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Background: The kinds and identification rates of major bacteria causing bacterial skin infections have changed steadily over time. Although studies of the causative pathogen changes over time have been reported worldwide, no follow-up studies of bacterial skin infections have been conducted in Korea since 2009. Objective: To investigate the changes in the identification rate and antibiotic susceptibility of causative pathogens of bacterial skin infections, especially S. aureus, over time in Korea. Methods: This study was conducted in outpatient clinics in 2006, 2009, 2012, 2015, and 2018, in which the data on age, sex, identification of bacteria, and susceptibility to antibiotics were retrospectively analyzed. Results: Of the 350 cases, except for suspected normal flora, 213 (60.9%) were positive for S. aureus, accounting for the highest percentage, followed by 22 (6.3%) for P. aeruginosa, 7 (2%) for Serratia marcescens, and 6 (1.7%) for Bacillus species, Enterococcus faecalis, and Staphylococcus lugdunensis. The identification rate of methicillinresistant S. aureus (MRSA) increased from 2009 to 2015 and then decreased in 2018. Conclusion: The proportion of MRSA gradually increased from 2006 to 2015 but suddenly reversed in 2018, possibly due to improved education for infection prevention or changes in the virulence of the circulating strains of MRSA. Also, based on our findings, MRSA is currently susceptible to trimethoprim-sulfamethoxazole and vancomycin.

Tumid lupus erythematosus (TLE) as a rare variant of cutaneous lupus erythematosus (CLE) is characterized by edematous, urticarial-like annular papules and plaques. TLE has similar histopathologic findings to CLE such as periadnexal lymphocytic infiltration and interstitial mucin deposition. Although TLE develops on sun-exposed areas at any age, it is rarely distributed along the Blaschko lines and develops in infancy and childhood. Unlike CLE, skin lesion of TLE heals without leaving scarring or dyspigmentation. Here, we report a rare case of unilateral linear TLE in a 4-year-old girl, which was improved by intralesional corticosteroid injection and oral antimalarial drug with leaving postinflammatory hyperpigmentation.

This study was undertaken to evaluate the clinical efficacy, safety, and histological changes induced by dietary omega-3 fatty acid and γ-linoleic acid in acne vulgaris. A 10-week, randomised, controlled parallel dietary intervention study was performed in 45 participants with mild to moderate acne, which were allocated to either an omega-3 fatty acid group (2,000 mg of eicosapentaenoic acid and docosahexaenoic acid), a γ-linoleic acid group (borage oil containing 400 mg γ-linoleic acid), or a control group. After 10 weeks of omega-3 fatty acid or γ-linoleic acid supplementation, inflammatory and non-inflammatory acne lesions decreased significantly. Patient subjective assessment of improvement showed a similar result. Heamatoxylin & eosin staining of acne lesions demonstrated reductions in inflammation and immunohistochemical staining intensity for interleukin-8. No severe adverse effect was reported. This study shows for the first time that omega-3 fatty acid and γ-linoleic acid could be used as adjuvant treatments for acne patients.

