The diagnosis of brain death is essential for deceased donor organ transplantation. Currently, extracorporeal membrane oxygenation (ECMO) is used to increase the chance of survival of patients with severe cardiac and respiratory failure. Therefore, cases of ECMO-dependent potential donors are increasing. The apnea test (AT) is a mandatory component in the clinical determination of brain death. However, conventional AT is not easily applicable to ECMO-dependent potential donors because both the ventilator and ECMO play an important role in carbon dioxide elimination. Accordingly, different methods of AT from those used in routine procedures must be considered. We report here a case of conventional AT with time delay and two cases of AT within 3 minutes by adjusting sweep gas flow rate of ECMO in ECMO-dependent potential donors.
Apnea* ; Brain Death ; Carbon Dioxide ; Diagnosis ; Extracorporeal Membrane Oxygenation ; Humans ; Membranes* ; Organ Transplantation ; Respiratory Insufficiency ; Tissue Donors* ; Transplants ; Ventilators, Mechanical

BACKGROUND: Henna is a natural dye derived from the leaves of the tree Lawsonia inermis known for its very low allergic properties. Recently, however, cases of pigmented contact dermatitis after henna dyeing have been increasing. OBJECTIVE: To analyze the clinical and histologic features of pigmented contact dermatitis caused by henna dyeing. METHODS: We retrospectively reviewed the clinical and histopathologic features of patients diagnosed with pigmented contact dermatitis after henna dyeing from June 2014 to August 2017. RESULTS: A total of 22 patients with a history of henna dyeing were included. All patients were female, and mean age was 58.9±8.2 years. They presented with rapidly spreading dark brownish patches located mostly adjacent to the hairline, such as at the forehead, temple, and lateral cheek. The mean duration between symptom onset and henna dyeing was 4.52 months (0~15). Standard patch test and as is test using henna showed no significant results. There were 18 patients with pruritus, which was only present at the early stage. Histopathologic examinations showed lichenoid inflammation with dermal melanin incontinence, vacuolar alteration, epidermal apoptotic cells, and perivascular inflammation. CONCLUSION: These results suggest that pigmented contact dermatitis observed after henna dyeing was caused by the toxicity of henna itself, not by other additives. The active ingredient of henna is lawsone (2-hydroxy-1,4-naphthoquinone), which may have induced pigmented contact dermatitis by its own cellular toxicity. Dermatologists should consider henna dyeing as a potential cause of pigmentation of the face and neck.
Cheek ; Dermatitis, Contact* ; Female ; Forehead ; Humans ; Inflammation ; Lawsonia Plant ; Melanins ; Neck ; Patch Tests ; Pigmentation ; Pruritus ; Retrospective Studies ; Trees

BACKGROUND: Citron is well known for an abundance of antioxidative and anti-inflammatory ingredients such as vitamin C, polyphenol compounds, flavonoids, and limonoids. OBJECTIVE: In this study, we aimed to evaluate the effects of citron essential oils on rosacea mediators in activated keratinocytes in vitro. METHODS: Normal human epidermal keratinocytes (NHEKs) were stimulated with 1α, 25-dihydroxyvitamin D3 (VD3) and interleukin 33 (IL-33) with LL-37 to induce rosacea mediators such as kallikrein 5 (KLK5), cathelicidin, vascular endothelial growth factor (VEGF), and transient receptor potential vanilloid 1 (TRPV1). These mediators were analyzed by performing reverse-transcription polymerase chain reaction (PCR), quantitative real-time PCR, immunocytofluorescence and enzyme-linked immunosorbent assay after NHEKs were treated with citron seed and unripe citron essential oils. RESULTS: The messenger RNA (mRNA) and protein levels of KLK5 and LL-37 induced by VD3 were suppressed by citron seed and unripe citron essential oils. Furthermore, the mRNA and protein levels of VEGF and TRPV1 induced by IL-33 with LL-37 were also suppressed by citron essential oils. CONCLUSION: These results show that citron essential oils have suppressive effects on rosacea mediators in activated epidermal keratinocytes, which indicates that the citron essential oils may be valuable adjuvant therapeutic agents for rosacea.
Ascorbic Acid ; Enzyme-Linked Immunosorbent Assay ; Flavonoids ; Humans ; In Vitro Techniques ; Interleukin-33 ; Kallikreins ; Keratinocytes* ; Limonins ; Oils, Volatile* ; Polymerase Chain Reaction ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Rosacea* ; Vascular Endothelial Growth Factor A

Background: Pigmented contact dermatitis (PCD) is a non-eczematous contact dermatitis characterized by hyperpigmentation with few or no signs of dermatitis. The pathomechanism of PCD is still unknown; there are few case reports of PCD caused by hair dye, henna, and cosmetics. Objective: This study aimed to analyze the clinical features and the significance of risk factors in adult Korean patients with PCD. Methods: We retrospectively reviewed 75 patients with PCD. Clinical features including age, sex, duration, location, and risk factors were obtained from electronic medical records. To determine the significance of the risk factors of PCD, we compared these patients with 155 patients diagnosed with allergic contact dermatitis (ACD) without hyperpigmentation. Results: The mean age of onset of PCD in patients was 55.5 years, and the male:female ratio was 1:14. The mean duration of PCD was 16.3 months. The number of patients with PCD who had histories of hair dye use (n=67, 89.3%) and health supplement consumption (n=18, 24.0%) was significantly higher than that of patients with ACD. There were no significant differences in medication, cosmetic changes, stress history, results of patch test, patch testing with the patient’s own products, immunoglobulin E (kU/L), and eosinophils (cells/μL). Conclusion This study analyzed the clinical features and risk factors of PCD and ACD in adult Korean patients, and it suggests that PCD may be caused by irritation induced by variable factors and not allergic reactions.

