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Background Distinguishing benign lesion from early malignancy in melanocytic lesions of the nail unit still remains a diagnostic challenge, both clinically and histopathologically. While several immunohistochemistry (IHC) stainings have been suggested to help discriminate benign subungual melanocytic proliferation (SMP) and subungual melanoma in situ (MIS), the diagnostic utility of IHC staining for cyclin D1 and PRAME has not been thoroughly investigated in melanocytic lesions of nail unit. Methods This retrospective study included cases of benign SMP and subungual MIS confirmed by biopsy at Asan Medical Center from January 2016 to December 2020. Cases of melanocytic activation without proliferation and melanoma where dermal invasion was identified were excluded. Cyclin D1 and PRAME expression was assessed by counting proportion of melanocytes with nuclear positivity under 200x magnification. Results A total of 14 patients with benign SMP and 13 patients with subungual MIS were included in this study. 11 patients with benign SMP (71.4%) and 5 patients with subungual MIS (38.5%) showed > 60% nuclear immunostaining for cyclin D1, respectively. While 13 patients with benign SMP (92.9%) showed totally negative staining for PRAME, 10 patients with subungual MIS (76.9%) exhibited > 50% nuclear immunostaining for PRAME. Using the cutoff of 10%, PRAME exhibited good overall discrimination between benign SMP and subungual MIS (AUC = 0.849, 95% CI = 0.659–0.957). Conclusions This study suggests that PRAME IHC staining as a reliable discriminator in distinguishing subungual MIS from benign SMP.

Several studies have determined the correlation between programmed cell death protein-1 (PD-1) and chronic plaque psoriasis (CPP). However, limited studies have assessed the association between PD-1 expression and the clinicoprognostic and distinct clinicopathological characteristics of CPP and guttate psoriasis (GP). Twenty-nine patients with skin biopsy-confirmed CPP were recruited at the Asan Medical Center between January 2018 and June 2020, and 33 patients with biopsy-confirmed GP were enrolled between January 2002 and June 2020. The clinicoprognostic and histopathological characteristics were analyzed according to immunohistochemical PD-1 expression in the epidermal or dermal inflammatory infiltrates. The CPP and GP lesions were divided into PD-1-low and PD-1-high groups. The CPP epidermal PD-1-high group had typical histopathological changes and significantly higher psoriasis area and severity index scores (p = 0.014) and disease duration (p = 0.009) than the epidermal PD-1-low group. In patients with GP, compared with the dermal PD-1-high group, the dermal PD-1-low group exhibited significantly higher disease duration (p = 0.002) and relapse rate of plaque psoriasis (p = 0.005) and significantly lower relapse-free survival (p = 0.016). Upregulated epidermal PD-1 expression was correlated with the chronicity and severity of CPP, while downregulated dermal PD-1 expression was correlated with poor prognosis of GP.

In recent years, variable rejuvenation techniques, such as hyaluronic acid (HA) fillers and radiofrequency (RF) devices, have become popular. We evaluated the RF hydro-injector (RFHI) device that simultaneously delivers both a microneedle intradermal RF treatment and a HA filler injection to overcome the disadvantages of HA filler and RF devices alone. This study aimed to assess the efficacy and safety of the RFHI device for the rejuvenation of the periorbital area, including the lateral canthal lines (LCLs) and the infraorbital area. A total of 24 subjects were enrolled in this study and underwent 2 to 3 treatments using the RFHI device. The investigator’s global assessment of the lateral canthal line (IGA-LCL) and the global esthetic improvement scale (GAIS) were used to evaluate the improvement in the LCL. Cutometer® was used to evaluate the skin’s elasticity, and the Antera 3D image capture system® was used to evaluate the degree of wrinkles, roughness, and pore volume. At the 8 week follow-up after the first treatment session, both the IGA-LCL and GAIS showed significant improvement. The improvement in the wrinkles, roughness, and pore volume, measured by the Antera 3D image capture system®, was statistically significant. No serious adverse event was reported. This RFHI device, which delivers both microneedle intradermal RF treatment and HA filler injection, is effective and safe for periorbital rejuvenation.

