Purpose: This study aimed to assess the real-world clinical outcomes of consolidative durvalumab in patients with unresectable locally advanced non–small cell lung cancer (LA-NSCLC) and to explore the role of radiotherapy in the era of immunotherapy. Materials and Methods: This retrospective study assessed 171 patients with unresectable LA-NSCLC who underwent concurrent chemoradiotherapy (CCRT) with or without consolidative durvalumab at Asan Medical Center between May 2018 and May 2021. Primary outcomes included freedom from locoregional failure (FFLRF), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS). Results: Durvalumab following CCRT demonstrated a prolonged median PFS of 20.9 months (p=0.048) and a 3-year FFLRF rate of 57.3% (p=0.008), compared to 13.7 months and 38.8%, respectively, with CCRT alone. Furthermore, the incidence of in-field recurrence was significantly greater in the CCRT-alone group compared to the durvalumab group (26.8% vs. 12.4%, p=0.027). While median OS was not reached with durvalumab, it was 35.4 months in patients receiving CCRT alone (p=0.010). Patients positive for programmed cell death ligand 1 (PD-L1) expression showed notably better outcomes, including FFLRF, DMFS, PFS, and OS. Adherence to PACIFIC trial eligibility criteria identified 100 patients (58.5%) as ineligible. The use of durvalumab demonstrated better survival regardless of eligibility criteria. Conclusion The use of durvalumab consolidation following CCRT significantly enhanced locoregional control and OS in patients with unresectable LA-NSCLC, especially in those with PD-L1–positive tumors, thereby validating the role of durvalumab in standard care.

Background: The rapid economic development of South Korea provides a unique model to study changes in the clinical characteristics, treatment approaches, and clinical outcomes of patients with rheumatic mitral stenosis (MS) relative to socioeconomic growth. Methods: From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, 2,337 patients diagnosed with moderate or severe rheumatic MS between January 2001 and December 2020 were analyzed. Patients were grouped into consecutive 5-year intervals based on their year of diagnosis. Clinical characteristics, echocardiographic data, and clinical outcomes were assessed. Results: Over 20 years, the severity of mitral stenosis increased from 79.1% to 90.2%; similarly, the average age at diagnosis increased from 54.3 to 63.0 years (all P < 0.001). Comorbidities such as hypertension and atrial fibrillation increased (6.3% to 29.5% and 41.4% to 46.9%, respectively; all P for trend < 0.05). The rate of mitral intervention within five years after diagnosis increased from 31.2% to 47.4% (P for trend < 0.001). However, clinical outcomes of rheumatic mitral stenosis deteriorated over time in the composite outcomes (log-rank test, P < 0.001). Conversely, the incidence of stroke remained stable (60.6–73.7%; P < 0.001), which might be attributed to the increased use of anticoagulation therapy. Conclusion This study observed an increase in patient age, comorbidities, and valve disease severity as the country transitioned from a developing to developed status. Despite a rise in mitral valve interventions, clinical outcomes deteriorated over 20 years, highlighting the need for modified treatment approaches to improve patient outcomes.

BACKGROUND: Systemic immunomodulatory treatment is actively recommended in the treatment for moderate to severe atopic dermatitis (AD) patients. However, consensus criteria for the classification of AD severity or treatment refractoriness have not been established yet. OBJECTIVE: To establish consensus criteria on the definition of severity classification and treatment refractoriness of AD to provide a basis for proper treatment strategy. METHODS: The Korean Atopic Dermatitis Association (KADA) comprised a task force team to establish a definition of moderate to severe AD. A draft of definition of moderate to severe AD was made on the basis of evidence. The recommendation was confirmed by KADA members through a web-based survey. RESULTS: KADA approved that AD with 16≤eczema area and severity index (EASI)<23 should be basically defined as moderate AD whereas AD with EASI score ≥23 should be considered as severe AD. They agreed that it would be reasonable to raise the severity level if patient's daytime or nighttime pruritus numerical rating scale is equal to or higher than 7 (≥7) or dermatology life quality index score exceeds 10. AD patients who do not reach EASI 50 after appropriate treatment for three months should be considered as a non-responder. Patients with recurrence (EASI ≥16) within three months after cessation of treatment should be considered as a recurrent AD. CONCLUSION: KADA built a consensus of definition of moderate and severe AD and treatment-refractoriness. These guidelines are expected to help physicians determine proper treatment options in need.
Advisory Committees ; Classification ; Consensus ; Dermatitis, Atopic ; Dermatology ; Diagnosis ; Humans ; Pruritus ; Quality of Life ; Recurrence ; Treatment Failure ; Withholding Treatment

