Background: Although almost all interventional pulmonologists agree that rigid bronchoscopy is irreplaceable in the field of interventional pulmonology, less is known about the types of diseases that the procedure is used for and what difficulties the operators face during the procedure. The purpose of this study is to evaluate what diseases rigid bronchoscopy is used for, whether it is widely used, and what challenges the operators face in Korea. Methods: We enrolled 14 hospitals in this retrospective cohort of patients who underwent rigid bronchoscopy between 2003 and 2020. An online survey was conducted with 14 operators to investigate the difficulties associated with the procedure. Results: While the number of new patients at Samsung Medical Center (SMC) increased from 189 in 2003–2005 to 468 in 2018–2020, that of other institutions increased from 0 to 238.The proportion of SMC patients in the total started at 100% and steadily decreased to 59.2%.The proportion of malignancy as the indication for the procedure steadily increased from 29.1% to 43.0%, whereas post-tuberculous stenosis (25.4% to 12.9%) and post-intubation stenosis (19.0% to 10.9%) steadily decreased (all P for trends < 0.001). In the online survey, half of the respondents stated that over the past year they performed less than one procedure per month. The fewer the procedures performed within the last year, the more likely collaboration with other departments was viewed as a recent obstacle (Spearman correlation coefficient, r s = −0.740, P = 0.003) and recent administrative difficulties were encountered (r s = −0.616, P = 0.019). Conclusion This study demonstrated that the number of patients undergoing rigid bronchoscopy has been increasing, especially among cancer patients. For this procedure to be used more widely, it will be important for beginners to systematically learn about the procedure itself as well as to achieve multidisciplinary consultation.

Background: Guselkumab is a monoclonal antibody that selectively blocks the p19 subunit of interleukin-23. It has shown good efficacy and safety profile in several clinical trials of plaque psoriasis. However, studies on the efficacy of guselkumab in patients treated with other biologics are lacking. Objective: We aimed to investigate the efficacy and safety profile of guselkumab in patients with moderate-to-severe plaque psoriasis. We also compared the efficacy of guselkumab between biologic-naïve (Bio-Naïve) and biologicexperienced (Bio-Ex) patients. Methods: This multicenter, retrospective study included 72 patients treated with guselkumab. The patients’ clinical characteristics and psoriasis area and severity index (PASI) scores were recorded at each visit. The PASI90 and PASI100 responses and mean PASI scores were compared between the Bio-Naïve and Bio-Ex groups. Results: Fifty-five Bio-Naïve patients and 17 Bio-Ex patients were included in the study. At week 20, there were no significant differences in the PASI90 (64.2% vs. 53.8%) and PASI100 (28.3% vs. 15.4%) responses between the groups. However, at weeks 36 and 44, the PASI90 response (week 36: 89.2% vs. 36.4% and week 44: 97.8% vs. 63.6%) and the PASI100 response (week 36: 64.9% vs. 18.2% and week 44: 68.9% vs. 27.3%) were significantly higher in the Bio-Naïve group (p＜0.05). There were no differences in PASI90 and PASI100 responses between the groups in terms of other clinical characteristics and comorbidities at week 20. Conclusion The efficacy of guselkumab remained consistent among patients in whom other biologics had failed. However, the efficacy was slightly lower in the Bio-Ex group than in the Bio-Naïve group.

Background: Risankizumab is a humanized immunoglobulin G1 monoclonal antibody that selectively binds to the p19 subunit of interleukin-23. Risankizumab has demonstrated rapid and excellent therapeutic effects in several clinical trials. Although a growing number of studies have reported data on the real-world efficacy and safety of risankizumab for the treatment of psoriasis, no such study has been conducted in Korea. Objective: We evaluated the real-world efficacy and safety of risankizumab for the treatment of moderate-to-severe plaque psoriasis in Korean patients. Methods: This was a retrospective single-center study. A total of 33 patients treated with risankizumab, for at least 16 weeks, were enrolled. Based on electronic medical records, the clinical characteristics, psoriasis area and severity index (PASI) score, body surface area, and adverse events were investigated. Results: The mean PASI score was significantly reduced at 4 weeks of risankizumab treatment (3.27±2.15) and gradually reduced at week 16 (1.06±0.97) and week 52 (0.24±0.63) (p＜0.05). At week 16, all patients achieved a PASI 75 response, and 66.7% and 27.3% of patients achieved PASI 90 and PASI 100 responses, respectively. Obese patients (body mass index, BMI≥25 kg/m2 ) showed a lower PASI 90 response than non-obese patients (BMI＜25 kg/m2 ) at week 16. Older patients (age≥65 years) showed significantly higher PASI scores than younger patients (age＜65 years) at week 16. Mild to moderate adverse events were reported in four patients; however, no patient discontinued treatment. Conclusion Risankizumab was very effective in a real-world clinical practice with a favorable safety profile in Korean patients with moderate-to-severe psoriasis.

