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Background Identifying the genetic basis of airflow limitation is one of the most interesting issues for understanding chronic obstructive pulmonary disease (COPD) pathophysiology. Several studies have shown that some genetic variants associated with COPD have been identified in genome-wide association study (GWAS), especially in patients with moderate to severe COPD; genetic susceptibility for airflow limitation in the early COPD phase has not been widely studied. Objective We investigated the genetic variants in early COPD. Methods The present study analyzed Gene-environment interaction and phenotype (GENIE) cohort that included participants who received health screening examination. The association between single nucleotide polymorphism (SNP) and susceptibility to early COPD (FEV1 predicted ≥50% and FEV1/FVC

BackgroundDegree of expression of programmed death-ligand 1 (PD-L1) is related with Immune check point inhibitors (ICIs) response but is not obligate predictive marker and needs sufficient tissue. Therefore, there is unmet need for easily accessible peripheral blood (PB) biomarkers and evaluation of the prognostic value of this marker is needed. We investigated the application of serum peripheral lymphocyte count (PLC) as a predictive PB biomarker for ICI response in patients with NSCLC. MethodsWe conducted a retrospective study and reviewed the medical charts of patients with NSCLC who were treated with ICIs at Seoul National University Hospital. We evaluated the association between PLC and progression-free survival using a Cox proportional hazard model. The PLC before and after 1 month of immunotherapy was collected. The quartile groups of PLC were compared using the Kruskal-Wallis statistical test.ResultsA total of 231 patients were treated with immunotherapy for NSCLC. The median follow-up period was 4.7 months. During the follow-up period, the disease progressed in 138 patients (59.7%). The post-treatment PLC groups Q2-4 showed significantly lower disease progression than group Q1 in our adjusted model (Q4 hazard ratio: 0.41, 95% confidence interval: 0.25–0.68, p < 0.001). The overall survival also showed similar results. An association between adverse events and PLC was not observed in this study. ConclusionWe revealed that an increased post-treatment PLC was associated with favorable progression-free and overall survival with NSCLC patients treated with ICIs. Therefore, PLC could be a surrogate marker for ICI responses in NSCLC.

Background Acne scarring can be divided into 2 types: atrophic and hypertrophic scars. Papular acne scars are commonly encountered, skin-colored papules on the chin and back. Objective This study aimed to estimate the prevalence of each acne scar type and to investigate the clinical manifestations of papular acne scars. Methods This retrospective study included 416 patients with acne scars. Dermatologists classified the scars into 3 types (atrophic, papular, and keloid type) based on clinical photographs and analyzed the clinical and histologic features of papular acne scars. Results Among 416 patients with acne scars, 410 patients (98.56%) had atrophic scars, 53 patients (12.74%) had keloid scars, and 46 patients (11.06%) had papular acne scars. Twenty patients (4.81%) had both papular and keloid acne scars. Histologic analysis showed fibrotic tissue in both keloid and papular acne scars. Fibrosis of the papular scar was limited to the upper dermis. Conclusion Papular acne scars were significantly more prevalent in patients with keloid scars than in those without keloid scars. These results provide a basis for understanding papular acne scars, which have been under-recognized. The association between papular and keloid acne scars can suggest the decision for scar treatment.

Background The impact of reflux esophagitis on the decline of lung function has been rarely reported. This study was performed to evaluate the association between erosive reflux esophagitis and lung function changes. Methods We included patients with normal lung function who underwent esophagogastroduodenoscopy for health screening from a health screening center. Patients with persistent erosive reflux esophagitis on two discrete endoscopic examinations were designated as the erosive reflux esophagitis group. We also selected patients without erosive reflux esophagitis and matched them 1:4 with patients from the erosive reflux esophagitis group. We estimated annual forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) changes from baseline and compared these estimates by the linear mixed regression model. We also estimated the biannual incidence of chronic obstructive pulmonary disease (COPD). Results In total, 1,050 patients (210 patients with erosive reflux esophagitis, and 840 matched controls) were included. The median follow-up duration for spirometry was six years. In patients with erosive reflux esophagitis, mild reflux esophagitis (A grade) was most common (165 patients, 78.6%). The adjusted annual FEV1 change in patients with erosive reflux esophagitis was −51.8 mL/yr, while it decreased by 46.8 mL/yr in controls (P = 0.270). The adjusted annual FVC decline was similar between the two groups (−55.8 vs. −50.5 mL/yr, P = 0.215). The estimated COPD incidence during the follow-up period was not different between the erosive reflux esophagitis and control groups. Conclusion In patients with normal lung function, the presence of erosive reflux esophagitis did not affect the annual declines in FEV1 or FVC., Graphical Abstract