OBJECTIVES: This report describes the development process of a drug dosing database for ethical drugs approved by the Korea Food & Drug Administration (KFDA). The goal of this study was to develop a computerized system that supports physicians' prescribing decisions, particularly in regards to medication dosing. METHODS: The advisory committee, comprised of doctors, pharmacists, and nurses from the Seoul National University Bundang Hospital, pharmacists familiar with drug databases, KFDA officials, and software developers from the BIT Computer Co. Ltd. analyzed approved KFDA drug dosing information, defined the fields and properties of the information structure, and designed a management program used to enter dosing information. The management program was developed using a web based system that allows multiple researchers to input drug dosing information in an organized manner. The whole process was improved by adding additional input fields and eliminating the unnecessary existing fields used when the dosing information was entered, resulting in an improved field structure. RESULTS: A total of 16,994 drugs sold in the Korean market in July 2009, excluding the exclusion criteria (e.g., radioactivity drugs, X-ray contrast medium), usage and dosing information were made into a database. CONCLUSIONS: The drug dosing database was successfully developed and the dosing information for new drugs can be continually maintained through the management mode. This database will be used to develop the drug utilization review standards and to provide appropriate dosing information.
Advisory Committees ; Databases, Pharmaceutical ; Drug Utilization Review ; Humans ; Isothiocyanates ; Korea ; Pharmacists ; Radioactivity

Wolf's isotopic response describes the occurrence of a new, unrelated disease that appears at the same location as a previously healed skin disease, and the most common primary skin disease of this phenomenon is herpes zoster. Several cutaneous lesions have been described to occur at the site of healed herpes zoster, and granulomatous dermatitis and granuloma annulare have been reported to be the most common second diseases. The pathogenesis of the isotopic response is still unclear. Morphea can develop at the site of regressed herpes zoster and a few such cases have been reported. We present here an additional case of morphea that developed at the site of previously healed herpes zoster, and we review the relevant literature.
Dermatitis ; Granuloma Annulare ; Herpes Zoster ; Scleroderma, Localized ; Skin Diseases

Lichen planus pigmentosus (LPP) is a rare variant of lichen planus, and it is characterized by hyperpigmented, dark brown to violaceous colored macules or patches on the sun exposed areas of the skin. The term of LPP-inversus was proposed to describe some cases with LPP arising on the intertriginous areas. Clinically, LPP-inversus is characterized by well defined dark brown to violaceous macules or patches with minimal symptoms and it is predominantly confined on the flexural areas. The histological characteristics are a lichenoid inflammatory infiltrate on the upper dermis, melanophages and pigmentary incontinence. The clinical course can vary. We present here an additional case of LPP-inversus that developed on the both inguinal folds and we review the relevant literature.
Dermis ; Lichen Planus ; Lichens ; Skin ; Solar System

BACKGROUND: Pyogenic granuloma is a common vascular neoplasm of the skin and mucous membranes. However, few comprehensive studies are available on the clinical and histopathological characteristics of pyogenic granuloma. OBJECTIVE: To analyze the clinical and histopathological characteristics of pyogenic granuloma. METHODS: Patients with pyogenic granuloma diagnosed clinically and histopathologically were reviewed retrospectively. RESULTS: Fifty patients (17 males and 33 females) were enrolled, and the mean age of onset was 33.6 years old. The mean lesion size was 6.7 mm. Forty-eight patients had a solitary lesion, whereas two patients had multiple lesions on the skin and mucosa. The most common area for lesions was the head and neck followed by the hands, trunk, and lower extremities. Patient complained of easy bleeding, pain, tenderness, and pruritus. Dermoscopic findings of nine lesions showed patterns of a reddish homogenous area, white scaly collarette, white rail lines, and a hemorrhagic crust. Histopathological findings of all biopsy cases showed a lobular pattern of angiomatous tissue with numerous congested capillaries, a flattened epidermis, a well-formed epidermal collarette, and CD34-positive endothelial cells. Various treatment modalities including surgery and laser have been used, but lesions recurred following a single laser treatment with a pulsed dye laser or long-pulsed Nd:YAG laser. CONCLUSION: A correlation between clinicopathological and dermoscopic findings was useful for the differential diagnosis of other diseases mimicking pyogenic granuloma and to detect recurrence after treatment. Laser treatments were less invasive therapy, but the recurrence rate was higher than that of other surgical modalities when used alone. Additional prospective studies are needed to determine the effectiveness of the various treatment modalities.
Age of Onset ; Biopsy ; Capillaries ; Dermoscopy ; Diagnosis, Differential ; Endothelial Cells ; Epidermis ; Estrogens, Conjugated (USP) ; Granuloma, Pyogenic ; Hand ; Head ; Hemorrhage ; Humans ; Lasers, Dye ; Lower Extremity ; Male ; Mucous Membrane ; Neck ; Pruritus ; Recurrence ; Skin ; Vascular Neoplasms

