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This study aimed to evaluate the role of APOE polymorphisms (rs429358 and rs7412) in the risk of age-related macular degeneration in a sample of the Southeastern Brazilian population. Seven hundred and five unrelated individuals were analyzed, 334 with age-related macular degeneration (case group), and 371 without the disease (control group). In the case group, patients were further stratified according to disease phenotypes, divided into dry and wet age-related macular degeneration, and non-advanced and advanced age-related macular degeneration. APOE polymorphisms (rs429358 and rs7412) were evaluated through polymerase chain reaction and direct sequencing. In the comparison of cases vs. controls, none of the associations reached statistical significance, considering the Bonferroni-adjusted P-value, although there was a suggestive protection for the E3/E4 genotype (OR = 0.626; P-value = 0.037) and E4 carriers (OR = 0.6515; P-value = 0.047). Statistically significant protection for both the E3/E4 genotype and E4 carriers was observed in the comparisons: advanced age-related macular degeneration vs. controls (OR = 0.3665, P-value = 0.491 × 10−3 and OR = 0.4031, P-value = 0.814 × 10−3, respectively), advanced age-related macular degeneration vs. non-advanced age-related macular degeneration (OR = 0.2529, P-value = 0.659 × 10−4 and OR = 0.2692, P-value = 0.631 × 10−4, respectively). In the comparison of wet age-related macular degeneration vs. control, protection was statistically significant only for E3/E4 (OR = 0.4052, P-value = 0.001). None of the comparisons demonstrated any significant association for E2 genotypes or E2 carriers in age-related macular degeneration risk in this study. Findings suggest a protective role of the E4 haplotype in the APOE gene in the risk for advanced and wet forms of age-related macular degeneration, in a sample of the Brazilian population. To our knowledge, this is the first Brazilian study to show the association between APOE polymorphisms and age-related macular degeneration.

Background: Age-related macular degeneration (AMD) is a multifactorial disease and one of the main causes of blindness in people over 50 years old. The etiology and pathophysiology of AMD are not well understood. The aim of this study was to investigate whether the rs1143627 variant allele of IL1B, which encodes Interleukin (IL)-1β, a key cytokine, mediates immune and inflammatory responses.Methods: A case-control study was conducted with 397 AMD patients and 402 controls in Brazil. IL1B genotyping was carried out with TaqMan® genotyping assay. Differences in IL1B allele frequencies and genotypes were evaluated between patients and controls and between wet and dry subgroups of AMD. Relationships between allele presence/genotype and disease risk are reported as odds ratios (ORs) with 95% confidence intervals (CIs).Results: Genotype proportions for the rs1143627 variant allele of IL1B were similar between AMD patients and controls (p = .21), with 84.38% of AMD patients and 79.60% of the controls carrying the variant allele. We observed a trend toward the variant allele being associated with AMD risk (OR = 1.38, 95% CI 0.95-2.03, p = .08), as well as a trend toward the variant allele being associated with increased risk for wet AMD in particular (OR = 1.23, 95% CI 0.96-1.56, p = .08).Conclusions: The rs1443627 variant was not associated with AMD risk in this Brazilian population sample. Larger studies are warranted to determine whether the trends observed in this study reflect a relationship between this variant and risk of AMD, especially wet AMD.

Jalili syndrome (JS) is an autosomal recessive disease characterized by a combination of cone-rode retinal dytrophy (CRD) and amelogenesis imperfect (AI). Mutations in cyclin and CBS domain divalent metal cation transport mediator 4 (CNNM4) gene cause JS. Here we described 2 families (3 members) affected by JS. In the first family, JS was caused by the homozygous p.Leu324Pro (c.971T > C) missense mutation and the affected patient developed both CRD and AI. In the second family, a specific combination of a compound heterozygous mutation was found – the p.Leu324Pro (c.971T > C) missense transition and the novel p.Tyr581* (c.1743C > G) nonsense mutation. The proband showed CRD and AI, but her father just developed eye alterations. Together, these findings suggest that the p.Leu324Pro mutation in homozygosis induces a complete phenotype with both CRD and AI, but in heterozygosis and in composition with the novel p.Tyr581* nonsense mutation in CNNM4 promotes variable clinical expressivity, particularly with lack of dental phenotypes. These different phenotypes could be explained by deletions affecting the proband's homologous allele, epistasia or interactions with environmental factors leading to residual activity of protein.

Objectives To assess Asian data from Global Prevalence Study on Infections in Urology (GPIU study) which has been performed more than 10 years. Methods Seventeen Asian countries participated in the GPIU study between 2004 and 2013. Data for these countries were collected from the web-based GPIU database. The point prevalence of urinary tract infections (UTI) and antimicrobial susceptibility of representative pathogens were analysed for Asian geographic regions. Results A total of 6706 patients (5271 male, 1435 female) were assessed during the study period, and 659 patients were diagnosed with a UTI (9.8%). Of these UTI patients, 436 were male and 223 were female. Mean patient age was 54.9 ± 19.3 years. Pyelonephritis and cystitis were the most common clinical diagnoses, representing 30.7% and 29.9% of patients, respectively. Escherichia coli was the most frequently identified uropathogen (38.7%). For the patients with urinary tract infection, cephalosporins were the most frequently used antibiotics (34.4%), followed by fluoroquinolones (24.1%), aminoglycosides (16.8%). Fluoroquinolone resistance was relatively high (ciprofloxacin 54.9%, levofloxacin 39.0%), and cephalosporin resistance 42% (42.5–49.4%). Of the antibiotics evaluated, uropathogens had maintained the highest level of susceptibility to amikacin and imipenem (24.9% and 11.3% resistance rates, respectively). Conclusion Uropathogens in many Asian countries had high resistance to broad-spectrum antibiotics. Knowledge of regional and local resistance data and prudent use of antibiotics are important for proper management of UTI in Asian countries.