Introduction Tongue diagnosis is a convenient and non-invasive method for examining the functional condition of the body. The presence of teeth marks (TMs) on the tongue surface indicates a swollen tongue and decreased resilience of the tongue surface. The aim of this study was to investigate whether teeth mark level (TML), a novel TM indicator, is useful for determining deficiency patterns (DPs) in patients with chronic fatigue (CF). Methods In total, 152 participants with CF were recruited. They were classified by two Korean medicine doctors (KMDs) into the following groups: qi deficiency (n = 45), blood deficiency (n = 37), yin deficiency (n = 36), and yang deficiency (n = 34). All the participants’ tongue images were obtained with a computerized tongue image analysis system after the diagnostic process. To objectively measure TMs, we calculated TMLs from the tongue images. Results Differences in the TMLs among the DPs were analyzed with multiple linear regression analysis. The TMLs of the clay-tongue models showed a close relationship with the number and depth of the TMs (r = 0.99 and 0.98, respectively). The TMLs showed different trends according to the DPs (P Conclusions The close relationship between TML and the DPs suggests that TML has the potential to be used in clinics as a supplementary means to differentiate among syndromes in CF and to evaluate therapeutic effects and prognosis in CF. Trial registration: CRIS no. KCT0001199.

Background:There are limited data regarding the difference in progression pattern between acral melanoma and nonacral melanoma.Aims:The objectives of this study were to compare the progression pattern between acral and nonacral melanoma and evaluate its impact on clinical outcomes.Methods:Clinical and histopathological features, survival outcomes and prognostic factors of 492 patients with acral melanoma or nonacral melanoma were retrospectively evaluated using the Asan Medical Center database.Results:The male-to-female ratio and the mean age was 1:0.92 and 60.2 years for acral melanoma (n= 249), and 1:0.85 and 58.4 years for nonacral melanoma (n= 243), respectively. The demographic difference was not significant. Although prediagnosis duration was longer and the advanced stage was more common in acral melanoma than that in nonacral melanoma, the vertical growth phase was more common in nonacral melanoma than that in acral melanoma, whereas, the horizontal diameter is longer in acral melanoma than that in nonacral melanoma. Dissemination to lymph nodes was more common in acral melanoma than that in nonacral melanoma. Lymph node involvement was associated with deeper Breslow thickness in nonacral melanoma but not in acral melanoma. The degree of correlation of prediagnosis duration with horizontal diameter was remarkable in acral melanoma, but with Breslow thickness in nonacral melanoma. Overall survival was worse in acral melanoma than that in nonacral melanoma. The prognostic value of Breslow thickness was more remarkable in nonacral melanoma than that in acral melanoma.Limitations:This study is a retrospective, single-center design.Conclusion:Acral melanoma has a longer radial growth phase compared with nonacral melanoma. However, acral melanoma is commonly associated with lymph node dissemination which contributed to worse survival in acral melanoma than nonacral melanoma.

Introduction: In traditional East Asian medicine, the color and shape features of a tongue reflect the health of the body. The repeatability of computerized tongue diagnosis is highly dependent on the image acquisition process. In this study, a method for providing frontal and profile feedback gridlines for the tongue image acquisition process was proposed and the resulting color and shape repeatability was assessed. Methods: Eight subjects were recruited and 120 images were acquired. For each subject, 15 tongue images were acquired with three different gridline types, including no gridline (Group I), frontal gridlines (Group II), and frontal and profile gridlines (Group III) in a pseudo-randomized order. To evaluate repeatability, intra-class correlation coefficients (ICCs) were calculated from the mean values and histogram fitting parameters for Commission Internationale de l’Eclairage L*a*b*, profile angles, and tongue area ratios (TARs) of four edge regions, respectively. Results: The ICCs for all the color features in Group I were lower as compared with those in Group II and additionally, the ICCs for all the color features in Group III were larger compared with those in Group II. The ICCs of the shape features were lower than those of the color features. The ICCs of TARs in Group I were lower than those in Groups II and III. From the tip to the root of the tongue region, the ICCs of mean luminance tended to decrease in all the groups, but the intensity of the decline in Group III was lower than those in Group I and Group II. Conclusions: The proposed tongue image acquisition process with frontal and profile gridlines improved the repeatability of color and shape features and potentially improve diagnostic accuracy of computerized tongue diagnosis. © 2014 Elsevier GmbH. All rights reserved.

