Objective: This study investigated the associations between paraspinal muscle measurements on chest computed tomography and clinical outcomes of elderly patients with community-acquired pneumonia (CAP). Methods: This single-center, retrospective, observational study analyzed elderly patients (≥65 years) with CAP hospitalized through an emergency department between March 2020 and December 2022. We collected their baseline characteristics and laboratory data at the time of admission. The paraspinal muscle index and attenuation were calculated at the level of the 12th thoracic vertebra using chest computed tomography taken within 48 hours before or after admission. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between paraspinal muscle measurements and 28-day mortality. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to evaluate the prognostic predictive power. Results: Of the 338 enrolled patients, 60 (17.8%) died within 28 days after admission. A high paraspinal muscle index was associated with low 28-day mortality in elderly patients with CAP (adjusted odds ratio, 0.994; 95% confidence interval, 0.992–0.997). The area under the ROC curve for the muscle index was 0.75, which outperformed the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65 years) metric, both of which showed an AUC of 0.64 in predicting mortality. Conclusion A high paraspinal muscle index was associated with low 28-day mortality in patients aged 65 years or older with CAP.

The occurrence of an abdominal wall hematoma caused by abdominal paracentesis in patients with liver cirrhosis is rare. This paper presents a case of an abdominal wall hematoma caused by abdominal paracentesis in a 67-year-old woman with liver cirrhosis with a review of the relevant literature. Two days prior, the patient underwent abdominal paracentesis for symptom relief for refractory ascites at a local clinic. Upon admission, a physical examination revealed purpuric patches with swelling and mild tenderness in the left lower quadrant of the abdominal wall. Abdominal computed tomography revealed advanced liver cirrhosis with splenomegaly, tortuous dilatation of the para-umbilical vein, a large volume of ascites, and a large acute hematoma at the left lower quadrant of the abdominal wall. An external iliac artery angiogram showed the extravasation of contrast media from the left deep circumflex iliac artery. Embolization of the target arterial branches using N-butyl-2-cyanoacrylate was then performed, and the bleeding was stopped. The final diagnosis was an abdominal wall hematoma from the left deep circumflex iliac artery after abdominal paracentesis in a patient with liver cirrhosis.

Objectives: Gastrointestinal cytomegalovirus (CMV) disease is a major contributor to mortality in immunocompromised patients. Few studies have discussed upper gastrointestinal CMV (UGICMV) disease in immunocompetent patients. We compared the clinical outcomes of UGI-CMV between immunocompromised and immunocompetent patients. Methods: This retrospective study included patients with UGI-CMV disease from five tertiary hospitals across Korea (2010– 2022). Patients’ clinical data and outcomes were recorded. Results: UGI-CMV was diagnosed in 54 patients; 27 (50.0%) had esophageal, 24 (44.4%) had gastric, and 3 patients (5.6%) had duodenal involvement. Patients’ median age was 64 years (interquartile range 53–75 years), and the most common comorbidities included hypertension (57.4%) and diabetes (38.9%). The predominant symptom was abdominal pain (46.3%), and the most common endoscopic finding was ulcers (70.4%). Antiviral treatment was administered to 31 patients, and 23 patients underwent observation without treatment. We investigated 32 immunocompromised (59.3%) and 22 immunocompetent (40.7%) patients and observed no intergroup differences in comorbidities and in laboratory and endoscopic findings. Immunocompromised patients had longer length of hospitalization (median 46.2 days vs. 20.0 days, p=0.001). However, treatment outcomes, including the need for intensive care unit admission and mortality did not significantly differ. The overall mortality rate was 13.0%; one patient from the immunocompromised group died of UGI-CMV disease. The treatment success rate was higher in immunocompromised patients who received antiviral therapy (p=0.011). Conclusions UGI-CMV disease is not uncommon in immunocompetent patients, although symptoms are milder than those in immunocompromised patients. Our findings emphasize the importance of clinical vigilance for accurate diagnosis of CMV infection, particularly in susceptible symptomatic patients and highlight the need for active antiviral treatment for management of immunocompromised patients.

Clear cell acanthoma (CCA) is an uncommon, benign epithelial tumor presenting as a well-defined, slow-growing solitary nodule. The diagnosis of CCA is usually based on clinical and histopathological evaluation of the tumor.However, when such type of benign tumor occurs on an exposed area, a biopsy is not always the best diagnostic option since it may leave scar. The recent advent of dermoscopy has offered an accurate and non-invasive method to diagnose CCA without resorting to skin biopsy. A 40-year-old male presented with a shiny, erythematous-to-brown, flattened nodule on the left cheek. Dermoscopic examination revealed a ‘string of pearls’ vascular pattern, a characteristic dermoscopic feature of CCA. Under the clinical and dermoscopic impression of CCA, a 595 nm pulsed dye laser (PDL) therapy targeting the vascular tissue in the superficial dermis of the lesion was chosen for a minimally invasive treatment.After repeated sessions of PDL, an optimal cosmetic outcome was achieved and no recurrence was recorded during the follow-up period. Herein, we report a case of presumed CCA which was successfully diagnosed and treated by utilizing non-invasive modalities.