Age-related macular degeneration is a multifactorial disease that can lead to vision impairment in older individuals. Although the etiology of age-related macular degeneration remains unknown, risk factors include age, ethnicity, smoking, hypertension, obesity, and genetic factors. Two main loci have been identified through genome-wide association studies, on chromosomes 1 and 10. Among the variants located at the 10q26 region, rs11200638, located at the HTRA1 gene promoter, has been associated with age-related macular degeneration in several populations and is considered the main polymorphism. We conducted a replication case-control study to analyze the frequency and participation of rs11200638 in the etiology of age-related macular degeneration in a sample of patients and controls from the State of Sao Paulo, Brazil, through polymerase chain reaction and enzymatic digestion. The frequency of the A allele was 57.60% in patients with age-related macular degeneration and 36.45% in controls (p value

Background/Purpose Slower gait speed is a good predictor of falls, dependency, disability, and mortality. However, the cutoff point of the gait speed to best predict the bad outcomes is controversial. The purpose of this study was to determine the cutoff point of gait speed that best predicts Instrumental Activities of Daily Living (IADL) dependency. Methods The study targeted 8000 people aged ≥ 65 years who had been enrolled in 2008 and followed up in 2011 for the Living Profiles of Older People Survey in Korea. The population was divided into an independent group and a dependent group with 2011 Korean Instrumental Activities of Daily Living (K-IADL) scores of 10 and ≥ 11, respectively. The gait speed was measured as the time taken to walk 2.5 m at a usual pace without any help, and the best result of two trials was chosen for analysis. Results The area under the curve was highest (0.642) at gait speed of 0.6 m/s, with a sensitivity and specificity of 68.44% and 55.09%, respectively. The dependency hazard ratio of IADL was statistically significant in the group with gait speed less than 0.6 m/s, 1.974 (95% confidence interval, 1.646–2.367). The dependency hazard ratio of IADL was also statistically significant in the same group after adjusting for all relevant variables, 1.613 (95% confidence interval, 1.332–1.955). Conclusion The gait speed of 0.6 m/s may be considered as the new standard of a screening tool to predict IADL dependency in Korean people aged ≥ 65 years.

Background/Purpose The aim of our study is to develop a concise and effective dementia screening tool for use in primary care, wherein we selected five items from the Global Deterioration Scale (GDS) that were most predictive of dementia diagnosis. Methods Our study population comprised 191 patients older than 60 years who visited four university hospitals between 2008 and 2011 for impaired memory or medical care. Our 5-item screening tool is an abbreviated version of the GDS. We compared the assessment results obtained through our model with those obtained through the GDS in order to evaluate the accuracy of our tool in detecting dementia. Results The screening tool had a sensitivity of 91.2%, specificity of 75.0%, a cutoff value of 12.495, and an area under the curve of 0.911 (95% confidence interval, 0.862–0.948; p Conclusion We anticipate that our abridged GDS, composed of five items, will facilitate a rapid, yet effective assessment of patients in primary care centers. Its use will benefit both patients and medical professionals by minimizing the length of time required to conduct the assessment, and by allowing early diagnosis and care of patients. However, further research with a larger population is required to verify its efficacy.

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness worldwide. Considered a multifactorial disease, genetic and environmental factors corroborate for its developme...

Background: An association between LOC387715/ARMS2 (rs10490924) gene polymorphism and AMD has been reported. The aim of this study was to evaluate whether this polymorphism is associated with AMD in a Brazilian cohort.Materials and Methods: In total, 126 unrelated AMD patients (mean age 74.17 ± 7.64) were compared with 86 healthy controls (mean age 71.82 ± 7.12). Study subjects were classified according to the International ARM Epidemiological Study Group definition for early and late-stage AMD. LOC387715/ARMS2 rs10490924 polymorphism was evaluated through polymerase chain reaction and direct sequencing.Results: The T allele frequency was significantly higher in AMD patients than in controls (39.6% compared to 20.3%). The odds ratio (OR) for AMD was 2.05 (95% CI 1.13–3.71) for heterozygotes (TG) and 8.32 (95% CI 2.30–45.99) for homozygotes (TT).Conclusions: These results suggest that there is a contribution of the rs10490924 SNP of the LOC387715/ARMS2 gene to AMD susceptibility in this sample of t...

