Purpose: The accurate localization of bifurcation points in the brain near the circle of Willis is essential for labeling cerebral arteries and detecting potential aneurysms. Studies on the development of segmentation-based landmark localization methods for cerebral angiography are lacking. This study aimed to develop and validate a method for localizing anatomical landmarks using a three-dimensional (3D) encoder-decoder deep convolutional neural network architecture. Materials and Methods: Time-of-flight magnetic resonance angiography (MRA) images of 224 subjects obtained from publicly available datasets were used. Ten anatomical landmark points were annotated, and four different landmark subset configurations were trained and validated. For each configuration, 3D U-Net-based models were developed using the MRA images and their corresponding annotated landmarks. The deep learning prediction results were evaluated in terms of landmark localization errors. Results: Among the four configurations, the configuration with five landmark subsets produced the smallest landmark localization errors in the test dataset. Post-processing of the U-Net-predicted segmentation masks further reduced the mean localization errors across all landmark points for the configuration with five subsets. Conclusion The proposed landmark localization method effectively identified major anatomical landmarks around the circle of Willis and showed the potential to automate segmental analyses of intracranial arterial tortuosity.

Purpose: Stem cell transplantation (SCT) has historically played a major role in the long-term remission of mantle cell lymphoma (MCL), an incurable hematological malignancy. Using data from the Korean Society of Bone and Marrow Transplantation registry, we retrospectively analyzed the role of autologous (auto) and allogeneic (allo) SCT in longterm MCL survival. Methods: This study analyzed data from 188 patients (age ≥ 19 years at the time of transplantation) who underwent a transplant for MCL from 2011 to 2020. Progression-free survival (PFS) was defined as the time from transplantation to disease progression, relapse, or death from any cause. Overall survival (OS) was defined as the time from transplan‑ tation to death from any cause or the last follow-up. Results: In total, 109 patients underwent consolidative SCT after first-line chemotherapy. The 3-year PFS and OS rates were 65.4% and 78.5%, respectively, in the auto-SCT group, and 66.7% and 71.4%, respectively, in the allo-SCT group. The PFS and OS did not differ significantly between the auto- and allo-SCT groups. As part of salvage treatment, 52 patients with relapsed or refractory disease underwent auto- or allo-SCT. Patients who underwent auto-SCT with complete remis‑ sion/partial remission status reported better outcomes. In patients with refractory status, allogeneic transplantation using human leukocyte antigen (HLA) fully matched donors was a significantly favorable factor for PFS and OS. Conclusion The long-term survival of patients who underwent consolidative transplantation was similar to that reported in previous studies. Auto-SCT may be beneficial in patients who respond to salvage therapy, whereas allo-SCT with HLA-matched donors may be an alternative for patients with refractory disease. 

Objectives: This study aimed to examine health-related characteristics and chronic disease risk in middle-aged Koreans based on their fat energy intake ratio. Methods: We analyzed data from 7,274 Koreans aged 40–64 years using the 7th (2016–2018) Koreans National Health and Nutrition Examination Survey. Participants were classified into three groups based on their fat energy intake ratio: insufficient (< 15%), adequate (15%–30%), and excessive (> 30%). We assessed their socio-demographic characteristics; lifestyle characteristics; biochemical characteristics; quantitative and qualitative nutrient intakes, measured using dietary reference intakes for Koreans and index of nutrition quality (INQ); and chronic disease risk. Results: Significant differences were observed between the groups in age, gender, income, education, and residence region. The insufficient group had the highest proportion of older adults, male, lower income, rural residents, and lower education levels. The groups differed significantly in lifestyle characteristics, with the insufficient group having the highest rates of no walking, heavy drinking, smoking, and poor subjective health perception. Biochemical characteristics in the insufficient group exhibited the lowest levels for fasting blood glucose, hemoglobin A1c, and triglycerides. Significant differences were found in both the quantitative and qualitative intake of nutrients. The insufficient group had the lowest intake of most nutrients except fiber, whereas the excessive group had the lowest fiber intake. Based on the INQ, vitamin A and Ca were the lowest in the insufficient group, and vitamin C and folic acid were the lowest in the excessive group. The risk of diabetes mellitus and metabolic syndrome was highest in the deficient group, and the risk of liver cirrhosis was highest in the excessive group. Conclusion Insufficient or excessive fat energy intake ratio negatively affects nutrient intake and chronic disease risk. Fat energy intake of 15%–30% is important for improving nutrient intake and managing chronic diseases, such as diabetes mellitus, metabolic syndrome, and liver cirrhosis. We suggest that education and an appropriate social environment are necessary to ensure this fat energy intake.