Background The COVID-19 pandemic is predicted to significantly affect patients with lung cancer, owing to its rapid progression and high mortality. Studies on lung cancer diagnosis and treatment during an epidemic are lacking. We analyzed the impact of COVID-19 on lung cancer diagnosis in Korea, where lung cancer incidence continues to rise. Methods The number of newly diagnosed lung cancer cases in three university-affiliated hospitals during the pandemic and their clinical features were compared with lung cancer cases diagnosed during the same period in the past 3 years. The effectiveness of measures taken by the study hospitals to prevent nosocomial transmission was reviewed. Results A total of 612 patients were diagnosed with lung cancer from February through June, 2017–2020. During the pandemic, the number of patients who sought consultation at the division of pulmonology of study hospitals dropped by 16% from the previous year. Responding to the pandemic, the involved hospitals created physically isolated triage areas for patients with acute respiratory infection symptoms. Wide-range screening and preventive measures were implemented, thus minimizing the delay in lung cancer diagnosis. No patient acquired COVID-19 due to hospital exposure. The proportion of patients with stage III–IV non-small-cell lung cancer (NSCLC) significantly increased (2020: 74.7% vs. 2017: 57.9%, 2018: 66.7%, 2019: 62.7%, p = 0.011). The number of lung cancers diagnosed during this period and the previous year remained the same. Conclusions The proportion of patients with advanced NSCLC increased during the COVID-19 pandemic.

Background Although elevated serum gamma‐glutamyltransferase (GGT) is a known indicator of increased risk of several cancers, the clinical value of repeated measurements of GGT has not been determined. Therefore, we aimed to investigate whether repeatedly elevated serum GGT levels are associated with the risk of respiratory cancer incidence. Methods We included participants who had undergone the Korean Health screening four times during 2009–2012 and had previously undergone four consecutive examinations. Those who were diagnosed with respiratory cancer before the date of examination were excluded. The participants obtained one GGT point if their GGT levels were in the highest quartile (the quartile 4 group). We analyzed the association between GGT points and respiratory cancer incidence by Cox proportional hazard models. Results During mean follow‐up of 6.39 ± 1.2 years, 3,559,109 participants were enrolled. Of them, 8,944 (0.34%) men and 1,484 (0.14%) women were newly diagnosed with respiratory cancer. In multivariate analysis adjusted for confounding factors, male participants with 4 GGT points had a significantly higher hazards of developing respiratory cancer than those with 0 GGT points (hazard ratio [HR]: 1.39; 95% confidence interval [CI]: 1.31–1.48). Among female, participants with the highest points of GGT also had sixfold increased risk of developing laryngeal cancer. However, no significant association was observed between GGT points and lung cancer incidence among women (HR: 0.95; 95% CI: 0.81–1.11). Conclusion Repeatedly elevated serum levels of GGT were associated with a higher risk of respiratory cancer incidence, especially in men. This finding suggests that physicians can identify a person with a higher risk of respiratory cancer through a simple repeated measurement of GGT., This study is first study to investigate whether repeatedly elevated Gamma‐glutamyltransferase (GGT) levels are associated with the risk of respiratory cancers including lung and laryngeal cancers using a large database. Among men, the higher the GGT points, the higher was the risk of respiratory cancer, both laryngeal and lung cancer development. Among women, elevated level of GGT is associated with sixfold higher risk of laryngeal cancer incidence. Persistently elevated serum levels of GGT are associated with an increased risk of respiratory cancer development.

Background: Filler injection has become an extremely popular method for facial skin rejuvenation, including the periorbital area. In the recent years, new polynucleotide (PN)-containing filler products have been used for esthetic purposes.Aim: We aimed to investigate the efficacy and safety of PN filler injection in the periorbital area.Patients/methods: A total of 27 subjects were enrolled in this randomized, pair-matched, and active-controlled study. Each subject received filler injections thrice with two-week intervals, with a PN filler injection on one side and a non-crosslinked hyaluronic acid (HA) filler injection on the contralateral side of the periorbital area.Results: Improvements in the visual analog scale and global esthetic improvement scale scores were not significantly different between the PN and HA groups. The improvement rates of skin elasticity and hydration decreased over time in both groups, with the PN group showing a higher improvement rate. The improvement rates of roughness and pore volume were higher in the PN group than in the HA group. The improvement rate of dermal density was not significantly different between the groups. No serious adverse events were reported.Conclusion: The PN filler injection is effective and safe for periorbital rejuvenation.