BACKGROUND Some disagreements surround the effects of calcium-channel blockers (CCBs) on the risk of dementia. The purpose of this study was to investigate the protective effects of CCBs on dementia among elderly hypertensive Koreans.Methods and Results:We conducted a large population-based cohort study using the senior cohort database of the Korean National Health Insurance Service (2002-2013). Subjects were elderly hypertensive Koreans older than 60 years of age. A total of 18,423 patients (CCB user group: 13,692 patients; non-CCB antihypertensive user group: 4,731 patients) were statistically analyzed using the Cox proportional hazard regression model to estimate the adjusted hazard ratio (aHR) and confidence intervals (CIs) of dementia associated with CCB use. There were 2,881 cases (21.0%) of dementia in the CCB user group and 1,124 cases (23.8%) in the non-user group. CCB use significantly reduced the risk of total dementia (aHR 0.81, 95% CI 0.75-0.87, P

Background Antihypertensive medication represents one of the most common prescriptions for senior individuals. Numerous studies have assessed the influence of antihypertensive treatment on the risk for osteoporotic fracture, yet much controversy remains. We analyzed the relationship between the incidence of osteoporotic fracture and the average number of daily antihypertensive drugs (NDAD) included in the prescription of elderly hypertensive patients. Methods The study population was derived from the National Health Insurance Service–Senior Cohort (2002–2013), and consisted of elderly patients (≥60 years) diagnosed with hypertension in 2009, who did not have osteoporotic fractures in 2008, and underwent at least one national health check-up between 2009 and 2013, and had complete records after 2010. The outcome measured was the incidence of osteoporotic fractures between 2010 and 2013. The study population was stratified into the three groups (low, moderate, and high), in terms of NDAD. Results A total of 137,304 hypertensive patients were included. A multivariate model corrected by age, gender, body mass index, systolic blood pressure, underlying disease, smoking status, and use of medicines showed that the groups with moderate and high NDAD exhibited, respectively, 12% and 16% lower risk of osteoporotic fracture compared to that in the group with low NDAD. In terms of the risk of osteoporotic fracture associated with the number of daily thiazide diuretics (NDTD), the adjusted odds ratios (aOR; 95%CI) were 0.89 (0.84–0.94) and 0.93 (0.84–1.02) in the groups with moderate and high NDTD, respectively compared to low NDTD as reference. As to NDADnotTD, the aOR (95%CI) were 0.90 (95%CI, 0.86–0.94) and 0.89 (95%CI, 0.84–0.95) in the groups with moderate and high NDADnotTD, respectively compared to low NDADnotTD as reference. Conclusion In elderly hypertensive patients, the incidence of osteoporotic fracture decreased as the NDAD increased. The incidence rate of osteoporotic fracture also decreased with the increase in the number of daily non-thiazide antihypertensive drugs.

Results: The correlation coefficients between Korean FI and K-Y checklist, Korean FI and CHSFI, and K-Y checklist and CHSFI were 0.61, 0.43, and 0.44 respectively. The range of Kappa value for each item on the Korean FI was 0.28 to 0.60 and 0.19 to 0.65 for the K-Y checklist. Cronbach's alpha for the Korean FI was 0.58 and 0.64 for the K-Y checklist. The AUC for the Korean FI was 0.79, and 0.64 for the K-Y checklist. The validity index for the items on the Korean FI ranged from 0.28-0.53 to 0.60-0.78 and 0.19-0.44 to 0.65-0.81 for the K-Y checklist. Conclusion: The K-Y checklist is a valid and reliable instrument to measure frailty in the Korean elderly population. Follow- up studies are needed.

Purpose: This study was aimed at identifying levels of compliance of patients with metabolic syndrome and the factors influencing their compliance. Methods: Data were collected from patients with metabolic syndrome at K medical center in 2009 using questionnaires. The data were analyzed using ANOVA, t-test, Scheffe test, Pearson correlation, and stepwise multiple regression. Results: The mean score of health behavior compliance was 2.82 (range: 1.43~3.87). Of the factors significantly influencing compliance with health behavior, health perception, exercise efficacy, age and perceived severity explained the 42.8% variance of compliance with health behavior. The factor explaining the highest level of variance was health perception. Conclusion: It is essential for health professionals to consider the aforementioned four factors when developing interventions to increase compliance with health behavior of the patient with metabolic syndrome.

This paper investigates the determination factors’ variation of real estate price after sub-prime financial crisis, in korea, using a VAR model. The model includes land price, housing price, housing rent (Jensei) price, which time period is from 2000:1Q to 2011:2Q and uses interest rate, real GDP, consumer price index, KOSPI, the number of housing construction, the amount of land sales and practices to impulse response and variance decomposition analysis. Data cover two sub-periods and divided by 2008:3Q that occurred the sub-prime crisis; one is a period of 2000:1Q to 2008:3Q, the other is based a period of 2000:1Q to 2011:2Q.As a result, Comparing sub-prime crisis before and after, land price come out that the influence of real GDP is expanding, but current interest rate’s variation is weaken due to the stagnation of current economic status and housing construction market. Housing price is few influenced to interest rate and real GDP, but it is influenced its own variation or Jensei price’s variation. According to the Jensei price’s rapidly increasing in nowadays, housing price might be increasing a rising possibility. Jensei price is also weaken the influence of all economic index, housing price, comparing before sub-prime financial crisis and it is influenced its own variation the same housing price. As you know, real estate price is weakened market basic value factors such as, interest rate, real GDP, because it is influenced exogenous economic factors such as population structural changes. Economic participators, economic officials, consumer, construction supplyers need to access an accurate observation about current real estate market and economic status.Keywords: Real Estate Market, Land Price, Housing Price, Jensei Price, Structural Variation, Vector Auto Regression Model

