Ji Hyun Lee

Obstructive sleep apnea screening and perinatal outcomes in Korean pregnant women

PurposeThis study was intended to evaluate the attributable risk of obstructive sleep apnea (OSA) by a sleep questionnaire to adverse pregnancy outcomes.MethodsThis was a prospective, cohort study in Korean pregnant women. Berlin questionnaire was employed for symptom-based OSA screening during the third trimester and obstetric outcome data were obtained in 276 deliveries. The relationship between symptom-based OSA and outcomes were explored using SPSS version 18.0 and stratified by obesity (BMI strata <30 and ≥30). Our primary outcome was the compound occurrence of SGA (fetal) or preeclampsia (maternal). Multivariate models were applied in controlling for potential confounders.ResultsThe overall prevalence of OSA was 32.2xa0% and it was significantly related with the higher maternal BMI, more body weight at delivery, and weight gain during pregnancy (pxa0=xa00.007, pxa0=xa00.003, pxa0=xa00.005, respectively). There were no significant differences in the primary outcomes according to the positivity of OSA by screening, regardless of the stratification by obesity. The cesarean delivery rate was significantly higher in the OSA positive group (36.0 vs 22.5xa0%, pxa0=xa00.018), but it was not significant in the each strata of obesity. In multivariate analysis, the outcomes of birth weight, preeclampsia, cesarean delivery, and small for gestational age were also not different according to the positivity of OSA.ConclusionsIt seems that the prevalence of OSA by a sleep questionnaire is overestimating OSA in Korean pregnant women. Polysomnography might be needed to diagnose OSA and to evaluate the relationship between OSA and the occurrence of SGA or preeclampsia.

Prevalence of Atopic Dermatitis in Korean Children Based on Data From the 2008-2011 Korean National Health and Nutrition Examination Survey

Population-based studies of atopic dermatitis (AD) in Korean children are lacking. Thus, the purpose of this study was to determine the prevalence, geographic distribution, and risk factors of AD in the Korean pediatric population. We examined AD prevalence using data from the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES), which was a cross-sectional survey of 8,947 children up to age 18 throughout the country. Overall, 13.50% of children reported a diagnosis of AD. The age-standardized prevalence ranged from 9.13% to 17.67% between cities and provinces, with the highest prevalence-observed in many of the larger cities at low latitudes, as well as Jeju-do. After adjusting for confounders, high economic status was found to be a significant factor for predicting increased prevalence of AD, with an odds ratio of 1.35 (95% confidence interval of 1.02-1.79, P=0.0034). Urban living (odds ratio 1.24, 95% confidence interval of 1.00-1.53, P=0.0526) was also associated with a higher prevalence of AD. In this first large scale, nationwide study in Korean children, we found that the overall prevalence of AD depends on age, household income, and geographic distribution.

Disease Awareness and Management Behavior of Patients with Atopic Dermatitis: A Questionnaire Survey of 313 Patients

Background Patients with atopic dermatitis (AD) should be relatively well informed about the disorder to control their condition and prevent flare-ups. Thus far, there is no accurate information about the disease awareness levels and therapeutic behavior of AD patients. Objective To collect data on patients knowledge about AD and their behavior in relation to seeking information about the disease and its treatment. Methods We performed a questionnaire survey on the disease awareness and self-management behavior of AD patients. A total of 313 patients and parents of patients with AD who had visited the The Catholic University of Korea, Catholic Medical Center between November 2011 and October 2012 were recruited. We compared the percentage of correct answers from all collected questionnaires according to the demographic and disease characteristics of the patients. Results Although dermatologists were the most frequent disease information sources and treatment providers for the AD patients, a significant proportion of participants obtained information from the Internet, which carries a huge amount of false medical information. A considerable number of participants perceived false online information as genuine, especially concerning complementary and alternative medicine treatments of AD, and the adverse effects of steroids. Some questions on AD knowledge had significantly different answers according to sex, marriage status, educational level, type of residence and living area, disease duration, disease severity, and treatment history with dermatologists. Conclusion Dermatologists should pay more attention to correcting the common misunderstandings about AD to reduce unnecessary social/economic losses and improve treatment compliance.