Background/aims Patients with diabetes mellitus (DM) and tuberculosis (TB) have increased morbidity and a high risk of treatment failure or recurrence. It is important to manage both diseases simultaneously. Among anti-diabetic drugs, metformin inhibits intracellular growth of mycobacteria. Therefore, we examined the effects of metformin on TB treatment, especially in patients with DM. Methods This retrospective cohort study included patients with culture-positive pulmonary TB diagnosed between 2011 and 2012. The primary study outcome was sputum culture conversion after 2 months of treatment. Results Of 499 patients diagnosed with culture-positive pulmonary TB, 105 (21%) had DM at diagnosis. Among them, 62 (59.5%) were treated with metformin. Baseline characteristics, except for the presence of chronic renal disease, were not significantly different between the metformin and non-metformin groups. Metformin treatment had no significant effect on sputum culture conversion (p = 0.60) and recurrence within 1 year after TB treatment completion (p = 0.39). However, metformin improved the sputum culture conversion rate in patients with cavitary pulmonary TB, who have higher bacterial loads (odds ratio, 10.8; 95% confidence interval, 1.22 to 95.63). Conclusion Among cavitary pulmonary TB patients with DM, metformin can be an effective adjunctive anti-TB agent to improve sputum culture conversion after 2 months of treatment.

In South Korea, a cluster of humidifier disinfectant-induced lung injury (HDLI) cases developed between 2006 and 2011. There are no existing reports regarding the rate of humidifier disinfectant (HD) usage in the general population of Korean children. The purpose of this study was to investigate the rate of humidifier and HD usage in the general population of Korean children. This is a general population-based birth cohort multicenter study, Panel Study of Korean Children (PSKC) from 2008, a humidifier and HD-related questionnaire administered to 1577 subjects (809 male, 768 female) in 2015 (n=1577). The questionnaire consisted of four categories (humidifier usage, HD usage, exposure duration, and type of HD brands). A total of 75.6% (1192/1577) had used a humidifier, and the rate of HD usage was found to be 31.1% (409/1316). Polyhexamethylene guanidine (PHMG), used as a disinfectant, was found to have the highest usage rate (62.0%). HD was used for less than 3 months of the entire lifetime of most of the subjects. In conclusion, approximately 30% of young Korean children were exposed to HD. PHMG-containing HD was the most commonly used. These results suggest that a nationwide epidemiologic investigation is needed urgently, and children exposed to HD should be investigated regarding their status of lung injury, including a pulmonary function test. Moreover, a long-term follow-up period may be required to evaluate HD usage-associated lung injury.

Introduction: Identifying the genetic basis of airflow limitation is one of the most interesting issues for understanding COPD pathophysiology. Although some genetic variants associated with COPD have been identified in genome-wide association study (GWAS), especially in patients with moderate to severe COPD, genetic susceptibility for airflow limitation in the early COPD phase has not been widely studied. Methods: Genotyping was performed, using the Affymetrix Axiom® Customized Biobank Genotyping Arrays (Affymetrix, Santa Clara, CA, USA), on blood samples from the Gene-environment interaction and phenotype (GENIE) cohort that included participants who received health screening examination at the Seoul National University Hospital Healthcare System Gangnam Center (SNUH-GC) between February 2014 and October 2016. The association between single nucleotide polymorphism (SNP) and susceptibility to early COPD (FEV1 predicted ≥50% & FEV1/FVC Results: A total of 130 patients with early COPD and 3,478 controls (1,700 ever-smokers and 1,778 never-smokers) were recruited. When compared with the total controls, certain SNPs (rs2818103, rs875033, rs9354627, rs34552148) on chromosome 6 were included at the top of our list (p= 5.6 × 10-7 ~9.6 × 10-6) although they did not reach genome-wide significance. When compared with the never-smoker controls, two SNPs (rs2857210, rs2621419) of the HLA-DQB2 gene class were persistently associated with susceptibility to early COPD. Conclusion: Certain SNPs located on chromosome 6 or the HLA-DQB2 gene were the top-scoring SNPs for the association with susceptibility to early COPD in the Korean GENIE cohort.