Traditional first-line treatment of chronic bacterial prostatitis (CBP) is administration of empirical antibiotics. However, the efficacy rate is low and long-term antibiotic therapy can result in adverse events and bacterial resistance. For these reasons, a new treatment or preventive modality that can replace traditional antibiotic therapy is required. There are several reports that E. coli extract has a preventive effect on recurrent urinary tract infection (UTI). Cranberries are also known to have beneficial effects in preventing UTI. To evaluate the preventive effect of E. coli extract and cranberries on CBP, 48 rats were randomly divided into 4 groups; control, ciprofloxacin, E. coli extract, and cranberry groups. All drug treatments were conducted for 3 weeks, and then we developed a CBP rat model. After 4 weeks, the results of microbiological culture of prostate and urine samples as well as histological findings for the prostate were analyzed for each group. The infection rate in the ciprofloxacin group was significantly lower than that in the control group. The microbiological cultures of the prostate and urine samples demonstrated reduced bacterial growth in all experimental groups compared with the control group. Histopathologic examination showed significantly decreased prostatic inflammation in all groups compared with the control group. These results suggest that E. coli extract has a potential preventive effect on the development of CBP, and cranberry also exhibits promising activity in this context.

Aim: To evaluate the preventive effect of finasteride on chronic bacterial prostatitis (CBP), Wistar rats were divided into four groups: control, ciprofloxacin, finasteride, and ciprofloxacin/finasteride. Methods: All drug pretreatments were conducted for 4 weeks, and then experimental CBP was induced by instillation of a bacterial suspension (Escherichia coli Z17 O2:K1;H–). Results: After 4 weeks, results of microbiological cultures of prostate and urine samples as well as histological findings of the prostate in each group were analyzed. Finasteride significantly reduced bacterial infection and decreased inflammatory cell infiltration in prostatic tissue compared with the control group. The group given both finasteride and antibiotic showed a greater inhibition of bacterial infection in the tissue than those given either finasteride or antibiotic alone. Conclusion: Our experiments suggest the possibility that finasteride has a preventive effect on development of CBP, although there is as yet no consensus on the mechanism of this effect.

Our purpose was to evaluate the feasibility of using ultrasonographic criteria of thyroid capsular continuity and tumor contour to differentiate macroscopic extra-thyroidal extension (ETE) from microscopic ETE, as well as non-ETE from ETE. On ultrasonography, we evaluated thyroid capsular continuity (C0 = continuous, C1 = discontinuous, C2 = invisible), and thyroid tumor contour (P0 = in normal parenchyma, P1 = abutting, P2 = bulging), which were grouped into type 1-9 classifications. Either C1-2 or P1-2 was more prevalent in ETE than non-ETE. C1 and P2 tended to be associated with macroscopic ETE, whereas C0 and P1 were significantly associated with microscopic ETE. Types 6, 8 and 9 were more likely to have ETE than non-ETE; type 6 (C1 P2) and type 9 (C2 P2) were significantly associated with macroscopic ETE, whereas type 8 (C2 P1) was associated more with microscopic ETE. Macroscopic and microscopic ETE, as well as non-ETE and ETE, can be differentiated using these pre-operative ultrasonographic criteria.

PURPOSE: To verify the perception of Brazilian ophthalmologists regarding the role played by Genetics in their routine medical activity and their conduct when dealing with patients, with hereditary diseases who need genetic counseling. METHODS: A cross-sectional survey was conducted by means of invitations to participate in an interview on this subject. The questionnaires were sent to 200 ophthalmologists who work in the area of Campinas, SP, Brazil. RESULTS: Among the 73 professionals who answered the questionnaire (36%), there was a high rate of positive answers (49-88%) concerning their knowledge of genetics and a low rate (10-33%) of use of this knowledge in their clinical practice. The frequency of genetic ophthalmopathies in clinical practice was relevant in the opinion of 68% of the interviewees; 92% indicated a relevant relationship between genetically determined ocular disorders and the prevention of blindness through detection, early treatment and genetic counseling. More extensive genetic knowledge was considered indispensable to 84% of the professionals, but 16% answered that it was irrelevant. CONCLUSIONS: Although these ophthalmologists have basic notions of genetics (88,0%) and are aware of its importance in the prevention of blindness, a great majority of Brazilian ophthalmologists have not acquired adequate knowledge of genetics and, in practice, rarely use its therapeutic and preventive potential. OBJETIVO: Verificar a percepção de oftalmologistas brasileiros em relação à contribuição da Genética em sua atuação médica rotineira, bem como a sua conduta em face de portadores de doenças hereditárias que necessitem de aconselhamento genético MÉTODOS: Estudo transversal, em que duzentos oftalmologistas que atuam na região de Campinas, SP, Brasil (universidades e/ou clínicas particulares) foram convidados a participar de uma entrevista sobre o assunto. RESULTADOS: Aqueles que aceitaram o convite (36%), enviaram um questionário respondido, via correio (n=73). A importância das oftalmopatias genéticas em relação a sua freqüência na clínica prática foi relevante na opinião de 68% dos entrevistados e 92% manifestaram sua opinião como sendo muito importante a relação das oftalmopatias genéticas e a prevenção à cegueira, por meio da detecção e tratamento precoces e aconselhamento genético. Quanto à opinião dos entrevistados sobre melhorar seus conhecimentos em genética, 84% consideraram imprescindível, porém 16% responderam que é irrelevante. CONCLUSÕES: De um modo geral, embora os oftalmologistas entrevistados tenham adquirido noções básicas de Genética (88%) e estão conscientes de sua importância na prevenção da cegueira, os conhecimentos de genética da grande maioria dos oftalmologistas brasileiros são incompletos e, na prática, quase que inexplorados em seu potencial terapêutico e preventivo.