Adenoid cystic carcinoma of the breast is an uncommon type of breast cancer, and it accounts for 0.1% of all breast cancer. In contrast to the aggressive nature of extramammary adenoid cystic carcinoma, adenoid cystic carcinoma of the breast has a more favorable prognosis. A 55-year-old female patient presented with a 6-month history of a tender mass confined to the nipple of the left breast. A skin biopsy showed a linear and tubular pattern of atypical cells, which was consistent with adenoid cystic carcinoma. Left breast conserving surgery with axillary lymph node dissection was performed. The histopathology of the specimen showed a 1.5 cm sized mass localized to the nipple, and the axillary lymph nodes were positive for tumor metastasis.
Adenoids ; Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Adenoid Cystic ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental ; Middle Aged ; Neoplasm Metastasis ; Nipples ; Prognosis ; Skin

BACKGROUND: Herpes zoster is a common dermatologic disorder. However, there has been no reported study of herpes zoster in children exclusively in the Korean literature. OBJECTIVE: The purpose of this study was to analyze epidemiological features and clinical characteristics of herpes zoster in children. METHODS: A retrospective study was performed by reviewing the medical records of 64 patients who were under 12 years old and who had herpes zoster. We searched for cases occurring during a 10-year-period from January 2000 to December 2009. We analyzed for age, gender, accompanying symptoms, dermatomal distribution, underlying disease, treatment and complications. RESULTS: Children under 12 years old account for 2.48% of all herpes zoster patients. The ratio of males to females is 1:1. The number of enrolled patients was increasing according to age (p=0.0004). The number (p=0.0009) and the proportion (p=0.0187) of pediatric patients has been increasing year by year. Underlying diseases were observed in 17.2%, and included asthma, atopic dermatitis, chronic sinusitis, epilepsy and tic disorder. There was no patient with immunocompression. Lesions of herpes zoster were most frequently found in the trigeminal dermatome (35.9%), followed by the thoracic (34.4%), cervical (14.1%), lumbar (9.4%), and sacral (4.7%) dermatomes, and multiple involvement (1.16%). Pain accompanying herpes zoster was reported in 54.7% and pruritus in 71.9%. Complications were observed in 14.1%; the most common one was eye involvement. CONCLUSION: The incidence of accompanying pain in children with herpes zoster is lower than in adults with this disease. However, the incidence of accompanying pruritus was higher in children than in adults. Postherpetic neuralgia did not developed in children.
Adult ; Asthma ; Child ; Dermatitis, Atopic ; Epilepsy ; Eye ; Female ; Herpes Zoster ; Humans ; Incidence ; Male ; Medical Records ; Neuralgia, Postherpetic ; Pruritus ; Retrospective Studies ; Sinusitis ; Tic Disorders

OBJECTIVES: To determine whether a novel marine micro-organism with anticancer properties, H31, the metabolic product of Bacillus SW31, has anti-tumor effects on head and neck cancer, and potential for apoptotic-enhancing anti-cancer treatment of affected patients. METHODS: The cell viability and apoptosis assays were performed. Changes in the signal pathway related to apoptosis were investigated. Then, the therapeutic effects of H31 were explored in mouse xenograft model and drug toxicity of H31 was examined in zebrafish model. RESULTS: We identified the anticancer activity of H31, a novel metabolic product of Bacillus SW31. Bacillus SW31, a new marine micro-organism, has 70% homology with Bacillus firmus and contains potent cytotoxic bioactivity in head and neck cancer cells using MTT assay. Combined with c-JUN, p53, cytochrome C, and caspase-3, H31 induced apoptosis of KB cells, a head and neck cancer cell line. In a separate in vivo model, tumor growth in C3H/HeJ syngeneic mice was suppressed by H31. In addition, in a zebrafish model used for toxicity testing, a considerable dose of H31 did not result in embryo or neurotoxicity. CONCLUSION: Growth inhibition and apoptosis were achieved both in vitro and in vivo in head and neck cancer cells after exposure to H31, a metabolite from the marine Bacillus species, without any significant toxicity effects even at considerable H31 dose concentrations.
Animals ; Apoptosis ; Bacillus ; Caspase 3 ; Cell Line ; Cell Survival ; Cytochromes c ; Drug Toxicity ; Embryonic Structures ; Head ; Head and Neck Neoplasms ; Humans ; KB Cells ; Marine Toxins ; Mice ; Signal Transduction ; Toxicity Tests ; Transplantation, Heterologous ; Zebrafish