In this paper, we propose a new method using strain gauges-based Flexible Epidermal Tactile Sensor Array. It acquires electric signals generated according to the movements of the wrist based on strain gauge estimating the degree of deformation such as tension, compression, and twist. The proposed sensor array showed that it can analyze the eight motions of the wrist. The proposed method was verified by confirming gesture recognition accuracy with multiple subjects. The accuracy of the proposed method showed greater performance than the existing gesture recognition devices in the comparison tests.

A 65-year-old male patient with chronic dysphagia was found to have a 2 cm mass at gastro-oesophageal junction on endoscopy. Biopsy showed squamous hyperplasia without malignancy. Controlled radial expansion balloon dilatation and partial resection were performed but the symptoms recurred. He finally underwent endoscopic mucosa resection and histology showed well-differentiated verruciform squamous proliferation limited to the mucosa. Small amounts of tumour remnants were treated during subsequent follow-up endoscopies and the patient has been tumour free since then. Diagnosis of oesophageal verrucous carcinoma can be challenging and could be managed with endoscopic resection. In this report, we review the literature and present our experience with a patient with oesophageal verrucous carcinoma.

Background Anti-programmed cell death-1 (PD-1) immunotherapy using antibodies such as nivolumab or pembrolizumab has shown promise for treating various types of cancer. In this study, we reviewed the frequency and spectrum of cutaneous adverse events (AEs) caused by PD-1 antibodies and their possible correlation with treatment response. Methods We reviewed records of all patients from a single institution treated with either nivolumab or pembrolizumab from August 1, 2014 to April 1, 2017. Results Of 211 patients included in the study, 134 (63.5%) were treated with nivolumab and 77 (36.5%) with pembrolizumab. Thirty-five patients (16.4%) developed cutaneous AEs. Cutaneous AEs were significantly associated with longer treatment cycles (P = 0.001). The prevalence of cutaneous AEs did not differ between nivolumab (17.2%) and pembrolizumab (15.6%). Patient age, gender, baseline Eastern Cooperative Oncology Group scale and underlying malignancy were not associated with development of cutaneous AEs. Median time until onset of cutaneous AEs was 50.0 days (range, 1–378 days). Anti-PD-1 therapy was tolerable in most of patients with grade 1 (65.2%) and grade 2 (23.9%) cutaneous AEs. Pruritus (32.6%) and eczema (21.7%) were the most commonly reported cutaneous AEs. In lung cancer patients, cutaneous AEs were not associated with better treatment outcomes after adjusting for the number of treatment cycles. Conclusion Both pembrolizumab and nivolumab exhibited tolerable cutaneous safety profiles in a variety of cancer patients undergoing anti-PD-1 therapy. Cutaneous AEs of anti-PD-1 therapy were not associated with antibody type, underlying malignancy, patient characteristics, or improved response., Graphical Abstract

Nevus sebaceous(NS) is a congenital hamartoma of cutaneous structures including both surface epithelial and adnexal components. NS is usually removed by surgical excision. Here, we report an interesting case of NS on the face which showed good response to carbon dioxide (CO2) laser treatment combined with isotretinoin. A 22 - year - old female patient visited our dermatology clinic with skin lesion on the right cheek. Physical examination revealed multiple grouped, rice sized yellowish papules on the right cheek. Histopathologic findings revealed minimal papillomatosis, and acanthosis of epidermis with abundant of sebaceous gland proliferation in dermis. Based on these findings, we diagnosed her as NS. She was treated with CO2 laser for nevus ablation instead of surgical excision, because of location and size of the lesion with possibility of scar on face. After CO2 laser treatment, she took isotretinoin to prevent recurrence of NS. After 12 months later, lesion was well maintained without recurrence. Most investigators suggest that surgical excision is the treatment of choice of NS. However, remove nevus sebaceous by surgical excision leave linear scar. To minimize scar, there were several other treatment options include CO2 laser treatment.However, there was possibility of recurrence after laser treatment. To prevent recurrence, we treated her with isotretinoin and kept in good state for 12 months.