Transepidermal water loss (TEWL) in psoriatic skin lesions seems to be related to the severity of the psoriasis, and the electrical capacitance and conductance of the skin are indicators of the hydration level of the stratum corneum. We compared the characteristics of these electrical measurements, in assessing the persistent effect of a moisturizing cream on skin hydration and barrier function in psoriasis patients. Seventeen Korean psoriasis patients were recruited. Their right leg was treated with the moisturizer twice daily for 6 weeks, while their left leg was used as the control site. For each patient, one psoriatic plaque on each leg was selected as the involved psoriatic lesion. Uninvolved psoriatic skin was regarded as the apparently healthy looking skin 4-5 cm away from the periphery of the psoriatic lesion. The TEWL, electrical capacitance and conductance were measured, in order to evaluate the barrier function and hydration level of the stratum corneum. The clinical and biophysical data for each patient were recorded at the start of the study and after 2, 4 and 6 weeks. The degree of skin dryness at the applied area improved progressively. The electrical capacitance at the treated psoriatic lesion increased significantly after 2 weeks, and this improvement was maintained during the entire study period. However, no noticeable change was observed in the electrical conductance. The TEWL showed an inverse pattern to that of the skin capacitance, decreasing during the study period. The skin capacitance and TEWL exhibited good correlation with the visual assessment of skin dryness, but the skin conductance did not. Our data suggest that electrical capacitance and TEWL may be useful in the evaluation of the effect of a moisturizer on the hydration status and barrier function of psoriatic skin.

This paper reports on a 36-year-old woman with GAPO syndrome, a rare autosomal recessive condition characterized by growth retardation (G), alopecia (A), pseudoanodontia (P), and optic atrophy (O). Her parents are consanguineous and one of her sisters is also affected. Since the first description by Anderson and Pindborg in 1947, 27 individuals have been reported with this diagnosis. They were from at least 19 different families (four of them from Brazil, including the present one), suggesting a founder effect. The phenotype of this condition, initially considered as the result of an ectodermal dysplasia, could be attributed to the accumulation of extracellular connective tissue matrix and its progressive character must be pointed out. The clinical findings, especially ophthalmological features that include bilateral glaucoma, are reviewed and discussed.

Background: Many reports have been released to assess skin types, skin colors and cutaneous sensitivity to broad band UVB or UVA. Objective: This study was performed to investigate the usefulness of skin type and skin color as the parameter of narrow band UVB (NBUVB) sensitivity. Methods: The minimal erythema dose (MED) of 40 psoriasis patients was investigated by irradiating several doses ranging from 200 to 1500 mJ/cm2. Before phototesting, the skin color of buttock was measured with a tristimulus colorimeter. Results: The median and mode value of MED of NBUVB was 950 mJ/cm2. Skin type was well correlated with the MED and there was a significant relationship between the L* value and MED, but not for the a* and b* values. Conclusion: The MED value of NBUVB in our study is a basic data to set the phototherapy protocol. Our result showed that skin type and L* value might be useful for predicting the sensitivity to NBUVB irradiation.

Background: Although the use of an oral retinoid as monotherapy is an effective treatment for psoriasis, it is usually used in combination with other topical or systemic therapies including topical corticosteroids, UVB phototherapy, psoralens + UVA (PUVA) chemotherapy and cyclosporine mainly in an effort to reduce or avoid adverse effects. Aim: To compare the efficacy of the calcipotriol + acitretin combination treatment with acitretin alone over a long period in Korean patients with psoriasis. Methods: A randomized, bilateral paired comparison was conducted involving 40 patients with psoriasis who received calcipotriol + acitretin combination therapy and 20 psoriasis patients who received acitretin alone. The initial dose of acitretin was 10 or 20 mg/day. The dose was adjusted at each visit (2, 4 and 6 weeks) in steps of 10mg according to patient responsiveness and adverse effects. The maximum dose was 40 mg/day. The treatment duration for all patients ranged from 4–52 weeks. After 12 weeks, the efficacy of therapy, according to Psoriasis Area and Severity Index scores, was assessed. At the end of the study (52 weeks), we selected patients who had achieved complete clearance and compared the duration of treatment and total dose of acitretin used in both groups. Results: After 12 weeks, 16 patients (40%) achieved complete clearance in the calcipotriol + acitretin group and 3 patients (15%) in the acitretin monotherapy group (p < 0.05). After 52 weeks, 24 patients (60%) in the calcipotriol + acitretin group and 8 patients (40%) in the acitretin monotherapy group achieved complete clearance. The duration of treatment and total dose of retinoid required to achieve clearance were slightly lower in the calcipotriol + acitretin combination group, however, this was not statistically significant. With the exception of liver enzyme elevation (which affected more patients in the acitretin monotherapy group than in the combination group), adverse effects were not significantly different. Discussion: Our results showed that calcipotriol might enhance the clinical outcome of systemic acitretin therapy. More large, well-controlled, long-term studies need to be conducted to determine whether there is indeed a beneficial effect of the addition of calcipotriol to acitretin treatment and whether this effect is maintained over long-term periods.