The radial artery pulse is one of the major diagnostic indices used clinically in both Eastern and Western medicine. One of the prominent methods for measuring the radial artery pulse is the piezoresistive sensor array. Independence among channels and an appropriate sensor arrangement are important for effectively assessing the spatial-temporal information of the pulse. This study developed a circular-type seven-channel piezoresistive sensor array using face-down bonding (FDB) as one of the sensor combination methods. The three-layered housing structure that included independent pressure sensor units using the FDB method not only enabled elimination of the crosstalk among channels, but also allowed various array patterns to be created for effective pulse measurement. The sensors were arranged in a circular-type arrangement such that they could estimate the direction of the radial artery and precisely measure the pulse wave. The performance of the fabricated sensor array was validated by evaluating the sensor sensitivity per channel, and the possibility of estimating the blood vessel direction was demonstrated through a radial artery pulse simulator. We expect the proposed sensor to allow accurate extraction of the pulse indices for pulse diagnosis.

Tongue diagnosis is an essential process to noninvasively assess the condition of a patient's internal organs in traditional medicine. To obtain quantitative and objective diagnostic results, image acquisition and analysis devices called tongue diagnosis systems (TDSs) are required. These systems consist of hardware including cameras, light sources, and a ColorChecker, and software for color correction, segmentation of tongue region, and tongue classification. To improve the performance of TDSs, various types TDSs have been developed. Hyperspectral imaging TDSs have been suggested to acquire more information than a two-dimensional (2D) image with visible light waves, as it allows collection of data from multiple bands. Three-dimensional (3D) imaging TDSs have been suggested to provide 3D geometry. In the near future, mobile devices like the smart phone will offer applications for assessment of health condition using tongue images. Various technologies for the TDS have respective unique advantages and specificities according to the application and diagnostic environment, but this variation may cause inconsistent diagnoses in practical clinical applications. In this manuscript, we reviewed the current trends in TDSs for the standardization of systems. In conclusion, the standardization of TDSs can supply the general public and oriental medical doctors with convenient, prompt, and accurate information with diagnostic results for assessing the health condition.

Study of Skin Elasticity and Perspiration of Elderly Female according toSasang Constitution (SC) Chang-Jin Jung, Bon-Cho Ku, Jae-Chul Lee, Jaeuk-U. Kim, Young-Ju Jeon, Keun-Ho Kim, Jong-Yeol Kim, and Young-Min Kim Korea Institute of Oriental MedicineObjectivesSasang Constitution (SC) is determined by various physical and psychological attributes. Recently, skin propertieshave been used effectively to describe SC types in clinics. In this paper, we investigated the constitution dependenceof skin elasticity and skin perspiration by using quantitative measurement devices. MethodsThe skin elasticity of forearm and the skin perspiration of forehead and philtrum were measured in 223 elderly female subjects. To determine the subject’s constitution, we adopted the classification results from a newly developeddiagnostic tool. For the clarity of constitution, we excluded low-scored subjects in their SC classification. Results & ConclusionsAs a result, the elasticity hysteresis of forearm (EHFa) of Taeum-in group was significantly less than the EHFa of Soeum-in group. Soeum-in group has high perspiration difference between philtrum and forehead (Diff.PhFh) compared to Taeum-in group in a significance level of .05. Taeum-in and Soeum-in group were significantly classified by EHFa and Diff.PhFh using a Support Vector Machine.Key Words: Sasang Constitution, Body Mass Index, Skin elasticity, Skin hysteresis, Perspiration

