Background: A set of criteria for severity classification is essential in alopecia areata (AA). Currently, no guidelines are universally accepted for defining AA severity. Objective: This study aimed to establish a set of consensus criteria for classifying the severity of and identifying treatment refractoriness in AA. Methods: A preliminary draft of the definition for moderate-to-severe AA was crafted based on available evidence, and members of the Korean Hair Research Society (KHRS) subsequently endorsed the recommendation through an online survey. Results: In the first Delphi round, consensus was attained on 15 questions. After refining certain items in the second round, consensus was achieved on 23 out of 26 questions. The KHRS first defined AA severity using the severity of alopecia tool (SALT). SALT ≥50 was defined as severe, 20≤ SALT <50 as moderate, and SALT <20 as mild. Moderate AA was considered severe if it meets one or more of the following criteria: dermatology life quality index >10, presence of accompanying eyebrow or eyelash loss, positive hair loss activity, or treatment-refractory AA. Conclusion These consensus criteria can help clinicians accurately diagnose AA, provide appropriate treatment, and monitor its progression.

Background: Alopecia areata (AA) is characterized by hair loss on the scalp and body, significantly impacting patients’ quality of life based on its severity. Objective: This study aims to identify crucial factors influencing the perception of severe AA from the patients’ viewpoint. Methods: A web-based survey was conducted among AA patients attending dermatology departments at 21 university hospitals in Korea. The survey comprised 17 criteria, exploring both clinical characteristics of AA patients and subjective determinants of disease severity. Results: A total of 791 AA patients and their caregivers participated in the survey. Approximately 30% of respondents developed AA during childhood, with 43.5% experiencing chronic courses lasting over 3 years. Half of the participants exhibited more than 20% scalp hair loss, and 42% reported additional hair loss on other body parts, such as eyelashes and nose hair.Most respondents agreed that patients with ≥20% scalp hair loss should be categorized as having severe AA. They also identified longer disease duration, involvement of non-scalp body hair, treatment refractoriness, and social or mental impairment requiring medical intervention as factors indicating increased disease severity. Conclusion This survey underscores the significant impact of AA on patients’ quality of life and highlights existing unmet needs in current treatment modalities.

This study was conducted to determine whether CD4 T cell responses to citrullinated fibrinogen occur in patients with rheumatoid arthritis (RA), especially in HLA-DR4-positive subjects. Whole peripheral blood mononuclear cells (PBMCs) of RA patients and control subjects were stimulated with citrullinated fibrinogen peptides, and T-cell production of proliferation and proinflammatory cytokines, such as interferon-gamma(IFN-gamma) and interleukin-17A (IL-17A), were measured. In addition, CD4 T cells from RA patients were stimulated with the citrullinated fibrinogen peptide, Fib-alpha R84Cit, identified as a DRB1*0401-restricted T cell epitope in HLA-DR4 transgenic mice, and the degree of T cell activation was examined similarly. No proliferative responses to the citrullinated fibrinogen peptides were observed in whole PBMCs or CD4 T cells from RA patients. Furthermore, no increased production of IFN-gamma or IL-17A was found in whole PBMCs or CD4 T cells stimulated with the citrullinated fibrinogen peptides, although these cells responded to recall antigen, a mixture of tetanus toxoid, purified protein derivative (PPD) from Mycobacterium tuberculosis, and Candida albicans. The results of this study indicate that anti-citrulline immunity in RA patients may be mediated by fibrinogen because there is no evidence of CD4 T cell-mediated immune responses to citrullinated fibrinogen peptides.
Animals ; Arthritis, Rheumatoid ; Candida albicans ; Cytokines ; Epitopes, T-Lymphocyte ; Fibrinogen ; HLA-DR4 Antigen ; Humans ; Interleukin-17 ; Mice ; Mice, Transgenic ; Mycobacterium tuberculosis ; Peptides ; T-Lymphocytes ; Tetanus Toxoid

BACKGROUND: The intensity of stimulation of intubation was expressed as the product of its force and duration. Theoretically, use of a lightwand might cause less adrenergic stimulation because the elevation of the epiglottis by the laryngoscope blade was not required. However, whether the hemodynamic responses to intubation with the lightwand differ from those with direct laryngoscope was a controversial topic. Additionally, there has been no clear study showing that the hemodynamic response to intubation is affected by intubation time. This study was designed to analyze the relationship between the magnitude of hemodynamic responses and the intubation time. METHODS: 50 ASA class 1, 2 elective surgical patients were randomly allocated into two groups; lightwand or direct laryngoscope group. Anesthesia was induced by a standardized technique. The changes in MAP and HR were recorded just before intubation, after intubation and 1 minute after intubation. Also the intubation time was recorded. RESULTS: There were no differences in MAP, HR, and intubation time between the groups. The following was the final regression equation from multiple linear regression analysis:the degrees of blood pressure elevation = + 11.2239 (P = 0.0296) + 6.6331 (P = 0.0846) x (group) + 1.0400 (P = 0.0004) x (intubation time). Adjusted R2 is 0.84 (P<0.05). CONCLUSIONS: There was a linear relation between the degree of blood pressure elevation and intubation time in direct laryngoscope group and lightwand group.
Anesthesia ; Blood Pressure* ; Epiglottis ; Hemodynamics ; Humans ; Intubation* ; Intubation, Intratracheal ; Laryngoscopes* ; Linear Models