Background/Purpose: Narrow-band (TL-01) UVB lamps are being increasingly used for phototherapy of psoriasis and other dermatoses, for their excellent effect compared with broad-band UVB sources. Many patients receiving phototherapy have complained about the tanning effect of ultraviolet radiation especially in dark-skinned ones. So we wished to know the degree of pigmentation induced by phototherapy during narrow-band UVB treatment. Methods: A total of 20 psoriasis patients receiving narrow-band UVB phototherapy were included in this study. A Minolta spectrophotometer CM-2002 was used to measure pigmentation. All patients were evaluated for skin color every seventh day for 7 weeks. The L* value (luminance) gives information about the relative lightness ranging from total black to pure white. The a* value represents the balance between red and green, and the b* value between yellow and blue. Results: The L* values which indicate luminance decreased continuously until the 5th week, when maximum tanning was obtained. Afterwards minimal change was observed until the 7th week. The change of a* and b* values also showed the pattern that was compatible with the above results. The mean individual typology angle of our subjects was 41.9°, which indicated they fell into ‘light’ group of constitutional skin color category. Conclusion: From this study, we found that pigmentation induced by narrow-band UVB phototherapy increased continuously until the 5th week and then did not progress. Our results provide standard data of skin pigmentation during narrow-band UVB phototherapy in Korean brown skin.

Sulforaphane is a natural product found in broccoli, which is known to exert many different molecular effects in the cell, including inhibition of histone deacetylase (HDAC) enzymes. Here, we examine for the first time the potential for sulforaphane to inhibit HDACs in HaCaT keratinocytes and compare our results with those found using HCT116 colon cancer cells. Significant inhibition of HDAC activity in HCT116 nuclear extracts required prolonged exposure to sulforaphane in the presence of serum. Under the same conditions HaCaT nuclear extracts did not exhibit reduced HDAC activity with sulforaphane treatment. Both cell types displayed down-regulation of HDAC protein levels by sulforaphane treatment. Despite these reductions in HDAC family member protein levels, acetylation of marker proteins (acetylated Histone H3, H4, and tubulin) was decreased by sulforaphane treatment. Time-course analysis revealed that HDAC6, HDAC3, and acetylated histone H3 protein levels are significantly inhibited as early as 6 h into sulforaphane treatment. Transcript levels of HDAC6 are also suppressed after 48 h of treatment. These results suggest that HDAC activity noted in nuclear extracts is not always translated as expected to target protein acetylation patterns, despite dramatic inhibition of some HDAC protein levels. In addition, our data suggest that keratinocytes are at least partially resistant to the nuclear HDAC inhibitory effects of sulforaphane, which is exhibited in HCT116 and other cells. © 2014 The Authors. Molecular Carcinogenesis published by Wiley Periodicals, Inc.

Background Facial involvement in psoriasis has received little attention in standard descriptions of the disease because the face has long been thought of as rarely involved. A few reports have suggested that facial involvement might be a sign of severe psoriasis. However, there have been no comparison studies on the severity of psoriasis between patients with and without facial involvement. Objective We sought to evaluate the prevalence and characteristics of facial involvement, and to compare the severity of psoriasis between the patients with and without facial psoriasis. Methods A total of 282 consecutive patients with psoriasis seen in our psoriasis clinic between May 2002 and November 2002 were enrolled in this study. Results Facial involvement was a marker of severe psoriasis. The face was often involved for patients with long duration or early onset of disease; with nail or joint involvement; and those requiring more extensive treatments. Patients with facial involvement were found to have more frequent pruritus, positive family history, and history of Koebner response. Conclusion Early recognition of facial psoriasis as a marker of severe disease can contribute to treatment of patients with psoriasis.

Spitz nevus is usually a solitary lesion. However, multiple Spitz nevi do arise and can be divided into two variants, agminated (grouped) or disseminated. We report an interesting case of multiple disseminated eruptive Spitz nevi with an unusual feature. The appearance of most of the nevi resembled that of melanocytic nevi, and clinically it was impossible to distinguish these multiple disseminated eruptive Spitz nevi from eruptive melanocytic one.