본 연구는 비육한우 32두(거세우 16두, 암소 16두)를 대상으로 (C-1구 거세우의 일반사료 : C-2구 암소의 일반사료 : T-1구 거세우에게 야생쑥 2%첨가 : T-2구 암소에게 쑥 2%첨가) 4개 처리구를 두고 14개월간(생후14개월-27개월) 비육시험한 결과는 다음과 같다. 27개월 시험종료 체중에서 대조구인 C-1구, C-2구는 각각 648.6, 623.1kg이었고, 처리구인 T-1구, T-2구는 각각 663.3 kg 및 620.7 kg으로서 T-1구가 가장 높았고, 총 증체량과 일당증체량에서도 T-1구가 각각 342.4 kg과 0.88 kg으로 가장 높았다. 1일 두당 총 사료섭취량은 대조구인 C-1구 및 C-2구와 처리구인 T-1구 및 T-2구가 각각 9.35, 9.09, 10.08 및 9.69 kg으로 T-1구가 가장 높았고, 사료요구율에서는 C-1구(11.28) > T-1구(11.48) > C-2구(11.52) > T-2(12.57)순으로 낮았다. 혈중 총콜레스테롤, GOT, GPT, 글리코스 및 BUN은 대체로 시험개시전보다 시험개시후가 더 높은 경향이었고, 특히 시험개시후의 총 콜레스테롤, GOT 및 glucose 함량은 처리구가 대조구보다 낮았다 (p $(84.25-87.88cm^2)$ 가 대조구 $(84.00-85.25cm^2)$ 보다 넓어졌다. 그 중에서 T-1구가 각각 14.75 mm와 $87.88cm^2$ 로 가장 좋았으며, 육량 및 육질등급은 처리구(각각, 2.02-2.50점, 2.85-3.05점)가 대조구(각각, 1.80점, 2.80-2.55점)보다 높았다. 본 시험의 결과를 종합해 볼 때 거세한우에게 쑥첨가는 일당증체량 증가, 도체중, 배최장근 단면적 및 육질개선 효과가 있는 것으로 판단된다. 【This study was conducted to determine the effect of mugwort powder supplementation on the fattening performance and carcass characteristics during a 14 month period (from 14 months to 27 months after birth) in 32 heads of fattening Hanwoo. Fattening Hanwoos were randomly assigned 4 treatments (8 heads/treatment): C-1 [(control (0%) with Hanwoo steers)], C-2 [(control (0%) with Hanwoo heifers)], T-1 (supplementation with 2.0% mugwort powder with Hanwoo steers) and T-2(supplementation with 2.0% mugwort powder with Hanwoo heifers). The final body weights for C-1, C-2, T-1 and T-2 at 27 months were 648.6kg, 623.1kg, 663.3kg and 620.7kg, respectively. The total gain and the daily gain were highest in the T-1 group (342.4 kg, 0.88 kg). Hanwoo steers were not significantly different from Hanwoo heifers. The feed intake for the C-1, C-2, T-1 and T-2 groups were 9.35 kg, 9.09 kg, 10.08 kg and 9.69 kg, with the T-1 value being highest. The feed conversion ratios were as follows: C-1 (11.28) > T-1 (11.48) > C-2 (11.52) > T-2 (12.57). The concentrations of total cholesterol, GOT, GPT, glucose and BUN in blood serum during the fattening period were higher after than before the experiment The total cholesterol, GOT and glucose after completion of the experiment were higher in the treatment groups than the control groups (p $(84.25-87.88cm^2)$ than the control groups $(84.00-85.25cm^2)$ with the highest over-all values in the T-1 group (p】

Introduction. According to traditional East Asian medicine (TEAM) theory, the tongue represents conditions of qi and blood. In the present study, the relationship between the tongue and the qi and blood in conditions with no apparent disease was investigated.Methods. A total of 454 elderly people with no apparent disease were recruited. Two Korean oriental medicine doctors classified subjects into a normal group (n = 402) and a sleep disorder group (n = 52). Three to five weeks after the experiment, 153 subjects were rerecruited for a second experiment. Two-dimensional color histograms, whose seven variables represent the color distribution in Commission Internationale de l'Éclairage 1976 (L*,a*,b*) color space, were produced from tongue images.Results. The color of the tongue body in the sleep disorder group appeared paler than that in the normal group, and the tongue coating in the normal group was less widely distributed compared with that in the sleep disorder group. The differences in tongue color between the normal at first experiment and sleep disorder at second experiment conditions were similar to the differences between the normal and the sleep disorder groups.Conclusions. The tongue states in the sleep disorder group indicate a qi and blood deficiency according to TEAM theory.

Background Human skin properties have been used as an important diagnostic component in traditional medicine as they change with health conditions. Sasang constitutional medicine (SCM) puts emphasis on the recognition of the constitution-specific skin features prior to the diagnostic decision of health. In this work, in search of skin-characteristics effectively reflecting SCM features, we compared several skin properties such as perspiration, visco-elasticity, elasticity, and elasticity hysteresis, in several candidate body parts. Methods We conducted a clinical study in which a total of 111 healthy females aged 50 – 70 years participated with their Sasang constitution (SC) types determined objectively by the Sasang constitutional analytic tool. Perspiration on the skin surface was estimated by using a capacitance sensor to measure the amount of moisture on the palm, forehead, and philtrum before and after a heating stimulus. We acquired the visco-elasticity, elasticity, and elasticity hysteresis at the forearm by Dermalab’s elasticity sensing device. An analysis of covariance (ANCOVA) was conducted to evaluate the effect of SC on the nine skin features acquired. Results The visco-elasticity of the forearm of the Soeum-in (SE) group was significantly lower than that of the Taeeum-in (TE) group (F = 68.867, p