Purpose: To evaluate and analyze the adequacy of breast magnetic resonance imaging (MRI)s taken before publication of the 2018 recommendation in South Korea. Materials and Methods: We enrolled 87 cases of breast MRIs, from January 2010 to November 2013, taken at external hospitals in the study. Breast MRI protocol elements are divided into three categories based on the recommendation by the Breast Imaging Study Group of the Korean Society of Magnetic Resonance: (1) Essential elements for breast MRI protocol; (2) Element to consider when evaluating imaging quality; and (3) Optional element for breast MRI protocol. Also, we divided enrolled cases into three groups based on their conducting locations -- (1) Primary hospitals, (2) Secondary hospitals, and (3) Tertiary hospitals-and analyzed them for the adequacy of imaging protocols based on the 2018 recommendation. We used a Chi-square test and Fisher’s exact test to identify differences between categorical variables. Results: Over 98% of the criteria for 'essential elements for breast MRI protocol' were satisfied when compared with the 2018 Recommendation. Over 96% of the criteria for 'elements to consider when evaluating imaging quality' were also satisfied, except for the slice thickness (83.9%). Optional elements for breast MRI protocol were satisfied with various percentages. There were no statistically significant differences between groups of tertiary, secondary, and primary hospitals; however, 3 tesla of MRI (P = 0.04), subtraction image protocol (P = 0.032), and DWI protocol (P = 0.03) were used more frequently in the tertiary hospitals than in the others. Conclusion We found that the categories of 'essential elements' and 'elements to consider when evaluating imaging quality' were satisfied at 98% and 96%, respectively, when compared with the 2018 Recommendation by the Breast Imaging Study Group of the Korean Society of Magnetic Resonance.

Purpose: To evaluate and analyze the adequacy of breast magnetic resonance imaging (MRI)s taken before publication of the 2018 recommendation in South Korea. Materials and Methods: We enrolled 87 cases of breast MRIs, from January 2010 to November 2013, taken at external hospitals in the study. Breast MRI protocol elements are divided into three categories based on the recommendation by the Breast Imaging Study Group of the Korean Society of Magnetic Resonance: (1) Essential elements for breast MRI protocol; (2) Element to consider when evaluating imaging quality; and (3) Optional element for breast MRI protocol. Also, we divided enrolled cases into three groups based on their conducting locations -- (1) Primary hospitals, (2) Secondary hospitals, and (3) Tertiary hospitals-and analyzed them for the adequacy of imaging protocols based on the 2018 recommendation. We used a Chi-square test and Fisher’s exact test to identify differences between categorical variables. Results: Over 98% of the criteria for 'essential elements for breast MRI protocol' were satisfied when compared with the 2018 Recommendation. Over 96% of the criteria for 'elements to consider when evaluating imaging quality' were also satisfied, except for the slice thickness (83.9%). Optional elements for breast MRI protocol were satisfied with various percentages. There were no statistically significant differences between groups of tertiary, secondary, and primary hospitals; however, 3 tesla of MRI (P = 0.04), subtraction image protocol (P = 0.032), and DWI protocol (P = 0.03) were used more frequently in the tertiary hospitals than in the others. Conclusion We found that the categories of 'essential elements' and 'elements to consider when evaluating imaging quality' were satisfied at 98% and 96%, respectively, when compared with the 2018 Recommendation by the Breast Imaging Study Group of the Korean Society of Magnetic Resonance.

Clear cell acanthoma (CCA) is an uncommon, benign epithelial tumor presenting as a well-defined, slow-growing solitary nodule. The diagnosis of CCA is usually based on clinical and histopathological evaluation of the tumor.However, when such type of benign tumor occurs on an exposed area, a biopsy is not always the best diagnostic option since it may leave scar. The recent advent of dermoscopy has offered an accurate and non-invasive method to diagnose CCA without resorting to skin biopsy. A 40-year-old male presented with a shiny, erythematous-to-brown, flattened nodule on the left cheek. Dermoscopic examination revealed a ‘string of pearls’ vascular pattern, a characteristic dermoscopic feature of CCA. Under the clinical and dermoscopic impression of CCA, a 595 nm pulsed dye laser (PDL) therapy targeting the vascular tissue in the superficial dermis of the lesion was chosen for a minimally invasive treatment.After repeated sessions of PDL, an optimal cosmetic outcome was achieved and no recurrence was recorded during the follow-up period. Herein, we report a case of presumed CCA which was successfully diagnosed and treated by utilizing non-invasive modalities.