Trastuzumab is the standard of care and has been shown to prolong survival of HER2-positive gastric cancer (GC) patients. However, HER2-positive is present only in about 20% of GC patients, there is a need to explore prognostic genetic markers for 80% of HER2-negative GC patients. The aim of this study was to identify the prognostic markers by elastic-net regularization and association rule mining and evaluate prognosis with selected genetic markers in HER2-negative metastatic GC (mGC) patients. A total of 143 HER2-negative mGC patients who have been treated with first-line chemotherapy in Yonsei Cancer Center, Korea between 2011 and 2018 were retrospectively assessed. Patients were categorized into two groups (responder or non-responder) based on the median progression-free survival (PFS: 7.8 months (95% confidence interval (CI), 6.3 - 8.9)) of the first-line chemotherapy. Targeted sequencing data of patients was obtained from CancerSCANTM and CANCER MASTER, and were analyzed with common variants of two panels. We used combined tools of elastic-net with 1,000 times of re-sampling bootstrap method and association rule mining to filter out and select critical genetic markers distinguishing responder or non-responder groups. To assess prognosis significance of selected genetic markers, we developed prognostic score based on the sum of sub-scores. If the right-hand-side of the rules signifies a responder, the patient is given a value of 0 when applying to the rule and 1 when they do not. PFS were determined by the Kaplan-Meier method and compared using the log-rank test. The 85 candidate genetic markers were selected by elastic-net with 60% of variable inclusion probability. Among the 85 candidate genetic markers, 12 genetic markers involved in 26 rules with lift greater than 1.5 were related to the responder group from association rule mining. The selected 12 genetic markers are included as follows: EGFR/KRAS normal copy number, APOBEC3B deletion, FGFR2/MLH1/PHLPP2/PARP4/SH2B3/BARD1/ALK/GNAS wild type, and NCOA3 mutation. The prognostic scores generated by selected genetic markers were 3, 4 and 5 respectively, and patients with higher scores had significantly poor prognosis than those with lower scores. Median PFS of each score group were 9.8 months (95% CI, 8.8 - 11.6), 7.5 months (95% CI, 5.7 - 8.6), and 5.2 months (95% CI, 1.2 - 6.7) for patients with consecutive scores of 3, 4 and 5 (P=0.017). The combined tool of elastic-net and association rule mining effectively found prognostic genetic markers and can be applied to develop the prognostic scoring system. The results of novel combined tool identified 12 multiple prognostic genetic markers and demonstrated significant survival differences in prognostic scores among HER2-negative mGC patients, although further studies are required. Note: This abstract was not presented at the meeting. Citation Format: Sejung Park, Woo Sun Kwon, Inhye Jeong, Hyun Jeong Kim, Jong Soo Hong, Jaeyoung Kim, Jingmin Che, Chung Mo Nam, Hyun Cheol Chung, Sun Young Rha. Exploring novel prognostic genetic markers using elastic-net regularization and association rule mining in HER2-negative metastatic gastric cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5096.

Orofacial granulomatosis is a rare granulomatous inflammatory disease, characterized by recurrent orofacial swelling. Infectious, genetic, and immunologic etiologies are suggested, but not fully understood. Herein, we report a case of synchronous orofacial granulomatosis with brain cavernous hemangioma in a 44-year-old female patient, which may be considered paraneoplastic syndrome.

/Si substratesby using pulsed laser deposition (PLD) system. We fabricated three different thin films of BTO, BTO/CNF andCNF/BTO/CNF for magneto-capacitor and studied their crystalline structure, surface and interface morphol-ogy, and magnetic and electrical properties. When three different structures of multilayered thin film werecompared, magnetization of CNF/BTO/CNF thin films was decreased by magnetic and dielectric interaction.Also we confirmed that capacitance of CNF/BTO/CNF multilayered thin film was enhanced as being near tet-ragonal structure with increasing of c/a ratio because of atomic bonding at interface between BTO dielectricand CNF magnetic materials. Finally, we studied the change of the capacitance of CNF/BTO/CNF multilay-ered thin film with magnetic field for emergence of magnetocapacitance and suggested a possibility of enhancedcapacitance.Keywords : magnetocapacitance, multilayer thin film, pulsed laser deposition, interface effect

The growth of rat adrenal nerve cells was remarkably enhanced by supplementing the cultured medium from the human fibroblast cell line, Hs 68. Maximum specific growth rate and length of the neurites were observed as 0.076 (1/hr) and 0.026 mm, respectively in 20% supplement of five day old medium. In adding more than 20% of the cultured medium both cell and neurite growth was severely decreased. It was interesting that the cultured medium from Hs 68 cells could play a role in the extension of the neurites rather than in the growth of neurite cells. It was also found that molecules lower than 50,000 daltons in the conditioned medium could improve the growth of neurite bearing cells and the extension of the neurites than larger molecules. The efficacy of the proteins (