Purpose: To evaluate the diagnostic accuracy of carotid Doppler ultrasonography (CDU) to predict the presence of subclinical coronary atherosclerosis in asymptomatic subjects with a zero coronary calcium score. Methods: Retrospective study of CDU and coronary CT angiography (CTA) findings in 118 asymptomatic subjects with a zero calcium score. CDU was considered abnormal when carotid intima-media thickness was >75 percentile or was ≥ 1 mm, or in presence of carotid plaque(s). We analyzed the diagnostic accuracy of CDU to predict the presence of non-calcified coronary plaque in comparison with coronary CTA. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of abnormal CDU to identify the presence of non-calcified coronary plaque on coronary CTA were 82.4% [(14/17); 95% confidence interval (CI), 56.6%-96.2%], 53.5% [(54/101); 95% CI, 43.3%-63.5%], 23.0% [(14/61); 95% CI, 13.1%-35.6%], and 94.7% [(54/57); 95% CI, 85.4%-98.9%], respectively. Conclusions: Although CDU has a low PPV for identifying the presence of non-calcified plaque on coronary CTA, its NPV is high to exclude subclinical coronary atherosclerosis in asymptomatic subjects with a zero calcium score. © Inc. J Clin Ultrasound, 2013

A case of identical male twins with Cohen syndrome who present multiple ophthalmic findings is reported. The patients were identical 16 year-old twin boys who showed down slanting eyelids, mild ptosis, high-grade myopia, small cortical lens opacities, posterior subcapsular cataracts, myotic and corectopic pupils with poor dilation due to focal iris atrophy and retinochoroidal dystrophy. Ophthalmologists must be aware of the ocular and systemic findings of Cohen syndrome in the evaluation of young patients with mental retardation and visual impairment.

The purpose of this study was to determine the relationship between plasma C-reactive protein (CRP) and body mass index (BMI) in elderly Korean men. A review of routine health examination records were done. Out of 671 eligible elderly men, who had their routine health examination in 2001 at a Health Promotion Center of a university hospital, 367 subjects were included after excluding inflammatory conditions. Subgroup analyses were performed on those who did not smoke and exercised regularly. Body composition, blood pressure, blood samples and radiologic examinations including chest radiography and abdominal ultrasound were obtained from each subject. Age, BMI, current smoking, regular exercise, WBC count, HDL-cholesterol, gamma glutamyl transferase were independently associated with logCRP. BMI subgroups according to the Asia-Pacific guideline did not show any difference in CRP level from each other by ANCOVA (p>0.05). However, BMI groups subdivided according to our criteria showed an association with CRP; the CRP level was lowest in the group of BMI between 18.5-19.4 and showed significant difference from BMI group of the highest BMI group (>or=29.0). Since elevated CRP levels are associated with higher risk for cardiovascular disease, lower BMI (18.5-19.4) levels may be advised for healthy elderly men in Korea.

Many reports have been released to assess skin types, skin colors and cutaneous sensitivity to broad band UVB or UVA.This study was performed to investigate the usefulness of skin type and skin color as the parameter of narrow band UVB (NBUVB) sensitivity.The minimal erythema dose (MED) of 40 psoriasis patients was investigated by irradiating several doses ranging from 200 to 1500 mJ/cm2. Before phototesting, the skin color of buttock was measured with a tristimulus colorimeter.The median and mode value of MED of NBUVB was 950 mJ/cm2. Skin type was well correlated with the MED and there was a significant relationship between the L* value and MED, but not for the a* and b* values.The MED value of NBUVB in our study is a basic data to set the phototherapy protocol. Our result showed that skin type and L* value might be useful for predicting the sensitivity to NBUVB irradiation.

Background/purpose: The successful use of narrow-band ultraviolet B (UVB) phototherapy for the management of psoriasis has prompted the examination of various combination treatments with narrow-band UVB. However, there have been contradictory reports on the effect of the calcipotriol–narrow-band UVB combination. This study was performed to compare the clinical efficacy of the calcipotriol–narrow-band UVB combination with narrow-band UVB alone. Methods: Of the 28 psoriasis patients, 10 were treated with the calcipotriol–narrow-band UVB and 18 with narrow-band UVB alone. Phototherapy was done once daily three times a week and the dose was gradually increased in a stepwise fashion by 0.05 J/cm2. At the end of therapy, overall efficacy was classified according to the chosen grading system. Results: On assessing the therapeutic results using the criteria selected, 90.0% patients (n = 9) in the calcipotriol–narrow-band UVB group and 61.1% patients (n = 11) in the narrow-band UVB group showed grade IV at the end of therapy. The calcipotriol–narrow-band UVB group showed more rapid improvement at the early stage. The final and total UVB dose were slightly lower in the calcipotriol–narrow-band UVB group but no significant difference was observed with respect to the total number of irradiations, duration of treatment, final UVB dose or total cumulative UVB dose required to reach grade IV in both groups (P > 0.05). The pattern of adverse effects was similar in both groups with a slightly higher frequency in the calcipotriol–narrow-band UVB group. Conclusion: Our results demonstrated that the total cumulative UVB dose required to reach grade IV was not significantly different in both groups, although it was slightly lower in the calcipotriol–narrow-band UVB group. However, a higher percentage of patients attained grade IV at the end of therapy in the combination group and this therapy was more effective in reducing the Psoriasis Area and Severity Index early in treatment. More studies are warranted to confirm these results.

We report a case of arsenic keratosis and pigmentation accompained by multiple Bowen's disease and genitourinary cancer in a 64-year-old man. He was a psoriasis patient with a history of herbal medication for about thirty years. He showed multiple hyperkeratotic plaques on the bilateral palms, soles, and multiple, brownish, scaly, elevated papules on the back in addition to diffuse hyperpigmentation. Biopsy confirmed arsenic keratosis and Bowen's disease. Transitional cell carcinoma was also detected on his ureter and bladder during follow-up. The skin lesions were treated with topical 5-fluorouracil, etretinate, and excision with improvement.