Purpose To compare clinical characteristics and outcomes between critically ill homeless and non-homeless patients admitted to the intensive care unit (ICU) in a Korea. Materials and methods We retrospectively analyzed the medical charts of homeless and non-homeless patients admitted to ICU at Seoul Boramae Medical Center between January 2012 and December 2017. Patients were selected using 1: 2 propensity score matching including age, sex, and type of ICU and multivariate analyses were performed to determine risk factors for hospital and ICU mortality. Results 56 homeless and 112 non-homeless matched patients were analyzed. The homeless patients were younger, included more men, and exhibited significantly higher readmission and ER admission rates. Although hospital and ICU mortality rates were similar between two groups, the homeless patients were significantly less likely to have family or substitute decision-makers and generally died after cardiopulmonary resuscitation. Adjusted multivariate analysis showed that homelessness was not an independent predictor of ICU or hospital mortality. The length of ICU stay was comparable between groups. Conclusions In Korea, ICU-admitted homeless patients are well managed without differences in terms of organ support quality and exhibit the same prognosis as non-homeless patients. However, the quality of end-of-life care for homeless patients remains poor.

This paper presents a new method of classifying speech data in Parkinson’s disease using the class probability output network (CPON) in which the conditional class probabilities are estimated using Beta distributions. In the proposed CPON, the uncertainty measure describing the uncertainty in the decision of classification is also calculated. If the given input pattern of speech features falls in the uncertain region of classification, the decision network as the second layer is activated and the decision is made from the conditional class probabilities and also the selected reference patterns. Otherwise, the decision is made just using the CPON as the first layer. As a result, the proposed method provides consistently improved classification performances. Through the simulation for classifying speech data in Parkinson’s disease using the UCI data set, the effectiveness of the proposed method is demonstrated.

Background: Finasteride has proved to be an effective treatment for men with AGA. Daily use of finasteride 1mg for three months or more is necessary before benefit is observed. Also, treatments for AGA, including finasteride 1mg, should be continued to treat AGA and maintain therapeutic effect. Objectives: To compare the maintenance effect of finasteride 1mg regimens, daily or every other months (EOM) use, after taking finasteride 1mg daily for 1 year. Methods: We enrolled 23 Korean men with AGA who were treated with finasteride 1 mg daily for 1 year. Patients were randomly divided into two groups, and then treated with finasteride 1 mg for 1 more year. We defined daily group as 9 patients who took finasteride 1 mg daily and EOM group as 14 patients who took it EOM. Treatment efficacy was assessed by the investigator’s global assessment. The 5-point scale was as follows: 4, greatly improved; 3, moderately improved; 2, slightly improved; 1, unchanged; 0, aggravated. Results: Two patients (22.2%) showed mild improvement and 6 patients (66.7%) showed no change in daily group. Five patients (35.7%) patients showed mild improvement and 7 patients (50.0%) had no change in EOM group. There were 1 patient (11%) with aggravation in daily group and 2 patients (14.3%) with aggravation in EOM group. Conclusion: Maintenance effect of finasteride 1mg EOM dosage showed similar to that of finasteride 1mg daily dosage during 1 year in Korean men with AGA, after taking finasteride 1 mg daily for 1 year.

This study compared and analyzed the occluding effects of fluoride compounds and desensitizers, which are commonly used in dental clinics, on dentinal tubules. This study also evaluated the persistence of the active ingredients over time by performing toothbrushing with an electric toothbrush. Thirty-five molar teeth, which had been extracted within the past 3 months from healthy people without tooth decays, amalgam fillings, or dental crowns, were divided into 4 pieces each. Of these, 135 teeth pieces were used as study specimens. These specimens were divided into a control group, an untreated group, and 5 experimental groups (acidulated fluoride gel, fluoride varnish, Gluma, Super Seal, and SE-Bond). The specimens were then subjected to toothbrushing equivalent to 1 week (140 times), 2 weeks (280 times), and 4 weeks (560 times), and the occluding effects on dentinal tubules in 3 regions of each specimen were examined under a scanning electron microscope. The fluoride varnish treated group showed the highest degree of dentinal tubule occlusion effects during the first, second, and fourth weeks of toothbrushing, with the SE-Bond treated group showing the second highest degree and the Gluma treated group showing the lowest degree. After 4 weeks of toothbrushing, the Gluma treated group and the Super Seal treated group showed the lowest degrees of dentinal tubule occlusion effects. In summary, the fluoride varnish treated group and the SE-Bond treated group displayed higher occlusion effects even after 4 weeks of treatment than did the other experimental groups. Therefore, it is the authors' belief that fluoride varnish and SE-Bond are effective for treating dentinal hyperesthesia.

