Background: This study is aimed to verify individual and regional-level factors affecting the depression of Koreans and to develop social programs for improving the depressive status. Methods: This study used individual-level variables from the Korean Community Health Survey (2018) and used the e-regional index of the Korean Statistical Information Service as the regional-level variable. A multi-level logistic regression was executed to identify individual and regional-level variables that were expected to affect the extent of depressive symptoms and to draw the receiver operating characteristic curve to compare the volume of impact between variables from both levels. Results: The results of the multi-level logistic regression analysis in regards to individual-level factors showed that older age, female gender, a lower income level, a lower education level, not having a spouse, the practice of walking, the consumption of breakfast higher levels of stress, and having high blood pressure or diabetes were associated with a greater increase in depressive symptoms. In terms of regional factors, areas with fewer cultural facilities and fewer car registration had higher levels of depressive symptoms.The comparison of area under the curve showed that individual factors had a greater influence than regional factors. Conclusion This study showed that while both, individual and regional-level factors affect depression, the influence of the latter was relatively weaker as compared to the first. In this sense, it is necessary to develop programs focused on the individual, such as social prescribing at the local or community-level, rather than the city and nation-level approach that are currently prevalent.

Cavernous hemangiomas rarely involve the female genital tract. It is difficult to identify vascular malformations when these lesions are concealed in the vagina or deep vulva area. We present a rare case of vaginal cavernous hemangioma in a 30-year-old primiparous woman with an early severe postpartum hemorrhage (PPH) and delayed continuous bleeding from the episiotomy site. She was treated successfully with transarterial embolization of the left vaginal artery. To our knowledge, this is the first reported case of PPH caused by rupture of a vaginal hemangioma during vaginal delivery in English literature.
Adult ; Arteries ; Episiotomy ; Female ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Postpartum Hemorrhage* ; Postpartum Period* ; Rupture ; Vagina ; Vascular Malformations ; Vulva

PURPOSE: In this study, factors of metabolic syndrome and nutritional status were examined according to gender and occupations using the 2013 Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: This study was conducted on 1,750 workers (male : 892, female : 858) aged between 30 and 64, who participated in a health survey, health examination, and nutrition survey using the 6th 2013 KNHANES. Occupations were classified into white collar and blue collar workers, and nutrient intake was analyzed using a food frequency questionnaire. Analysis of complex sample design data through SPSS 19.0 was used for analysis. RESULTS: The prevalence rate of metabolic syndrome among blue collar (35.1%) was higher than that among white collar workers (26.8%) in male subjects (p < 0.05) as well as in blue collar (24.8%) compared to white collar workers (8.9%) in female subjects (p < 0.001). Intake frequency per week, considering one portion by food category, showed significant differences in cooked rice (p < 0.05) and bakeries and confectioneries (p < 0.05) in make workers as well as stew and casserole (p < 0.01) and fruits (p < 0.05) in female workers. With regard to nutrient intake by occupation and gender, white collar workers consumed a greater amount of nutrients (not including total energy intake) compared to blue collar workers in both male and female workers. With regard to nutrient adequacy ratio (NAR) and mean adequacy ratio (MAR) according to gender and occupation, white collar workers showed higher numbers than blue collar workers in both male and female subjects. CONCLUSIONS: This study examined the prevalence rates of metabolic syndrome and nutrient intake according to gender and occupation. In both male and female subjects, blue collar workers showed higher prevalence rates compared to white collar workers, and their diet quality was worse than white collar workers' diet quality. Considering this result, customized nutrition education according to gender and occupation should be provided to workers to prevent diseases.
Diet ; Education ; Female ; Fruit ; Health Surveys ; Humans ; Korea* ; Male ; Nutrition Surveys* ; Nutritional Status* ; Occupations* ; Prevalence*

