. A paired t-test and Wilcoxon signed-rank test were used for statistical comparisons. RESULTS: Marginal reflex distance 2 decreased and marginal nose distance increased with both surgical techniques. TMH decreased from 337.3 ± 117.9 to 289.3 ± 69.1 µm (p = 0.024) in patients who had transcutaneous lower blepharoplasty, but increased from 186.5 ± 35.5 to 274.8 ± 58.3 µm (p = 0.000) in patients who had transconjunctival lower blepharoplasty. Medial and lateral TMHs decreased significantly from 228.8 ± 80.7 to 152.7 ± 42.1 µm (p = 0.008) in patients with transcutaneous lower blepharoplasty. TMH was significantly restored after lower blepharoplasty with either approach. CONCLUSIONS: Enhancing the lower eyelid position combined with orbicularis muscle tightening and lateral canthal support can normalize the TMH following lower eyelid blepharoplasty.

Both Educational Lectures and Reference Photographs Are Necessary to Improve the Accuracy and Reliability of Psoriasis Area and Severity Index (PASI) Assessment: Results from Korean Nation-Wide PASI Educational Workshop.

BACKGROUND: Accurate assessment of the severity of psoriasis is important in daily practice and clinical studies. However, the assessment of psoriasis area and severity index (PASI) reflects the physician's experience, and thus evaluations by physicians are inherently subjective, with intra-rater and inter-rater variability. OBJECTIVE: To elucidate the effectiveness of PASI educational lectures and the use of reference photographs on the improvement of accuracy and reliability in PASI assessments and to develop effective educational programs for PASI assessments. METHODS: We performed a before-and-after comparison study during nation-wide PASI educational workshops. The participants were asked to assess the severity components of PASI (erythema, thickness, scale, and affected area) three times: in the test administered before an educational lecture, the test immediately after the lecture, and lastly the test with the use of reference photographs. The improvement of accuracy and reliability was analyzed by comparing the results of three tests. RESULTS: Ninety-six board-certified dermatologists and residents participated and 72 participants completed all three tests. The accuracy and reliability of the assessment of severity components of PASI increased significantly after the educational lecture and the use of reference photographs. Use of reference photographs resulted in limited improvements when the recognition of three-dimensional structures was required, such as in the assessment of thickness or scale. CONCLUSION: Our study confirmed that the combination of standardized educational training and reference photographs can improve the accuracy and reliability of PASI assessments. Understanding how to evaluate three-dimensional psoriatic lesions can help with proper assessment of the severity of psoriasis.

The Impact of Skin Problems on the Quality of Life in Patients Treated with Anticancer Agents: A Cross-Sectional Study.

PURPOSE: Patients treated with anticancer agents often experience a variety of treatment-related skin problems, which can impair their quality of life. MATERIALS AND METHODS: In this cross-sectional study, Dermatology Life Quality Index (DLQI) and clinical information were evaluated in patients under active anticancer treatment using a questionnaire survey and their medical records review. RESULTS: Of 375 evaluated subjects with anticancer therapy, 136 (36.27%) and 114 (30.40%) were treated for breast cancer and colorectal cancer, respectively. We found that women, breast cancer, targeted agent use, and longer duration of anticancer therapy were associated with higher dermatology-specific quality of life distraction. In addition, itching, dry skin, easy bruising, pigmentation, papulopustules on face, periungual inflammation, nail changes, and palmoplantar lesions were associated with significantly higher DLQI scores. Periungual inflammation and palmoplantar lesions scored the highest DLQI. CONCLUSION: We believe our findings can be helpful to clinicians in counseling and managing the patients undergoing anticancer therapy.

Prevalence of Psoriasis in Korea: A Population-Based Epidemiological Study Using the Korean National Health Insurance Database.

BACKGROUND: Although psoriasis is universal in its occurrence worldwide, its prevalence varies by geographic location and race. A few hospital-based surveys have reported on the demographic characteristics in Korean patients with psoriasis. However, a nation-wide study on the prevalence of psoriasis in Korea remains uncompleted. OBJECTIVE: The purpose of this study was to determine the prevalence of psoriasis in Korea and to describe the demographic and social characteristics of afflicted individuals. METHODS: We identified patients with psoriasis using a relevant diagnostic code from the sixth revision of the Korean Standard Classification of Disease in the 2011~2015 claims database of the Health Insurance Review and Assessment Service of Korea. We estimated the annual prevalence of psoriasis and described the age and sex distribution of the patients, type and severity of psoriasis, comorbidities, type of health insurance, type of health-care institution and residence area. Patients with moderate-to-severe psoriasis were defined as those who had been treated with phototherapy, classical systemic agents, and/or biologic agents. RESULTS: The standardized prevalence of psoriasis was 453 per 100,000 individuals of the database population in 2015. We found male preponderance with a 1.3:1 male-to-female ratio, and that the largest number of patients belonged to the age group of 50s. Of the patients diagnosed with psoriasis in 2015, 83.8% had plaque psoriasis and 22.6% had moderate-to-severe psoriasis. CONCLUSION: The annual standardized prevalence of psoriasis in Korea was 453 per 100,000 of the population in 2015.

