Background: Green nail syndrome (GNS) is characterized by a greenish discoloration of the nail with accompanying nail apparatus disorders, such as onycholysis or paronychia. To date, data on the clinical characteristics of GNS are limited, especially in Korea. Objective: This study aimed to investigate the clinical characteristics of GNS. Methods: We retrospectively reviewed the medical records and clinical photographs of 78 patients with 91 GNS lesions diagnosed at the Pusan National University Hospitals (Busan and Yangsan) from 2009 to 2021. Results: Among 78 patients, 47 (60.3%) were female and 31 male (39.7%), with a mean age of 53.1 years (23∼82 years). This study included 56 fingernail (61.5%) and 35 toenail lesions (38.5%). Thumbnails and great toenails were the most common site, with 62 lesions (68.1%). Most patients presented predisposing conditions, such as frequent exposure to wet conditions (55.1%), immunosuppressive conditions (26.9%), and trauma history (29.5%). The most common colors, shapes, and eccentricities of GNS were blackish-green (31.9%), reverse triangle (53.8%), and distal eccentricity (42.9%), respectively. The GNS was accompanied by various nail diseases that mostly (80.2%) preceded the syndrome, and onycholysis was the most common (83.5%). Based on the involvement of the nail surface or subsurface, GNS can be divided into the superficial (15.4%), subungual (73.6%), and mixed (11.0%) subtypes, each of which shows different clinical features, such as multiplicity, color, shape, and eccentricity. Conclusion This is the largest-scale study showing the clinical characteristics of GNS and can be helpful for dermatologists who usually and primarily treat GNS.

Background: Pigmented purpuric dermatosis (PPD) is a chronic disorder characterized by distinct petechial hemorrhage and brownish pigmentation. The cause of PPD is unclear, but several underlying conditions are associated with it. Previous reports suggest that venous insufficiency (VI) might be related to PPD; however, a clear correlation remains unelucidated. Objective: To elucidate the causal relationship between PPD and VI. Methods: A total 118 patients diagnosed with PPD in the Department of Dermatology, Pusan National University Hospital from November 2006 to July 2019 were retrospectively reviewed. Doppler ultrasonography of the lower extremities was performed in 56 PPD patients, who were then divided into two groups: PPD with and without VI. We compared the clinical features between the two groups. In the PPD with VI group, we assessed the correspondence ratios between PPD and VI lateralities, and between the PPD distribution and the veins involved. Results: VI was detected in 35 of the 56 patients (62.5%). The PPD with VI group was significantly associated with wider distribution, darker coloration and longer disease duration. There was a positive correlation of laterality between PPD and VI, and between PPD distribution and the vein involved. Conclusion This findings suggest that VI is a clear provoker of PPD.

Background: This study aimed to identify chronicity predictors of pediatric primary immune thrombocytopenia (ITP). Methods: This study retrospectively reviewed the medical records of patients with primary pediatric ITP admitted to a tertiary medical center between 2010 and 2021.Forty-five patients with a platelet count ＜20,000/L at the time of diagnosis who were treated with intravenous immunoglobulin (IVIG) were enrolled in this study. Results: According to the disease phase, 28, 6, and 11 patients were classified into the newly diagnosed (ND), persistent, and chronic groups, respectively. The number of patients over 6 years of age was significantly higher in the chronic group than in the ND and persistent groups. After 14 days of IVIG treatment, more patients had a complete response in the non-chronic groups than in the chronic group. In univariate analysis of risk factor for chronic ITP, age 6 years or older and IVIG dose ＜2 g/kg were found to be risk factors for chronic ITP, and these two factors were also confirmed as significant risk factors in multivariate analysis. Conclusion In conclusion, in our study, patients over 6 years of age, and those who received IVIG doses less than 2 g/kg were more likely to progress to chronic ITP.

Background: In this study, the usefulness of within-subject biological coefficient of variation (CVI) and reference change values (RCVs) for delta check limits were investigated by comparing the population distributionbased delta check limits. Methods: For six tests, including aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transferase, glucose, creatinine, and hemoglobin, the RCV95%, RCV99%, and RCV99.9% delta limits were obtained. The nonparametric 95% and 99% delta limits were obtained from the population distribution of the delta percentage difference of the health examination group (January 2014 to December 2018) and the outpatient and inpatient groups (January to December 2018). Delta check alerts (%) in total and all three subgroups were examined according to the five different delta check limits. Additionally, we analyzed the correlation of the median CVIF estimates with population-delta check limits for the six tests. Results: The delta percentage difference of the six tests showed a nonnormal distribution, and median value significantly differed among the health examination, outpatient, and inpatient groups (all, P <0.001). The overall delta check alerts of six tests decreased in the order of RCV95%, RCV99%, and RCV99.9%, population distribution -95%, and -99% delta limits; the proportion of the health examination group gradually decreased and that of inpatients increased. A good correlation was observed between median CVI (range, 2.7% to 10.1%) and population distribution delta limits (r =0.96 to 0.99). Conclusions The RCV delta check limits should be applied differently depending on the health and disease group. CVI can be useful for estimating the delta check limits of the population.