Expression of insulin-like growth factor-II and insulin-like growth factor binding protein-1 in the placental basal plate from pre-eclamptic pregnancies

Objectives: To determine whether expressions of insulin‐like growth factor‐II (IGF‐II) and insulin‐like growth factor binding protein‐1 (IGFBP‐1) are altered in pre‐eclamptic placenta and to elucidate the possible relationship between their expressions and a mechanism for inadequate trophoblast invasion in pre‐eclampsia. Methods: Placental tissues were obtained at cesarean delivery from five normotensive, nine mild pre‐eclamptic and five severe pre‐eclamptic women at 33–39 completed weeks of gestation. After total ribonucleic acid was extracted, reverse transcriptase‐polymerase chain reaction was performed to determine IGF‐II and IGFBP‐1 mRNA expression. Product bands were quantitated by scanning densitometry and results were expressed as ratio of cytokines/β‐actin. Western blot analysis was also done to determine IGF‐II and IGFBP‐1 protein expression. Statistical analysis was determined by Kruskal–Wallis analysis of variance with the Scheffe multiple post‐hoc test. Results: The IGF‐II mRNA levels of mild and severe pre‐eclamptic placenta were significantly lower than that of uncomplicated placenta (P<0.005, P<0.001, respectively), with the level of severe pre‐eclamptic placenta being significantly lower than that of mild pre‐eclamptic placenta (P<0.05). As for the IGF‐II protein expression, a significant decrease was found among the three groups (P<0.001), correlating with the IGF‐II mRNA results. However, the mean IGFBP‐1 mRNA levels of mild and severe pre‐eclamptic placenta were significantly higher than that of uncomplicated placenta (P<0.05, P<0.005, respectively), with the level of severe pre‐eclamptic placenta being significantly raised compared with that of mild pre‐eclamptic placenta (P<0.05). Finally, a significant increase of IGFBP‐1 protein expression was noted among the three groups (P<0.001), correlating with the IGFBP‐1 mRNA results. Conclusions: This study suggests that IGF‐II and IGFBP‐1 might be associated with the impaired trophoblastic invasion that may lead to pathogenesis of pre‐eclampsia.

Association Between Obesity, Abdominal Obesity, and Adiposity and the Prevalence of Atopic Dermatitis in Young Korean Adults: the Korea National Health and Nutrition Examination Survey 2008-2010

Purpose Whether obesity is a risk factor for atopic dermatitis (AD) remains unclear. The aim of the present study was to investigate the association between obesity and AD in Korean young adults. Methods We included nationally representative data of 5,202 Korean adults aged 19-40 years, obtained from the cross-sectional Korea National Health and Nutrition Examination Survey 2008-2010. Results Single (unmarried) status was more frequently observed in AD patients (male, [P=0.0002] and female, [P<0.0001]). AD prevalence exhibited a U-shape trend in relation to body mass index (BMI), waist circumference (WC), and total body fat (BF) percentage, especially in young adult women. Women with BMI ≥25 kg/m2, WC ≥80 cm, and highest quartile (Q4) of total BF percentage had the highest prevalence of AD. The odds ratio (OR) for participants with both BMI ≥25 kg/m2 and WC ≥80 cm was 3.29 (95% confidence interval [CI] 1.71-3.55); therefore, having both general and abdominal obesity was considered a prominent risk factor for AD in young women. After adjustment for confounding factors, including age, smoking, alcohol drinking, exercise, vitamin D, income level, and single status, high BMI (≥30 kg/m2) (OR=4.08, 95% CI: 1.53-10.93), high WC (≥80 cm) (OR=2.05, 95% CI: 1.07-3.94), and high BF percentage (Q4) (OR=2.10, 95% CI: 1.24-3.57) were shown to be significantly associated with AD in young adult women. Conclusions In this large-scale nation-wide study of Korean adults, obesity was positively related to the presence of AD in women. Our findings suggest that weight management may help prevent AD.