We describe two Korean adult patients who had necrotizing papulovesicles mainly on their faces. Skin biopsy specimens showed perivascular and periadnexal infiltrate of atypical lymphoid cells with vasculitis in the dermis and subcutaneous tissue. In situ hybridization demonstrated a latent infection of Epstein–Barr virus in the majoriy of lymphoid cells in the dermis. These patients were diagnosed as having T-cell lymphoma. Interestingly, large granular lymphocytosis was found in the peripheral blood of Case 2.

The purpose of this study was to predict osteoporosis risk as decreasing muscle mass and to declare the cut-off value of low muscle mass in an elderly Korean population. This study was based on data from the 2008-2010 Korea National Health and Nutritional Examination Surveys (KNHANES). The subjects included 1,308 men and 1,171 women over 65 yr. Bone mineral density (BMD) and appendicular skeletal muscle (ASM) were measured by dual energy X-ray absorptiometry (DXA), and appendicular skeletal muscle was adjusted by height as a marker of sarcopenia. After confirming the correlation between low muscle mass and BMD, the best cut-off value of muscle mass to estimate osteoporosis was suggested through the receiver operating characteristic (ROC) curve. For both men and women, BMD correlated positively with low muscle mass when ASM/Ht(2) was used as a marker for sarcopenia. The ROC curve showed that ASM/Ht(2) was the best marker for osteoporosis at a cut-off value of 6.85 kg/m(2) for men and 5.96 kg/m(2) for women. When these cut-off values were used to determine sarcopenia, the risk of osteoporosis increased 4.14 times in men and 1.88 times in women. In particular, men (OR 2.12) with sarcopenia were more greatly affected than women (OR 1.15), even after adjusting for osteoporosis risk factors. In elderly Korean people, sarcopenia is positively correlated with BMD and there is a strong correlation between sarcopenia and osteoporosis with risk of bone fracture.

investigated. Results: Among 621 subjects, five (0.8%) were newly detected with hepatocellular carcinoma. Four underwent curative treatment, and all were detected by US (two surgical resections and two radiofrequency ablations). The remaining patient, whose disease was detected by an elevated AFP level, was infiltrative type with a poor prognosis. Of 492 subjects whose medical history was revealed, 45% had hepatitis B, 5% had hepatitis C, 1% had both, and 3% had other liver cirrhosis including alcoholic cirrhosis. The remaining 46% of subjects had no risk factors for liver cancer. Direct medical costs were estimated at 8,420,000 Won for detecting a single case of liver cancer, which was much lower than that of stomach cancer at 45,060,000 Won. If the non-high risk subjects were excluded, the cost for a single case of liver cancer decreased to 5,560,000 Won. Conclusions: The high-risk group should be more accurately defined by appropriate screening tests to optimize liver cancer surveillance. The detection rate by the liver cancer surveillance program was about 1%, and most tumors could be detected at the early stage by US. The role of AFP seemed to be small for early defection of liver cancer. (Korean J Med 2013;84:672-680)

Background The serial 100-7s subtraction, an item on the Mini-Mental State Examination (MMSE), is well known for being difficult for uneducated people. Therefore, we investigated into alternative serial subtractions for serial 100-7s subtraction in uneducated people. Methods One hundred sixty-nine subjects were enrolled by neurologic or neuropsychiatric out-patient clinics in 4 university medical centers. The subjects were divided into two groups: an uneducated group and an educated group (at least primary schooling) by questionnaire. We investigated the correlation between incorrect number of serial subtractions and Global Deterioration Scale (GDS) score in both groups and undertook receiver operating characteristic (ROC) curve analysis. MMSE including serial 40-4s subtraction, serial 20-2s subtraction, and serial 10-1s subtraction instead of serial 100-7s subtraction were arbitrally named MMSE4, MMSE2, and MMSE1. Results In the educated group, serial 100-7s subtraction showed the highest correlation with GDS score (correlation coefficient, 0.465; P < 0.001). In the uneducated group, serial 40-4s subtraction showed the highest correlation with GDS score (correlation coefficient, 0.608; P < 0.001), and serial 100-7s indicated the lowest correlation (correlation coefficient, 0.378; P = 0.023). In ROC curve analysis for MMSE, MMSE4, MMSE2, and MMSE1 to assess the presence of dementia (GDS score ≥ 3) in uneducated subjects, the area under the curve (AUC) was 0.648, 0.770, 0.758, and 0.711, respectively, and in educated subjects, AUC for MMSE, MMSE4, MMSE2, and MMSE1 was 0.729, 0.719, 0.716, and 0.714, respectively. Conclusion Out of MMSE items, serial 100-7s is adequate in the educated elderly, but may be less adequate in the uneducated elderly. Serial 40-4s seems to be more appropriate for MMSE in the uneducated elderly.

The causative effect of cigarette smoking on coronary heart disease, pulmonary disease, and many cancers is evident. Among nonsmoking persons, passive smoking is an important problem. Wives who have smoking husbands are more apt to increased incidence of a variety of cancers, cardiac disease, and chronic respiratory disease. This is similar in children who have smoking parents, they are more likely to suffer from growth retardation and pulmonary disease. 1) The necessity of antismoking effort is not a controversy but it is time to take up a positive attitude. To medical and public health care providers, helping people to stop smoking is one of the greatest challenges, today.