Background: Lifestyle modifications are critical in addressing metabolic dysfunction-associated steatotic liver disease (MASLD); however, the specific macronutrients that most significantly influence the disease’s progression are uncertain. In this study, we aimed to explore the role of carbohydrate, fat, and protein intake in MASLD development using decision trees, random forest models, and cluster analysis. Methods: Participants (n=3,951) from the Korean Genome and Epidemiology Study were included. We used the classification and regression tree analysis to classify participants into subgroups based on variables associated with the incidence of new-onset MASLD. Random forest analyses were used to assess the relative importance of each variable. Participants were grouped into homogeneous clusters based on carbohydrate, protein, fat, and total caloric intake using hierarchical cluster analysis. Subsequently, we used the Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for MASLD risk across the clusters. Results: Carbohydrate intake was identified as the most significant predictor of new-onset MASLD, followed by fat, protein, and total caloric intake. Participants in cluster 3, who consumed a lower proportion of carbohydrate but had higher total caloric, protein, and fat intake, had a lower risk of new-onset MASLD than those in cluster 1 after adjusting for confounders (cluster 1 as a reference; cluster 3: HR, 0.90; 95% CI, 0.82 to 0.99). Conclusion The study’s results highlight the critical role of macronutrient composition, particularly carbohydrate intake, in MASLD development. The findings suggest that dietary strategies focusing on optimizing macronutrients, rather than simply reducing caloric intake, may be more effective in preventing MASLD.

Purpose: Endocrine therapy is the first-line treatment recommended for patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer without visceral crisis. However, this recommendation has not been followed clinically because of efficacy issues. In this study, the survival of patients with HR-positive/HER2-negative metastatic breast cancer was evaluated based on the following first-line treatment regimens: the combination of palbociclib plus letrozole, conventional endocrine therapy, or chemotherapy. Methods: Medical records were reviewed for this retrospective analysis. Patients with HR-positive/HER2-negative metastatic breast cancer were included. Progression-free survival (PFS) and overall survival (OS) were compared based on first-line treatment regimens. Results: A total of 184 patients were included in the analysis. The first-line treatments were palbociclib plus letrozole in 46 patients (25.0%), endocrine therapy in 40 patients (21.7%), and chemotherapy in 98 patients (53.3%). The PFS of the palbociclib plus letrozole group was significantly longer than that of the endocrine therapy (hazard ratio=3.43, p<0.001) and chemotherapy (hazard ratio=2.88, p=0.001) groups. No significant difference was observed between the endocrine therapy and chemotherapy groups (p=0.430). The OS of the palbociclib plus letrozole group was significantly longer than that of the endocrine therapy (hazard ratio=5.34, p=0.009) and chemotherapy (hazard ratio 4.23, p=0.043) groups. No significant difference was observed between the endocrine therapy and chemotherapy groups (p=0.451). Conclusion The combination regimen of palbociclib and letrozole could be recommended as the first-line treatment of choice in patients with HR-positive/HER2-negative metastatic breast cancer.

Lupus miliaris disseminatus faciei (LMDF) is a rare granulomatous skin disease mainly affecting the central area of the face. A variety of treatments are reportedly of some benefit; however, controlled studies to establish the best treatment are lacking. Here, we report the cases of a 33-year-old man who presented with multiple, various-sized, erythematous maculopapules on the face and a 19-year-old man who presented multiple, reddish papuloplaques distributed on the face. Histopathological examinations of the two cases revealed large clear-boundary epithelioid cell granulomas with central necrosis surrounded by lymphocytic infiltration. Based on the clinical and histological findings, diagnoses of LMDF were made. As oral tetracycline and antimalarials were not fully effective in our cases, oral mini-pulse steroid therapy (dexamethasone, 5 mg bid for 2 days per week) was initiated. After several months, the eruption significantly improved, and most lesions were resolved. Here, we report two cases of LMDF successfully treated with oral mini-pulse steroid therapy.
Adult ; Antimalarials ; Diagnosis ; Epithelioid Cells ; Granuloma ; Humans ; Necrosis ; Skin Diseases ; Tetracycline ; Young Adult