A Comprehensive Review of the Treatment of Atopic Eczema

Atopic eczema (AE) is a chronic, inflammatory skin disorder which usually develops in early childhood. In spite of intensive investigations, the causes of AE remain unclear, but are likely to be multifactorial in nature. Environmental factors or genetic-environmental interactions seem to play a key role in disease progression. Among various measures of AE managment, cutaneous hydration, which improves barrier function and relieve itchiness, may be helpful to reduce the need for topical steroid use and therefore should be used as a basic treatment. Avoiding aggravating factors is also a basic treatment of AE. Standard medical treatment with a pharmacologic approach may be necessary if basic treatment fails to control symptoms satisfactorily. Recently, more attention is given to a proactive therapeutic by regular intermittent application of low potency steroids or topical calcineurin inhibitors to prevent new flares. Furthermore, various targeted biologics are being introduced for AE control and are proposed as promising therapies. This paper provides a summary of the recent literature on the manangement of AE and a treatment guideline.

Erythema Multiforme-like Targetoid Lesions in Secondary Syphilis

A 37-year-old woman presented with a 6 week history of pruritic targetoid lesions, which were violaceous, erythematous plaques in an annular pattern, 1–2 cm in size, on both palms (Fig. 1). She had no prior history of medication or herpes simplex infection before the skin lesions occurred. All other physical findings were normal. The clinical findings suggested EM. Skin biopsy performed on the palm was consistent with interface dermatitis, and showed hyperkeratosis, lymphocytic exocytosis, and vacuolization of the basal layer. A mild perivascular lymphohistiocytic infiltrate without plasma cells was present throughout the papillary dermis (Fig. 2). Proliferation of endothelial cells and a perivascular dermal infiltrate containing plasma cells, which are histological hallmarks of syphilis (2), were not seen. Warthin-Starry stain of the skin biopsy specimen was negative for spirochetes. To provide a direct association between Treponema pallidum and the targetoid skin lesions, polymerase chain reaction (PCR) technology was used to detect treponemal genomic DNA in the skin lesions. The 47-kDa lipoprotein gene (GenBank accession no. M88769 and M27493) (3, 4) for T. pallidum was amplified using 40 cycles of 94oC for 1 min, 58oC for 1 min, and 72oC for 1 min. The final product was separated on 2% agarose gel, stained with ethidium bromide, and visualized by BioPrint/Bio1D (Vilber Lourmat, France). A 658 bp band of the PCR product specific for T. pallidum was present only in the skin biopsy specimens from this patient, as in the positive control, but not in the negative control (Fig. 3). Serological tests for syphilis showed venereal disease research laboratory test titres of 1:32, and the fluorescent treponemal antibody absorption test IgM and T. pallidum haemagglutination assay were reactive.

Dermoscopic features of actinic keratosis and follow up with dermoscopy: A pilot study

Actinic keratosis (AK) is a common precursor of sun‐related squamous cell carcinoma. AK is difficult to be differentiated from other malignancies with the naked eyes. Dermoscopic features of AK were previously described in some studies, but not extensively investigated. We investigated the dermoscopic features of AK in Asians and assessed dermoscopy as a post‐treatment monitoring tool of AK. We retrospectively examined 34 AK lesions which had been diagnosed by histology. The changes of dermoscopic features and histopathological findings were assessed in all these lesions before and after treatment. Before treatment, 18 lesions were pigmented and 16 lesions were non‐pigmented AK dermoscopically. The frequent dermoscopic features of AK were keratin/scales (79.4%), red pseudonetwork (73.5%), targetoid‐like appearance (55.9%), rosette sign (38.2%) and absent fissures/ridges, crypts and milia‐like cysts. All the lesions had been treated with either photodynamic therapy, cryotherapy or 5% imiquimod cream. After treatment, dermoscopic features of 33 AK lesions were decreased or disappeared, and skin biopsies confirmed that atypical keratinocytes disappeared. One lesion showed accentuated and new dermoscopic features after treatment, and skin biopsy also showed progressing squamous cell carcinoma. In conclusion, scales, red pseudonetwork, targetoid‐like appearance and rosette sign were common dermoscopic findings of AK in Asians. In most cases, the treatment response correlated with the changes in dermoscopic features. These findings suggest that dermoscopy is a useful tool to monitor AK.