Recent studies have suggested that dietary factors, specifically glycaemic load, may be involved in the pathogenesis of acne. The aim of this study was to determine the clinical and histological effects on acne lesions of a low glycaemic load diet. A total of 32 patients with mild to moderate acne were randomly assigned to either a low glycaemic load diet or a control group diet, and completed a 10-week, parallel dietary intervention trial. Results indicate successful lowering of the glycaemic load. Subjects within the low glycaemic group demonstrated significant clinical improvement in the number of both non-inflammatory and inflammatory acne lesions. Histopathological examination of skin samples revealed several characteristics, including reduced size of sebaceous glands, decreased inflammation, and reduced expression of sterol regulatory element-binding protein-1, and interleukin-8 in the low glycaemic load group. A reduction in glycaemic load of the diet for 10 weeks resulted in improvements in acne.

Dear Editor: A 15-day-old boy visited our clinic presenting a palm sized erythematous patch located on his left cheek from birth, which was aggravated soon after his 1st vaccination against the hepatitis B virus. A skin biopsy revealed an oval shaped vascular lobules scattered in the dermis. It was a typical 'Cannonball' appearance (Fig. 1A). In high power field, the lobules were groups of ducts composed of proliferated endothelial cells. Tufted angioma (TA) was the most consistent diagnosis. The patient began receiving interferon a2b injection of 150 MU four times a week. However, the injection was ceased because 18 injections during a course of five weeks only brought intermittent fever with minimal effect. As an alternative option, propranolol (15 mg/d) and prednisolone (3 mg/kg/d) were given to the patient. Although a short-term tumor shrinkage was achieved, intermittent flare-ups of swelling, pain and tenderness persisted (Fig. 1B). Even vincristine (0.05 mg/kg/wk) failed to downsize the tumor. Fig. 1 (A) Discrete and oval shaped scattered lobules composed of capillaries with obstructed lumen (H&E, ×100). (B) At the age of 2 months, the patch is swollen to a plaque, hindering his eye-opening. The laboratory result at the four-month-follow up revealed a decreased platelet (107,000/ul), elevated D-dimer (4.66 ug/ml) and decreased fibrinogen (136 mg/dl), which implied the advent of Kasabach-Merritt syndrome (KMS). On this, he underwent nine sessions of combined chemotherapy of vincristine 0.05 mg/kg, actinomycin-D 1.5 mg/m2, cyclophosphamide 500 mg/m2 until now. For the one-year follow up since his first visit, neither the size of the tumor nor the KMS satisfactorily responded to the various treatment modalities. He still suffers from outbreaks of edema, tenderness and thrombocytopenia. For acute aggravation, methylprednisolone pulse therapy (30 mg/kg/day for 3 consequent days) and platelet transfusion were conducted for edema and thrombocytopenia, respectively (Fig. 2). Fig. 2 Treatment history is summarized. Each bar stands for the duration of corresponding medication, the upward arrow for methylprednisolone pulse therapy, and the cross for platelet transfusion. TA is a rare benign vascular tumor, which originates from the abnormal proliferation of endothelial cells1. Another vascular tumor, Kaposiform Hemangioendothelioma (KHE), shares many common properties with TA. Both have similar histopathology and can cause KMS. Although the immunohistochemistry for D2-40 differentiates KHE (positive for this marker) and TA (negative), it has currently been suggested that both are spectrums of the same vascular tumor. Unfortunately, there are no established treatments. Only several cases of using systemic agents or laser have been reported. It was suggested that physical trauma possibly aggravates the tumor by introducing various growth factors2. This hypothesis partly explains several cases of aggravated TA after skin punch biopsy at the authors' clinic (unpublished observation). We also experienced an aggravation of TA followed by a long pulsed Nd:YAG laser3. Interestingly in this case, the aggravation took place along with fever after vaccination. If the aggravation was correlated with mild inflammatory response caused by vaccination, we could hypothesize that even a mild inflammation triggers the proliferation of vascular tumor cells. Our experiences imply that TA is also associated with Koebner phenomenon (KP), which is similar to another vascular tumor, Kaposi's sarcoma, which is known to be developed as a manifestation of KP4. KMS is a rare condition characterized by thrombocytopenia and consumptive coagulopathy, arising in patients with vascular tumor. Treatment experiences using corticosteroid and chemotherapeutic agents have been reported5.