Background: Rosacea is a chronic inflammatory skin disease with a pathophysiological mechanism that remains unclear. Recently, dysregulation of the sensory nerve system has been implicated in the development of this condition. Objective: This study aimed to investigate the effect of capsaicin on neuroinflammatory mediators in rosacea. In addition, this study aimed to evaluate the attenuating effects of capsazepine, a transient receptor potential vanilloid type 1 (TRPV1) antagonist. Methods: We obtained skin tissue from both rosacea patients and normal individuals for an in vivo study. In addition, normal human epidermal keratinocytes (NHEKs) were cultured, and treated with capsaicin and capsazepine for an in vitro study. Quantitative changes in neuroinflammatory mediators were evaluated by semi-quantitative reverse transcription-polymerase chain reaction (PCR), real-time PCR, enzyme-linked immunosorbent assay, and immunofluorescence staining. Results: The data showed the increase of TRPV1, TRPV4, cathelicidin (LL37) and tumor necrosis factor-α (TNF-α) in skin tissue by real-time PCR. In addition, the data showed that cathelicidin (LL37), kallikrein-5 (KLK-5), TNF-α, vascular endothelial growth factor (VEGF), interleukin (IL)-1α, IL-1β, IL-8, and protease-activated receptor 2 (PAR2) increased in capsaicin-treated NHEKs. Capsazepine attenuated the expression of TRPV1 and other mediators, except for IL-8, in capsaicin-treated NHEKs. Conclusion We confirmed that TRPV1, TRPV4, cathelicidin (LL37) and TNF-α are increased in rosacea skin, and that capsaicin is associated with increase of neuroinflammatory mediators such as LL37, KLK-5, TNF-α, VEGF, IL-1α, IL-1β, IL-8, and PAR2. Modulators or inhibitors of neuroinflammatory mediators including TRPV1 could be potential therapeutic option in the treatment of patients with rosacea.

Background: Melatonin receptors are present in the human skin and retina. These receptors can be stimulated by light emitting diodes (LEDs) at specific wavelengths, thereby inducing cutaneous photorejuvenation. However, the underlying mechanism remains unclear. Objective: To evaluate the influence of LEDs at specific wavelengths on melatonin membrane receptor (MT1) and cutaneous photorejuvenation via the MT1 pathway in vitro. Methods: Normal human dermal fibroblasts (HDFs) were irradiated using LEDs at different wavelengths (410~940 nm) at a dose of 1 J/cm 2 . MT1 activity was evaluated after melatonin stimulation and LED irradiation. Thereafter, the expressions of collagen (COL) and matrix metalloproteinases (MMPs), with and without luzindole (MT1/2 receptor antagonist), were investigated via semi-quantitative reverse transcription polymerase chain reaction (PCR), real-time PCR, western blotting, and enzyme-linked immunosorbent assay. Results: In HDFs, the MT1 mRNA and protein levels increased significantly in response to melatonin (dose, 50 nM) (p<0.01) and LED irradiation at 595, 630, 850, and 940 nm (p<0.01). LED irradiation up-regulated COL type I and down-regulated MMP-1. Compared to LED irradiation without luzindole, LED irradiation with luzindole produced no significant increase in COL type I mRNA and protein levels (p<0.01). Conclusion We found that LED irradiation induces collagen synthesis and MMP-1 inhibition in HDFs via MT1 activation. Additionally, multiple LED wavelengths (595, 630, 850, and 940 nm) stimulated MT1 in HDFs, unlike in the eyes, where only blue light induced plasma melatonin suppression. This suggests the possibility of the melatoninergic pathway in photorejuvenation.

Background: Pigmented contact dermatitis (PCD) is a non-eczematous contact dermatitis characterized by hyperpigmentation with few or no signs of dermatitis. The pathomechanism of PCD is still unknown; there are few case reports of PCD caused by hair dye, henna, and cosmetics. Objective: This study aimed to analyze the clinical features and the significance of risk factors in adult Korean patients with PCD. Methods: We retrospectively reviewed 75 patients with PCD. Clinical features including age, sex, duration, location, and risk factors were obtained from electronic medical records. To determine the significance of the risk factors of PCD, we compared these patients with 155 patients diagnosed with allergic contact dermatitis (ACD) without hyperpigmentation. Results: The mean age of onset of PCD in patients was 55.5 years, and the male:female ratio was 1:14. The mean duration of PCD was 16.3 months. The number of patients with PCD who had histories of hair dye use (n=67, 89.3%) and health supplement consumption (n=18, 24.0%) was significantly higher than that of patients with ACD. There were no significant differences in medication, cosmetic changes, stress history, results of patch test, patch testing with the patient’s own products, immunoglobulin E (kU/L), and eosinophils (cells/μL). Conclusion This study analyzed the clinical features and risk factors of PCD and ACD in adult Korean patients, and it suggests that PCD may be caused by irritation induced by variable factors and not allergic reactions.

Nevus sebaceus is a congenital hamartoma with epidermal, follicular, and apocrine elements. Several skin appendage tumors can evolve secondarily from nevus sebaceus. Two different tumors often develop simultaneously on a nevus sebaceus lesion, but the growth of more than two tumors is rare. Herein, we report a case of four appendage tumors including trichoblastoma, tumor of the follicular infundibulum, sebaceoma, and sebaceous hyperplasia within a single nevus sebaceus lesion on the face of a 76-year-old female.
Aged ; Female ; Hamartoma ; Humans ; Hyperplasia* ; Nevus* ; Pituitary Gland* ; Skin