The Clinical Features and Pathophysiology of Acute Radiation Dermatitis in Patients Receiving Tomotherapy

BACKGROUNDnRadiation therapy (RT) including tomotherapy has been widely used to treat primary tumors, as well as to alleviate the symptoms of metastatic cancers.nnnOBJECTIVEnThe primary purpose of this study was to examine the characteristics of the clinical features and pathophysiological mechanisms associated with acute radiation dermatitis in cancer patients that received tomotherapy, and compare the results to patients treated by conventional radiation therapy.nnnMETHODSnThe study population consisted of 11 patients that were referred to the dermatology department because of radiation dermatitis after receiving tomotherapy; all patients were evaluated for clinical severity. The patients were assessed and identified using the National Cancer Institute Common Toxicity Criteria version (CTC) 3.0. We performed biopsies of the skin lesions that were examined for apoptosis using the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labelling (TUNEL) assay and stained immunohistochemically with monoclonal antibodies to CD8, CD4 and TGF-beta. As a positive control, patients with radiation dermatitis treated with conventional radiation therapy were also studied.nnnRESULTSnTHE RESULTS OF THE CLINICAL FEATURES OF THE SKIN OF TOMOTHERAPY PATIENTS WERE THE FOLLOWING: grade 1 (36%), grade 2 (55%) and other changes (9%). Among the population that had skin lesions due to acute radiation dermatitis, the mean number of positive cells per high power field (HPF) was the following: there were 30.50+/-7.50 TUNEL-positive cells, 34.60+/-12.50 CD8+ T cells, 5.19+/-3.17 CD4+ T cells and 9.95+/-1.33 TGF-beta positive cells measured per HPF. The mean number of positive cells per HPF for the patients that received conventional radiation therapy was: TUNLEL-positive cells in 7.5+/-1.64, CD8-, CD4- and TGF-beta-positive cells in 12.50+/-3.73, 3.16+/-1.47, 6.50+/-1.97.nnnCONCLUSIONnWe found that the number of TUNEL-positive cells and CD8+ T cells were higher in the lesions of patients receiving tomotherapy compared to the lesions of the patients receiving conventional radiation therapy. These findings suggest that tomotherapy without dose modification may cause significantly more severe forms of radiation dermatitis by apoptosis and cytotoxic immune responses than conventional radiation therapy.

Antiviral prophylaxis for preventing herpes zoster in hematopoietic stem cell transplant recipients: A systematic review and meta-analysis

ABSTRACT The optimal duration of prophylaxis for the varicella‐zoster virus following hematopoietic stem cell transplantation (HSCT) remains unclear. The purpose of this study was to systematically review the available literature to determine the optimal duration of antiviral prophylaxis for preventing herpes zoster (HZ) in allogeneic and autologous HSCT recipients. The MEDLINE and EMBASE databases were searched to identify relevant studies. The relative risk (RR) of HZ was calculated using fixed effects or random effects models depending on heterogeneity across the included studies. We analyzed six observational studies comprising a total of 3420 patients. In all HSCT recipients, the overall incidence of HZ in the prophylaxis group and the control group was 7.8% and 25.6%, respectively, with a pooled RR of 0.31 (95% CI, 0.26–0.37). The incidence of HZ in the subgroup wherein prophylaxis was given for at least 1 year and in the subgroup wherein prophylaxis was given for less than 1 year was 2.1% and 15.4%, respectively, with a pooled RR of 0.23 (95% CI, 0.04–1.39). Taken together, our results demonstrate that antiviral prophylaxis can significantly reduce HZ in HSCT recipients, and suggests that long‐term prophylaxis given for at least 1 year may be recommended for better preventive effects. HIGHLIGHTSOptimal duration of prophylaxis for varicella‐zoster following hematopoietic stem cell transplantation remains unclear.Our results demonstrate that antiviral prophylaxis can significantly reduce herpes zoster.It is suggested that long‐term prophylaxis given for at least 1 year may be recommended.