5-HT₆ receptor (5-HT₆R) is implicated in cognitive dysfunction, mood disorder, psychosis, and eating disorders. However, despite its significant role in regulating the brain functions, regulation of 5-HT₆R at the molecular level is poorly understood. Here, using yeast two-hybrid assay, we found that human 5-HT₆R directly binds to neuro-oncological ventral antigen 1 (Nova-1), a brain-enriched splicing regulator. The interaction between 5-HT₆R and Nova-1 was confirmed using GST pull-down and co-immunoprecipitation assays in cell lines and rat brain. The splicing activity of Nova-1 was decreased upon overexpression of 5-HT₆R, which was examined by detecting the spliced intermediates of gonadotropin-releasing hormone (GnRH), a known pre-mRNA target of Nova-1, using RT-PCR. In addition, overexpression of 5-HT₆R induced the translocation of Nova-1 from the nucleus to cytoplasm, resulting in the reduced splicing activity of Nova-1. In contrast, overexpression of Nova-1 reduced the activity and the total protein levels of 5-HT₆R. Taken together, these results indicate that when the expression levels of 5-HT₆R or Nova-1 protein are not properly regulated, it may also deteriorate the function of the other.
Animals ; Brain ; Cell Line ; Cytoplasm ; Eating ; Gonadotropin-Releasing Hormone ; Humans ; Immunoprecipitation ; Mood Disorders ; Psychotic Disorders ; Rats ; RNA Precursors ; RNA-Binding Proteins ; Serotonin ; Two-Hybrid System Techniques

We report a case of pulmonary aspiration during induction of general anesthesia in a patient who was status post esophagectomy. Sudden, unexpected aspiration occurred even though the patient had fasted adequately (over 13 hours) and received rapid sequence anesthesia induction. Since during esophagectomy, the lower esophageal sphincter is excised, stomach vagal innervation is lost, and the stomach is flaccid, draining only by gravity, the patient becomes vulnerable to aspiration. As the incidence of perioperative pulmonary aspiration is relatively low, precautions to prevent aspiration tend to be overlooked. We present a video clip showing pulmonary aspiration and discuss the literature concerning the risk of aspiration and its preventive strategies.
Anesthesia ; Anesthesia, General ; Esophageal Sphincter, Lower ; Esophagectomy ; Gravitation ; Humans ; Hypopharyngeal Neoplasms ; Incidence ; Intubation ; Respiratory Aspiration ; Stomach

BACKGROUND: Hes6 is a transcriptional regulator that induces transcriptional activation by binding to transcription repressor Hes1 and suppressing its activity. Hes6 is controlled by the ubiquitin-proteosome-mediated degradation system. Here we investigated the sumoylation of Hes6 and its functional role in its rhythmic expression. METHODS: Hes6, SUMO, and ubiquitin were transfected into HeLa cells and the expression pattern was observed by Western blot and immunoprecipitation. To confirm the effect of sumoylation on the rhythmic expression of Hes6, we generated mouse Hes6 promoter-driven GFP-Hes6 fusion constructs and expressed these constructs in NIH 3T3 cells. RESULTS: Overexpression of SUMO led to sumoylation of Hes6 at both lysine 27 and 30. Protein stability of Hes6 was decreased by sumoylation. Moreover, expression of a Hes6 sumoylation-defective mutant, the 2KR (K27/30R) mutant, or co-expression of SUMO protease SUSP1 with native Hes6, strongly reduced ubiquitination. In addition, sumoylation was associated with both the rhythmic expression and transcriptional regulation of Hes6. Wild type Hes6 showed oscillatory expression with about 2-hour periodicity, whereas the 2KR mutant displayed a longer period. Furthermore, sumoylation of Hes6 derepressed Hes1-induced transcriptional repression. CONCLUSION: Hes6 sumoylation plays an important role in the regulation of its stability and Hes1-mediated transcription. These results suggest that sumoylation may be crucial for rhythmic expression of Hes6 and downstream target genes.
Animals ; Blotting, Western ; HeLa Cells ; Humans ; Immunoprecipitation ; Lysine ; Mice ; NIH 3T3 Cells ; Periodicity ; Protein Stability ; Proteolysis* ; Repression, Psychology ; Sumoylation* ; Transcriptional Activation ; Ubiquitin ; Ubiquitination