No abstract available.
Dendritic Cells* ; Neurofibroma*

Intralymphatic histiocytosis (IH) is a rare disease with variable and nonspecific clinical features, but with characteristic histopathological findings. Histopathologically, dilated lymphatic vessels containing aggregates of mononuclear cells are observed near the reticular dermis. IH is often associated with other diseases, such as rheumatoid arthritis, osteoarthritis, joint metal implantation, and with breast cancer where it occurs over the mastectomy scar. Although the pathogenesis of IH is not defined, some authors have suggested that lymphatic vessel engorgement by histiocytes migrating from neighboring inflammatory reactions may play a key pathogenic role. We present a case of IH associated with breast cancer. A 50-year-old female developed multiple tender erythematous plaques on both breasts and the right shoulder 3 years after bilateral mastectomy. To our knowledge, this is the first case of IH in association with breast cancer in the Korean dermatologic literature.
Arthritis, Rheumatoid ; Breast Neoplasms* ; Breast* ; Cicatrix ; Dermis ; Female ; Histiocytes ; Histiocytosis* ; Humans ; Joints ; Lymphatic Vessels ; Mastectomy ; Middle Aged ; Osteoarthritis ; Rare Diseases ; Shoulder

BACKGROUND: Many studies about herpes zoster are available in Korean dermatological literature. However, only a few of them reported herpes zoster meningoencephalitis. OBJECTIVE: The aim of this study was to determine the epidemiology and clinical features of herpes-zoster meningoencephalitis compared with herpes zoster without meningoencephalitis. METHODS: We examined the medical records of 3,154 patients with herpes zoster, who had visited our hospital from January 2008 to March 2016. Among them, 159 patients underwent cerebrospinal fluid analysis. Fifty-one patients who were diagnosed with herpes zoster meningoencephalitis and the 3,103 patients who were without meningoencephalitis were subjected to examinations to assess the incidence rates, the age distribution, the ganglion distribution, severity of acute pain, postherpetic neuralgia, serum VZV IgM and IgG, the clinical aspects, the underlying diseases, and the presence of complications. RESULTS: The rate of herpes zoster meningoencephalitis was 1.61%, with a mean age of 53.95 years, and the female-to-male patient ratio was 1.68. The trigeminal nerve was the most frequently involved dermatome (53.7%), with the ophthalmic branch (V1) involved at a rate of 68.96% among them. The serum VZV IgM was significantly higher in herpes zoster meningoencephalitis compared with herpes zoster without meningoencephalitis. Dizziness, mental change, palsy, and myalgia with nausea/vomiting showed high predictive values. All the patients were treated with acyclovir for 10~14 days, and 1 of them expired (1.96%). CONCLUSION: The results of this study demonstrated that herpes-zoster meningoencephalitis was associated with high serum levels of VZV IgM compared with herpes zoster without meningoencephalitis. When a patient with herpes zoster has symptoms of headache and nausea/vomiting with dizziness, mental status change, palsy, or myalgia, herpes-zoster meningoencephalitis should be considered.
Acute Pain ; Acyclovir ; Age Distribution ; Cerebrospinal Fluid ; Dizziness ; Encephalitis, Varicella Zoster ; Epidemiology* ; Ganglion Cysts ; Headache ; Herpes Zoster ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Medical Records ; Meningoencephalitis* ; Myalgia ; Neuralgia, Postherpetic ; Paralysis ; Trigeminal Nerve

Velopharyngeal incompetence is rare and difficult to diagnose, especially if there is no structural or neurologic cause for it. The authors have recently experienced a case of unexplained velopharyngeal incompetence in a 67-year old female patient with terminal-staged breast cancer (T4N2M1), who had received surgery before but failed. During her hospitalization for palliative treatment, the patient was referred to our department for hypernasality, nasal regurgitation and poor oral intake. Although clinical evaluations were completed to find the causes of velopharyngeal incompetence, no definite causes were found. Authors performed a palatopharyngoplasty with the superiorly based pharyngeal flap and her symptoms were cured. We report our case with a brief review of the literatures.
Breast ; Breast Neoplasms ; Female ; Hospitalization ; Humans ; Muscular Diseases ; Palliative Care ; Paraneoplastic Syndromes ; Surgical Flaps ; Velopharyngeal Insufficiency

