Background: Although elective surgery for unruptured intracranial aneurysms (UIA) has increased, few studies have evaluated the risk factors for transfusion during UIA surgery. We evaluated the association between the preoperative De Ritis ratio (aspartate transaminase/alanine transaminase) and the incidence of intraoperative transfusion in patients who had undergone surgical UIA clipping. Methods: Patients who underwent surgical clipping of UIA were stratified into two groups according to the preoperative De Ritis ratio cutoff levels (< 1.54 and ≥ 1.54), and the propensity score (PS)-matching analysis was performed to compare the incidence of intraoperative transfusion. Logistic regression analyses were performed to determine the risk factors for intraoperative transfusion. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were performed to verify the improvement in the intraoperative transfusion predictive model upon addition of the De Ritis ratio. Results: Intraoperative transfusion incidence was 15.4% (77/502). We observed significant differences in the incidence of intraoperative transfusion (16.2% vs. 39.7%, P = 0.004) between the groups after matching. In the logistic regression analyses, the De Ritis ratio ≥ 1.54 was an independent risk factor for transfusion (odds ratio [OR]: 3.04, 95% CI [1.53, 6.03], P = 0.002). Preoperative hemoglobin (Hb) value was a risk factor for transfusion (OR: 0.33, 95% CI [0.24, 0.47], P < 0.001). NRI and IDI analyses showed that the De Ritis ratio improved the intraoperative blood transfusion predictive models (P = 0.031 and P = 0.049, respectively). Conclusions De Ritis ratio maybe a significant risk factor for intraoperative transfusion in UIA surgery.

Nevus comedonicus (NC, acneiform nevus) is a rare variant of adnexal hamartoma, which is clinically characterized as confluent clusters of dilated follicular orifices resembling comedones. NC usually occurs unilaterally along the line of Blaschko and presents at birth or develops during childhood. A 66-year-old man presented with a 6-month history of multiple skin-colored to brownish papules resembling comedones on both the upper and lower eyelids.The patient did not complain of ophthalmologic or neurologic symptoms. Skin punch biopsy revealed dilated follicular openings filled with eosinophilic keratinous material and lymphocytic infiltration. Based on clinical and histopathologic findings, a diagnosis of late-onset bilateral NC of the eyelids was reached.

The final analysis of the phase 3 Targeted Investigational Treatment Analysis of Novel Anti-androgen (TITAN) trial showed improvement in overall survival (OS) and other efficacy endpoints with apalutamide plus androgen deprivation therapy (ADT) versus ADT alone in patients with metastatic castration-sensitive prostate cancer (mCSPC). As ethnicity and regional differences may affect treatment outcomes in advanced prostate cancer, a post hoc final analysis was conducted to assess the efficacy and safety of apalutamide in the Asian subpopulation. Event-driven endpoints were OS, and time from randomization to initiation of castration resistance, prostate-specific antigen (PSA) progression, and second progression-free survival (PFS2) on first subsequent therapy or death. Efficacy endpoints were assessed using the Kaplan-Meier method and Cox proportional-hazards models without formal statistical testing and adjustment for multiplicity. Participating Asian patients received once-daily apalutamide 240 mg ( n = 111) or placebo ( n = 110) plus ADT. After a median follow-up of 42.5 months and despite crossover of 47 placebo recipients to open-label apalutamide, apalutamide reduced the risk of death by 32% (hazard ratio [HR]: 0.68; 95% confidence interval [CI]: 0.42-1.13), risk of castration resistance by 69% (HR: 0.31; 95% CI: 0.21-0.46), PSA progression by 79% (HR: 0.21; 95% CI: 0.13-0.35) and PFS2 by 24% (HR: 0.76; 95% CI: 0.44-1.29) relative to placebo. The outcomes were comparable between subgroups with low- and high-volume disease at baseline. No new safety issues were identified. Apalutamide provides valuable clinical benefits to Asian patients with mCSPC, with an efficacy and safety profile consistent with that in the overall patient population.
Male ; Humans ; Prostatic Neoplasms/pathology* ; Androgen Antagonists/therapeutic use* ; Prostate-Specific Antigen ; Castration ; Prostatic Neoplasms, Castration-Resistant/drug therapy*

Background: Topical recombinant human epidermal growth factor (rhEGF) is effective in the treatment of diabetic foot ulcers, surgical wounds, burns, and scars. Binding of EGF to EGF receptors results in cell proliferation and differentiation. Objective: This study aimed to evaluate the efficacy of topical rhEGF ointment compared with that of topical mupirocin in healing herpes zoster (HZ) lesions. Methods: Thirty patients diagnosed with typical HZ were recruited in August, 2018. The rats were randomly divided into two groups: topical mupirocin and topical rhEGF ointment. HZ lesions were evaluated using the Vancouver Scar Scale (VSS) at the initial visit, 1st, 2nd, and 4th weeks. Results: The total number of recruited patients (n=30) included males (n=16, 53.3%) and females (n=14, 46.7%) with a mean age of 58.2. The proportion of patients with a 50% reduction in the VSS score (VSS 50) at 2nd week was significantly higher in the rhEGF group (33.0% vs. 72.0%, respectively, p=0.035). The complete resolution rate (VSS=0, 1) at 4th week was also higher in the rhEGF group (17.5% vs. 50.0%, p=0.03). Conclusion Topical rhEGF showed a more rapid treatment response and anti-scarring effect than topical mupirocin in patients with HZ lesions.

Antithrombotic therapy is a cornerstone of acute ischemic stroke (AIS) management and secondary stroke prevention. Since the first version of the Korean Clinical Practice Guideline (CPG) for stroke was issued in 2009, significant progress has been made in antithrombotic therapy for patients with AIS, including dual antiplatelet therapy in acute minor ischemic stroke or high-risk transient ischemic stroke and early oral anticoagulation in AIS with atrial fibrillation. The evidence is widely accepted by stroke experts and has changed clinical practice. Accordingly, the CPG Committee of the Korean Stroke Society (KSS) decided to update the Korean Stroke CPG for antithrombotic therapy for AIS. The writing members of the CPG committee of the KSS reviewed recent evidence, including clinical trials and relevant literature, and revised recommendations. A total of 35 experts were invited from the KSS to reach a consensus on the revised recommendations. The current guideline update aims to assist healthcare providers in making well-informed decisions and improving the quality of acute stroke care. However, the ultimate treatment decision should be made using a holistic approach, considering the specific medical conditions of individual patients.

no abstract available.