Fixed drug eruption (FDE) is a well-defined hyperpigmented patch that recurs in a fixed location each time a particular drug is taken. Common causative agents of FDE are nonsteroidal anti-inflammatory drugs, non-narcotic analgesics, sedatives, anticonvulsants, sulfonamides, and tetracycline. We report a 33-year-old male who presented with a recurrent, localized, brownish-to-erythematous macule and papules on the peri-philtrum area two hours after taking valacyclovir. Three episodes of valacyclovir ingestion for treatment of Herpes simplex virus infection provoked a similar skin rash at the same site. Histopathology results showed vacuolar degeneration in the basal layer of the epidermis, pigmentary incontinence, and perivascular inflammatory cell infiltration in the papillary dermis. Although patch test and skin prick test showed negative responses to acyclovir and valacyclovir, an intradermal test showed a positive reaction only to valacyclovir. The oral provocation test to acyclovir and valacyclovir showed a positive reaction only to valacyclovir. Through drug history, histopathological examination, patch test, intradermal test, and oral provocation test, we established a final diagnosis of FDE due to valacyclovir without cross-reactivity to acyclovir. To find alternative therapeutic drugs, we suggest diagnostic tests with not only the suspected drugs, but also other drugs in the same class.

Background: Psoriasis is a chronic inflammatory autoimmune disease. Some studies have demonstrated a relationship of psoriasis with vitamin D (Vit D) deficiency or serum lipid levels. Objective: We aimed to compare serum levels of Vit D and lipids in patients with active psoriasis and control subjects. Additionally, we analyzed the relationship of disease severity with serum Vit D and lipid levels. Methods: A total of 243 patients were retrospectively analyzed. Statistical data were evaluated, and the values were considered significant at p＜0.05. Results: Statistically significant difference in Vit D levels between the psoriasis (n=117) and the control groups (n=126) was not found. In addition, an association between Vit D levels and the disease severity, using the psoriasis area and severity index (PASI) was not observed. The proportion of overweight patients (body mass index [BMI]≥ 23 kg/m2 ) was higher in the psoriasis group than in the control group, and there was a significant relationship between the increase in PASI and the serum triglycerides (TG) levels (p＜0.05). Conclusion The psoriasis and control groups did not show a statistical difference in serum Vit D levels. In the subgroup analysis of cases with normal BMI, excluding the underlying disease, no significant difference in Vit D levels between the two groups was observed. However, the association of psoriasis with factors, such as BMI and TG, was found to be significant; hence, these could be therapeutic targets in patients with psoriasis to improve their quality of life. Controlled and well-designed studies are required in the future.

PURPOSE: Solitary plexiform neurofibroma of the eyelid without neurofibromatosis is a rare disease. We report a case of solitary plexiform pigmented neurofibroma of the eyelid without neurofibromatosis. CASE SUMMARY: A 12-year-old male visited our clinic with a painless palpable subcutaneous mass on the right lower eyelid. He had a history of Batter syndrome and attention deficit hyperactivity disorder. On initial presentation, clinical features regarding neurofibromatosis such as Lisch nodule, optic nerve glioma, or high myopia were not observed. We performed excision and biopsy of the lower lid mass under general anesthesia. Macroscopically, the tumor was 4.0 × 1.5 × 1.5 cm in size with irregular nodules. Microscopically, the tumor consisted of multiple, variably sized tortous enlarged nerve fascicles with clusters of pigmented cells. Immunohistochemical results revealed expression of S-100 protein. Pigmented cells express both S-100 and melan-A proteins, while nonpigmented cells express S-100 protein only. The tumor was finally diagnosed as plexiform pigmented neurofibroma. Dermatological evaluation revealed no evidence of systemic neurofibromatosis. CONCLUSIONS: Plexiform neurofibroma should be considered in the differential diagnosis of an eyelid mass, even if the patient does not have a history or clinical features of neurofibromatosis. Plexiform neurofibroma can be successfully managed with surgical excision.
Anesthesia, General ; Attention Deficit Disorder with Hyperactivity ; Biopsy ; Child ; Diagnosis, Differential ; Eyelids* ; Humans ; Male ; MART-1 Antigen ; Myopia ; Neurofibroma ; Neurofibroma, Plexiform* ; Neurofibromatoses ; Neurofibromatosis 1 ; Optic Nerve Glioma ; Rare Diseases ; S100 Proteins