Clear cell acanthoma (CCA) is an uncommon, benign epithelial tumor presenting as a well-defined, slow-growing solitary nodule. The diagnosis of CCA is usually based on clinical and histopathological evaluation of the tumor.However, when such type of benign tumor occurs on an exposed area, a biopsy is not always the best diagnostic option since it may leave scar. The recent advent of dermoscopy has offered an accurate and non-invasive method to diagnose CCA without resorting to skin biopsy. A 40-year-old male presented with a shiny, erythematous-to-brown, flattened nodule on the left cheek. Dermoscopic examination revealed a ‘string of pearls’ vascular pattern, a characteristic dermoscopic feature of CCA. Under the clinical and dermoscopic impression of CCA, a 595 nm pulsed dye laser (PDL) therapy targeting the vascular tissue in the superficial dermis of the lesion was chosen for a minimally invasive treatment.After repeated sessions of PDL, an optimal cosmetic outcome was achieved and no recurrence was recorded during the follow-up period. Herein, we report a case of presumed CCA which was successfully diagnosed and treated by utilizing non-invasive modalities.

Clear cell acanthoma (CCA) is an uncommon, benign epithelial tumor presenting as a well-defined, slow-growing solitary nodule. The diagnosis of CCA is usually based on clinical and histopathological evaluation of the tumor.However, when such type of benign tumor occurs on an exposed area, a biopsy is not always the best diagnostic option since it may leave scar. The recent advent of dermoscopy has offered an accurate and non-invasive method to diagnose CCA without resorting to skin biopsy. A 40-year-old male presented with a shiny, erythematous-to-brown, flattened nodule on the left cheek. Dermoscopic examination revealed a ‘string of pearls’ vascular pattern, a characteristic dermoscopic feature of CCA. Under the clinical and dermoscopic impression of CCA, a 595 nm pulsed dye laser (PDL) therapy targeting the vascular tissue in the superficial dermis of the lesion was chosen for a minimally invasive treatment.After repeated sessions of PDL, an optimal cosmetic outcome was achieved and no recurrence was recorded during the follow-up period. Herein, we report a case of presumed CCA which was successfully diagnosed and treated by utilizing non-invasive modalities.

PURPOSE: Adjuvant chemotherapy (aCT) in rectal cancer patients who have undergone curative resection after neoadjuvant chemoradiation (nCRT) is controversial. We aimed to investigate the benefits of using aCT and the clinical impact of completing aCT in ypstage 2 rectal cancer patients.METHODS: We retrospectively reviewed clinicopathological data from patients who had undergone radical resection after nCRT between January 2006 and December 2012. In total, 152 patients with ypT3/4N0M0 rectal cancer were included. Of these patients, 139 initiated aCT, while 13 did not receive aCT (no-aCT). Among those who received aCT, 132 patients completed their planned cycles (aCT-completion) whereas 7 did not (aCT-incompletion). All patients received longcourse chemoradiation; a 5-fluorouracil-based regimen was used for nCRT in most patients. The prognostic factors affecting disease-free survival (DFS) and overall survival (OS) were analyzed.RESULTS: The median follow-up duration was 41 months. Demographic data did not differ significantly among the 3 groups. In multivariate analysis, open surgery, a tumor size >2 cm, retrieval of <12 lymph nodes, circumferential resection margin (CRM) positivity and aCT incompletion were independent prognostic factors for poor DFS. Old age (≥60 years), open surgery, CRM positivity, aCT incompletion, and lack of aCT initiation compared to aCT completion were independent prognostic factors for poor OS.CONCLUSION: In ypstage 2 rectal cancer patients, aCT after nCRT and total mesorectal excision affected both DFS and OS; however, only patients who completed planned aCT exhibited survival benefits. Therefore, improving patients’ compliance with the completion of aCT is desirable.
Chemoradiotherapy ; Chemotherapy, Adjuvant ; Compliance ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoadjuvant Therapy ; Rectal Neoplasms ; Retrospective Studies

Diffuse alveolar damage (DAD) is a histological change in lung tissue, and is generally caused by an acute lung injury, which is characterized by bilateral and widespread damages. Localized DAD occurs very rarely. The causes for DAD are numerous, but the chief cause is acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia, in cases of idiopathic manifestation. The 82-year-old patient, in this case study, showed a DAD lesion in only 1 lobe. The patient was otherwise healthy, with no previous symptoms of DAD. He was admitted to our medical center owing to localized infiltration, observed on his chest radiograph. Laboratory studies showed no signs of infections. DAD was confirmed by a surgical lung biopsy. The patient received corticosteroid treatment and had gradually improved. We report the case of a patient with localized, idiopathic DAD that cannot be classified as acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia.
Acute Lung Injury ; Aged, 80 and over ; Biopsy ; Humans ; Idiopathic Interstitial Pneumonias ; Idiopathic Pulmonary Fibrosis ; Lung ; Lung Diseases, Interstitial ; Lung Injury ; Thorax