BACKGROUND: Hypoxia often occurs during anesthesia of patients with tetralogy of Fallot (TOF). The factors that determine pulmonary circulation and oxygenation in patient with TOF are the degree of obstruction of right ventricular outflow tract (RVOT), right ventricular filling pressure, systemic vascular resistance, loss of negative pleural cavity pressure by thoracotomy, change of pulmonary vascular resistance due to positive pressure ventilation and degree of arteriopulmonary collateral connection. Hence pulse oximetry is a noninvasive technique for measuring arterial O2 saturation continuously, this study examined the correlation between the change of percutaneous arterial oxygen saturation (delta SpO2) and the change of mean arterial pressure (delta MAP) using pulse oximetry in these patients. METHODS: Twenty pediatric patients undergoing modified Blalock-Taussig shunt or total corrective operation were prospectively investigated. Immediately after induction, baseline values of MAP and SpO2 were determined and if there were some changes in SpO2 from baseline during operation, MAP on that value of SpO2 were collected. If SpO2 reduced, patients were treated with infusion of fresh frozen plasma or pentastach (2-10 ml/kg), injection of phenylephrine (10 microgram/kg) or esmolol (0.5 mg/kg). RESULTS: Intravascular volume loading only was executed in 4 patients, intravascular volume loading and phenylephrine administration was executed in 11 patients, and intravascular volume loading, phenylephrine and beta-blocker administration was executed in 5 patients. There were no significant correlation between delta MAP and delta SpO2 from linear correlation and regression analysis (r=0.23, p<0.05). CONCLUSIONS: Because delta SpO2 were not closely related with delta MAP and above mentioned factors could act closely among each others, meticulous anesthetic management is necessary during palliative or total corrective operation in patients with TOF.
Anesthesia ; Anoxia ; Arterial Pressure* ; Blalock-Taussig Procedure ; Humans ; Oximetry ; Oxygen* ; Phenylephrine ; Plasma ; Pleural Cavity ; Positive-Pressure Respiration ; Prospective Studies ; Pulmonary Circulation ; Tetralogy of Fallot* ; Thoracotomy ; Vascular Resistance

BACKGROUND: Lidocaine has been used for spinal anesthesia in short surgical procedure. However, transient neurologic symptoms (TNS) frequently occur after spinal anesthesia with lidocaine. Mepivacaine which has a silimar duration of action and rare incidence of TNS may be an alternative to lidocaine for spinal anesthesia. This study was designed to compare the efficacy of hyperbaric 1.5% lidocaine and 1.5% mepivacaine for spinal anesthesia. METHODS: Sixty patients, ASA physical status I or II, scheduled for lower abdominal or lower extremity procedures under spinal anesthesia were randomly allocated into two groups. Lidocaine group received 2% lidocaine 75 mg with 10% dextrose 1.25 ml. Mepivacaine group received 2% mepivacaine 75 mg with 10% dextrose 1.25 ml. After intrathecal injection of the anesthetics, sensorimotor block and recovery, cardiovascular effect and quality of surgical anesthesia were evaluated. TNS was evaluated 1 day after the operation. RESULTS: Both groups were similar with regard to demographic data and surgical procedures. The onset of sensory and motor blocks was similar in both groups. Time to regression to L5 sensory level and complete resolution of motor blockade were significantly prolonged in mepivacaine group than in lidocaine group (p<0.05). The effect of cardiovascular system was similar in both groups. Fentanyl was required for 4 cases only in the lidocaine group. None of both groups developed TNS. CONCLUSIONS: Hyperbaric 1.5% mepivacaine produced longer duration of action than hyperbaric 1.5% lidocaine in spinal anesthesia. This study didn't prove what drug develops a higher incidence of TNS.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics ; Cardiovascular System ; Fentanyl ; Glucose ; Humans ; Incidence ; Injections, Spinal ; Lidocaine* ; Lower Extremity ; Mepivacaine* ; Neurologic Manifestations