Background: YouTube is one of the most popular video-sharing websites in Korea, but incorrect or biased information is not properly regulated. Acne is common in adolescents and young adults who are familiar with YouTube. Thus, misleading information about isotretinoin in YouTube videos could distort the perception of treatment. Objective: We evaluated the quality of information about isotretinoin in YouTube videos. Methods: The keywords searched on YouTube Korea on July 1, 2020 were: isotretinoin, Roaccutane, and Isotinone. The DISCERN tool was used to evaluate the reliability and quality of information, and eight items were used to evaluate scientific accuracy and comprehensiveness: mechanism, indications, dose regimen, contraindications, side effects, blood tests, drug interactions, and pregnancy-related issues. Results: The number of videos searched was 728. After excluding duplicate or inappropriate videos, 164 videos were analyzed. In the DISCERN tool, the mean overall quality score was 2.24 on a 5-point scale from 1 to 5. The mean score in the 8-issue-criteria, a 3-point scale from 0 to 2, was 0.61. Particularly, indications, blood tests, and drug interactions were poorly addressed in YouTube videos. Medical personnel offer better video quality than non-medical personnel. However, no significant difference in quality existed between the videos of dermatologists and those of other medical personnel. The quality score was not correlated with the popularity of the video. Conclusion YouTube videos covering isotretinoin showed poor overall quality. Content quality did not have a significant correlation with popularity, so incorrect information could be propagated on YouTube.

Background: Biologics-experienced patients are more likely to show a lower response to biologics than that of biologic-naïve patients. However, no consensus on switching biologics exists. Objective: We aimed to investigate the switching patterns and efficacy of the switched biologics in patients with moderate-to-severe psoriasis in actual clinical practice. Methods: This multicenter retrospective study included 37 patients with a history of switching biologics. We analyzed the reasons for switching, the switching patterns, and psoriasis area and severity index (PASI) 75 response rates after switching biologics. We also analyzed the factors affecting the PASI75 response rate to the second biologic. Results: The reasons for switching baseline biologics were primary failure in five patients (13.5%), secondary failure in 28 patients (75.7%), and adverse events in four patients (10.8%). The second biologics prescribed mostly include interleukin (IL)-23 inhibitor in twenty-four patients (64.9%), IL-17 inhibitor in eight patients (21.6%), tumor necrosis factor-α inhibitor in three patients (8.1%), and IL-12/23 inhibitor in two patients (5.4%). A total of 46% of patients (17/37) switched biologics from IL-12/23 inhibitors to IL-23 inhibitors. The PASI75 response rates at the primary endpoint of the second and third biologics were 89.2% and 88.8%, respectively. Our study found that female sex and obesity were associated with the primary failure of the second biologic. Conclusion Secondary failure was the most common reason for switching baseline biologics. Korean dermatologists prefer different classes of biologics while switching. The PASI75 response rates at the primary endpoints of the second and third biologics were relatively satisfactory.

Ectopic nails are rare and characterized by the growth of nail-like structures in a location other than the typical nail unit. Diagnosis of the ectopic nail is based on histologic examination consistent with a fully developed nail plate and matrix structure. Surgical resection of the entire matrix of ectopic nails is the gold standard for management.Cases of acquired ectopic nails without traumatic events have rarely been reported. A 25-year-old woman presented with a 15-year nail-like structure below the 4th fingernail of the left hand. She denied any history of trauma.Histologically, the keratinous structure was consistent with the nail plate. Plain radiography revealed an osteolytic lesion on the distal phalanx. However, she refused further evaluation and surgical excision. Herein, we report a unique case of an acquired ectopic nail without trauma.

Ectopic nails are rare and characterized by the growth of nail-like structures in a location other than the typical nail unit. Diagnosis of the ectopic nail is based on histologic examination consistent with a fully developed nail plate and matrix structure. Surgical resection of the entire matrix of ectopic nails is the gold standard for management.Cases of acquired ectopic nails without traumatic events have rarely been reported. A 25-year-old woman presented with a 15-year nail-like structure below the 4th fingernail of the left hand. She denied any history of trauma.Histologically, the keratinous structure was consistent with the nail plate. Plain radiography revealed an osteolytic lesion on the distal phalanx. However, she refused further evaluation and surgical excision. Herein, we report a unique case of an acquired ectopic nail without trauma.

Here, we report a case of pleural paragonimiasis that was confused with tuberculous pleurisy. A 38-year-old man complained of a mild febrile sensation and pleuritic chest pain. Radiologic findings showed right pleural effusion with pleural thickening and subpleural consolidation. Adenosine deaminase (ADA) activity in the pleural effusion was elevated (85.3 IU/L), whereas other examinations for tuberculosis were negative. At this time, the patient started empirical anti-tuberculous treatment. Despite 2 months of treatment, the pleural effusion persisted, and video-assisted thoracoscopic surgery was performed. Finally, the patient was diagnosed with pleural paragonimiasis based on the pathologic findings of chronic granulomatous inflammation containing Paragonimus eggs. This case suggested that pleural paragonimiasis should be considered when pleural effusion and elevated ADA levels are observed.
Adenosine Deaminase ; Adult ; Chest Pain ; Eggs ; Humans ; Inflammation ; Ovum ; Paragonimiasis* ; Paragonimus ; Pleural Effusion ; Sensation ; Thoracic Surgery, Video-Assisted ; Tuberculosis ; Tuberculosis, Pleural*