Nitrobenzene is a poisonous agent, not commonly encountered in clinical practice, which belongs to the aniline dyes. Ingestion of nitrobenzene may cause methemoglobinemia, a condition in which the iron in hemoglobin is oxidized from the ferrous state to the ferric state, resulting in the inability to transport oxygen. A 41-year-old man presented with the clinical features of methemoglobinemia after drinking nitrobenzene. The patient was treated conservatively with intravenous methylene blue. We report a case of acute methemoglobinemia due to ingestion of nitrobenzene.
Aniline Compounds ; Coloring Agents ; Drinking ; Eating ; Hemoglobins ; Humans ; Iron ; Methemoglobinemia ; Methylene Blue ; Nitrobenzenes ; Oxygen

BACKGROUND: Adiponectin, an adipokine secreted from adipocytes, affects energy metabolism and also shows anti-diabetic and anti-inflammatory properties. Recent studies have reported that adiponectin plays a role in regulating skin inflammation. OBJECTIVE: This study aimed to investigate the effect of adiponectin on the expression of filaggrin (FLG) in normal human epidermal keratinocytes (NHEKs). METHODS: NHEKs were serum-starved for 6h before being treated with adiponectin. Afterward, cell viability was assessed by MTT assay. We also treated with calcium, interleukin (IL)-4, and IL-13 to provide positive and negative comparative controls, respectively. Gene mRNA expression was quantified using real time reverse transcription polymerase chain reaction, and protein expression was evaluated using Western blot. To evaluate the relationship among mitogen-activated protein kinases (MAPKs), activator protein 1 (AP-1), and FLG, we also treated cells with inhibitors for MAPKs JNK, p38, and ERK1/2. RESULTS: FLG and FLG-2 mRNA expression in NHEKs significantly increased after treatment with 10 µg/ml adiponectin. Adiponectin also restored FLG and FLG-2 mRNA expression that was otherwise inhibited by treatment with IL-4 and IL-13. Adiponectin induced FLG expression via AP-1 and MAPK signaling. CONCLUSION: Adiponectin positively regulated the expression of FLG and could be useful as a therapeutic agent to control diseases related to disrupted skin barrier function.
Adipocytes ; Adipokines ; Adiponectin* ; Blotting, Western ; Calcium ; Cell Differentiation ; Cell Survival ; Energy Metabolism ; Humans* ; Inflammation ; Interleukin-13 ; Interleukin-4 ; Interleukins ; Keratinocytes* ; Mitogen-Activated Protein Kinases ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger ; Skin ; Transcription Factor AP-1

Nontuberculous mycobacteria (NTM) are widely present in the environment, although they rarely cause infection in humans. However, infection by NTM has been increasingly recognized worldwide in the context of the human immunodeficiency virus (HIV) epidemic and therapeutic immunosuppression. Mycobacterium kansasii is a slow-growing photochromogenic mycobacterium, which mainly causes pulmonary infection in patients with predisposing lung diseases, and, occasionally, disseminated infection with poor outcomes in immunocompromised patients. We report on the first case of lymphadenitis caused by infection with M.kansasii in an HIV-infected patient in Korea. The patient showed significant improvement after receiving antituberculous therapy (isoniazid, rifabutin) in combination with surgical drainage and highly active antiretroviral therapy (abacavir, lamivudine, and lopinavir/ritonavir).
Antiretroviral Therapy, Highly Active ; Drainage ; HIV ; Humans ; Immunocompromised Host ; Immunosuppression ; Korea ; Lamivudine ; Lung Diseases ; Lymphadenitis ; Mycobacterium ; Mycobacterium kansasii ; Nontuberculous Mycobacteria