Acral Lentiginous Melanoma, Indolent Subtype Diagnosed by En Bloc Excision: A Case Report.

Nail unit melanoma is a type of acral lentiginous melanoma and requires histopathologic examination for a confirmed diagnosis. However, inadequate biopsy techniques make definitive diagnosis difficult. A 61-year-old man presented with progressive nail pigmentation for 15 years, which was clinically highly suspicious for malignancy. Acral lentiginous melanoma was not detected in punch and longitudinal biopsy specimens, but en bloc excision tissue revealed melanoma. Acral lentiginous melanoma is known to have a heterogeneous pathologic manifestation depending on the pigmented region and the time it takes to progress. In this regard, en bloc excision can be considered as a first-line biopsy technique to diagnose acral lentiginous melanoma, indolent subtype.

New Korean isolates of Pepper mild mottle virus (PMMoV) differ in symptom severity and subcellular localization of the 126 kDa protein.

Two isolates of Pepper mild mottle virus (PMMoV) were selected from a nationwide survey of pepper fields in South Korea in 2014 and 2015, in which Cucumber mosaic virus was also detected; the two PMMoV isolates, Sangcheong 47 (S-47, KX399390) and Jeongsong 76 (J-76, KX399389), share ~99% nucleotide and amino acid identity and are closely related to Japanese and Chinese isolates at the nucleotide level. Amino acid sequence comparisons revealed 99.73, 99.81, 98.44, and 100% identity in the ORF1, ORF2, MP, and CP, respectively, between S-47 and J-76. In addition, we generated infectious clones of S-47 and J-76, and T7 promoter driven transcripts of each inoculated to Nicotiana benthamiana produced very severe symptoms, whereas only mild symptoms developed in Capsicum annuum. Gene silencing suppressor function of 126 kDa and cytoskeleton-connected plasmodesmata localization of movement protein of S-47 and J-76 showed no difference between isolates, whereas 126 kDa of J-76 clearly formed intracellular aggregates not observed with S-47 126 kDa protein. Differences between these isolates in 126/183 kDa-related functions including subcellular localization suggest that differential interactions with host proteins may affect symptom development in C. annuum.

Complete nucleotide sequences and construction of full-length infectious cDNA clones of cucumber green mottle mosaic virus (CGMMV) in a versatile newly developed binary vector including both 35S and T7 promoters.

Seed-transmitted viruses have caused significant damage to watermelon crops in Korea in recent years, with cucumber green mottle mosaic virus (CGMMV) infection widespread as a result of infected seed lots. To determine the likely origin of CGMMV infection, we collected CGMMV isolates from watermelon and melon fields and generated full-length infectious cDNA clones. The full-length cDNAs were cloned into newly constructed binary vector pJY, which includes both the 35S and T7 promoters for versatile usage (agroinfiltration and in vitro RNA transcription) and a modified hepatitis delta virus ribozyme sequence to precisely cleave RNA transcripts at the 3' end of the tobamovirus genome. Three CGMMV isolates (OMpj, Wpj, and Mpj) were separately evaluated for infectivity in Nicotiana benthamiana, demonstrated by either Agroinfiltration or inoculation with in vitro RNA transcripts. CGMMV nucleotide identities to other tobamoviruses were calculated from pairwise alignments using DNAMAN. CGMMV identities were 49.89% to tobacco mosaic virus; 49.85% to pepper mild mottle virus; 50.47% to tomato mosaic virus; 60.9% to zucchini green mottle mosaic virus; and 60.96% to kyuri green mottle mosaic virus, confirming that CGMMV is a distinct species most similar to other cucurbit-infecting tobamoviruses. We further performed phylogenetic analysis to determine relationships of our new Korean CGMMV isolates to previously characterized isolates from Canada, China, India, Israel, Japan, Korea, Russia, Spain, and Taiwan available from NCBI. Analysis of CGMMV amino acid sequences showed three major clades, broadly typified as 'Russian,' 'Israeli,' and 'Asian' groups. All of our new Korean isolates fell within the 'Asian' clade. Neither the 128 nor 186 kDa RdRps of the three new isolates showed any detectable gene silencing suppressor function.