Pacinian corpuscles are sensory nerve-end organs located in the deep dermis and subcutaneous tissue of the palms or soles. Pacinian neuroma is an extremely rare feature, defined as hyperplasia or hypertrophy of Pacinian corpuscles. About half of Pacinian neuromas present with point tenderness. There have been a limited number of cases reported around the world. We observed a 45-year-old woman with an 8-month history of a tender whitish papule on her left thumb tip. Histopathologically, an enlarged hypertrophic Pacinian corpuscle in subcutaneous tissue, surrounded by numerous nerve fibers, was found. Herein, we report a case of Pacinian neuroma presenting as a tender papule on a fingertip that was clearly related to repetitive trauma at that site. This case shows that a meticulous history and histological examination can lead to an exact diagnosis and proper treatment.

Erythema multiforme (EM) is an extremely rare condition in infancy. To the best of our knowledge, there have been only three cases of neonatal EM described in the literature, and no such cases have been reported in Korea. A preterm neonate born at 35 weeks and six days of gestation presented with multiple annular erythematous patches with a targetoid shape over his entire body at 36 days of age (corrected age of 7 days). He had no systemic symptoms except for transient mild fever. No triggering factor except for hepatitis B and BCG vaccination was found. Neutropenia was noted upon laboratory analysis. Skin biopsy specimens showed findings suggestive of erythema multiforme. The skin lesions improved rapidly upon administration of intravenous methylprednisolone; however, neutropenia continued for a much longer period. The significance of neutropenia with respect to the development of EM was not clarified. There has been no recurrence of skin lesions over a one-year follow-up period.

Leukocytoclastic vasculitis (LV) is characterized by neutrophilic invasion and fibrinoid necrosis along with endothelial enlargement in postcapillary venules. Annular appearance of LV (ALV) is rare, but it can be accompanied by several systemic diseases. One of these systemic diseases is ulcerative colitis (UC), a subgroup of inflammatory bowel disease. Only one case was previously reported in which ALV was associated with UC, and herein we present one more case. A 66-year-old woman presented with painful polycyclic erythema on both palms, which had been present for 4 days. She had suffered from UC for 5 years. The patient had no fever or other systemic symptoms, and histological examination demonstrated typical LV. 200 mg of oral dapsone was taken daily to rapidly reduce her symptoms and signs, and after 1 week all lesions resolved completely without any adverse events. ALV is not a distinct condition and it can appear in a broad range of small vessel vasculitides. Although ALV in patients with UC is a very rare combination, clinicians need to be aware of this possible association.

Trichogerminoma is a rare neoplasm which was first described in 1992 and there is still controversy over its inclusion into the spectrum of trichoblastoma. A 79-year-old woman presented with a 5-year history of an asymptomatic nodule on the left posterior neck. Histologically, the lesion revealed a well-demarcated deep dermal nodule surrounded by a pseudocapsule. The tumor was composed of lobules with basophilic cells and some of the lobules displayed a distinctive pattern of densely packed 'cell balls' with peripheral condensation. Immunohistochemically, the tumor cells showed zonal CK5/6 immunoactivity in contrast with the negatively stained 'cell balls'. These characteristics were compatible with the diagnosis of trichogerminoma. We report here on a rare case of a hair germ tumor called trichogerminoma.