Background: This study is aimed to verify individual and regional-level factors affecting the depression of Koreans and to develop social programs for improving the depressive status. Methods: This study used individual-level variables from the Korean Community Health Survey (2018) and used the e-regional index of the Korean Statistical Information Service as the regional-level variable. A multi-level logistic regression was executed to identify individual and regional-level variables that were expected to affect the extent of depressive symptoms and to draw the receiver operating characteristic curve to compare the volume of impact between variables from both levels. Results: The results of the multi-level logistic regression analysis in regards to individual-level factors showed that older age, female gender, a lower income level, a lower education level, not having a spouse, the practice of walking, the consumption of breakfast higher levels of stress, and having high blood pressure or diabetes were associated with a greater increase in depressive symptoms. In terms of regional factors, areas with fewer cultural facilities and fewer car registration had higher levels of depressive symptoms.The comparison of area under the curve showed that individual factors had a greater influence than regional factors. Conclusion This study showed that while both, individual and regional-level factors affect depression, the influence of the latter was relatively weaker as compared to the first. In this sense, it is necessary to develop programs focused on the individual, such as social prescribing at the local or community-level, rather than the city and nation-level approach that are currently prevalent.

PURPOSE: Adjuvant chemotherapy (aCT) in rectal cancer patients who have undergone curative resection after neoadjuvant chemoradiation (nCRT) is controversial. We aimed to investigate the benefits of using aCT and the clinical impact of completing aCT in ypstage 2 rectal cancer patients.METHODS: We retrospectively reviewed clinicopathological data from patients who had undergone radical resection after nCRT between January 2006 and December 2012. In total, 152 patients with ypT3/4N0M0 rectal cancer were included. Of these patients, 139 initiated aCT, while 13 did not receive aCT (no-aCT). Among those who received aCT, 132 patients completed their planned cycles (aCT-completion) whereas 7 did not (aCT-incompletion). All patients received longcourse chemoradiation; a 5-fluorouracil-based regimen was used for nCRT in most patients. The prognostic factors affecting disease-free survival (DFS) and overall survival (OS) were analyzed.RESULTS: The median follow-up duration was 41 months. Demographic data did not differ significantly among the 3 groups. In multivariate analysis, open surgery, a tumor size >2 cm, retrieval of <12 lymph nodes, circumferential resection margin (CRM) positivity and aCT incompletion were independent prognostic factors for poor DFS. Old age (≥60 years), open surgery, CRM positivity, aCT incompletion, and lack of aCT initiation compared to aCT completion were independent prognostic factors for poor OS.CONCLUSION: In ypstage 2 rectal cancer patients, aCT after nCRT and total mesorectal excision affected both DFS and OS; however, only patients who completed planned aCT exhibited survival benefits. Therefore, improving patients’ compliance with the completion of aCT is desirable.
Chemoradiotherapy ; Chemotherapy, Adjuvant ; Compliance ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoadjuvant Therapy ; Rectal Neoplasms ; Retrospective Studies

BACKGROUND: Adiponectin, an adipokine secreted from adipocytes, affects energy metabolism and also shows anti-diabetic and anti-inflammatory properties. Recent studies have reported that adiponectin plays a role in regulating skin inflammation. OBJECTIVE: This study aimed to investigate the effect of adiponectin on the expression of filaggrin (FLG) in normal human epidermal keratinocytes (NHEKs). METHODS: NHEKs were serum-starved for 6h before being treated with adiponectin. Afterward, cell viability was assessed by MTT assay. We also treated with calcium, interleukin (IL)-4, and IL-13 to provide positive and negative comparative controls, respectively. Gene mRNA expression was quantified using real time reverse transcription polymerase chain reaction, and protein expression was evaluated using Western blot. To evaluate the relationship among mitogen-activated protein kinases (MAPKs), activator protein 1 (AP-1), and FLG, we also treated cells with inhibitors for MAPKs JNK, p38, and ERK1/2. RESULTS: FLG and FLG-2 mRNA expression in NHEKs significantly increased after treatment with 10 µg/ml adiponectin. Adiponectin also restored FLG and FLG-2 mRNA expression that was otherwise inhibited by treatment with IL-4 and IL-13. Adiponectin induced FLG expression via AP-1 and MAPK signaling. CONCLUSION: Adiponectin positively regulated the expression of FLG and could be useful as a therapeutic agent to control diseases related to disrupted skin barrier function.
Adipocytes ; Adipokines ; Adiponectin* ; Blotting, Western ; Calcium ; Cell Differentiation ; Cell Survival ; Energy Metabolism ; Humans* ; Inflammation ; Interleukin-13 ; Interleukin-4 ; Interleukins ; Keratinocytes* ; Mitogen-Activated Protein Kinases ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger ; Skin ; Transcription Factor AP-1