Pseudoaneurysm is one of life-threatening complications of chronic or acute pancreatitis. It can lead to massive bleeding into the abdominal cavity, the retroperitoneum, or the gastrointestinal tract. Hemosuccus pancreaticus, meaning hemorrhage through the pancreatic duct into the duodenum is an important diagnostic clue suggesting the presence of pancreatic pseudoaneurysm. A 74-yearold man presented with hematochezia and active bleeding from the ampulla of Vater was noted on upper endoscopy. Abdominal computed tomography scan demonstrated a nodular enhancing lesion within the pancreatic duct. Celiac trunk angiography also showed a nodular enhancing lesion suggesting pseudoaneurysm in the pancreas. However, due to the difficulty of identifying the feeder artery of pseudoaneurysm by selective angiography, embolization was not feasible. Therefore, distal pancreatectomy was performed and ruptured pseudoaneurysm within the pancreatic duct could be confirmed. Herein, we report a case of hemosuccus pancreaticus due to ruptured intraductal pseudoaneurysm that was successfully treated by surgical management. Korean J Pancreatobiliary 2016;21(1):40-44

Background Lymphocyte-activating gene 3 (LAG-3) and T-cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif (TIGIT) domains are emerging checkpoint proteins. Objective We evaluated LAG-3 and TIGIT protein expression patterns, correlated these patterns with programmed cell death 1 (PD-1) protein expression, and determined their effects on clinicopathologic characteristics and biologic responses in melanoma. Methods Diagnostic tissue from 124 patients with melanoma were evaluated for LAG-3, TIGIT, and PD-1 expression by immunohistochemistry. Clinicopathologic features and survival were analyzed according to the expression of LAG-3, TIGIT, and PD-1. Results LAG-3 and TIGIT expression on tumor-infiltrating lymphocytes were significantly correlated with that of PD-1 and was also significantly associated with negative prognostic factors: deeper Breslow thickness, lymph node involvement, and advanced stage of disease. However, PD-1 expression was not associated with clinicopathologic variables of prognostic significance. High expression of either LAG-3 or TIGIT was associated with worse survival. Subgroup analysis on the basis of Breslow thickness showed that both LAG-3 and TIGIT have prognostic significance regardless of tumor thickness. High expression of PD-1 was not predictive of survival. Limitations Retrospective study in a single institution and possibility of type 1 error. Conclusion Expression of LAG-3 and TIGIT represents an independent unfavorable prognostic factor in cutaneous melanoma.

Rosacea has a wide spectrum of clinical features, which include persistent facial redness, flushing, telangiectasia, inflammatory papules/pustules, hypertrophy and/or ocular features. The prognosis of rosacea according to clinical subtype has not been evaluated. We analyzed the prognosis of rosacea in 234 patients, which included 120 patients with mixed subtype, 75 with the erythematotelangiectatic rosacea subtype and 39 with the papulopustular rosacea (PPR) subtype. The prognosis of rosacea was classified as: (i) no improvement; (ii) partial remission; and (iii) complete remission. The frequencies of complete remission, time to complete remission and 1-year complete remission rate were compared between subtypes. Follow-up periods ranged 2-72 months (median follow-up, 17.5). Aggravation of the disease was found in 50.4% of patients during follow up. Partial or complete remission was noted in 61.5% and 20.9% of patients, respectively. The median time to complete remission was 56.0 months. The prognosis of disease was more favorable for patients with the PPR subtype than for patients with other subtypes with respect to the frequency of complete remission, median time to complete remission and the 2-year complete remission rate. In conclusion, papulopustular rosacea without remarkable centrofacial erythema showed a more favorable prognosis than other subtypes. Erythematotelangiectatic lesions in rosacea patients present a challenge for the treatment of rosacea.

PURPOSE To evaluate the diagnostic utility and predictors for determinate results of an enzyme-linked immunospot assay using induced sputum cells (IS ELISPOT) for a rapid diagnosis of pulmonary tuberculosis (TB). MATERIALS AND METHODS Subjects suspected of pulmonary TB who had either sputum acid fast bacilli smear-negative or not producing sputum spontaneously were prospectively enrolled. ELISPOT assay was performed using cells from induced sputum. RESULTS A total of 43 subjects, including 25 with TB (TB group) and 18 with non-TB disease (non-TB group) were enrolled. Results of IS ELISPOT were determinate in only 17/43 (39%) subjects, but all of determinate results were consistent with the final diagnosis. Of the 43 sputum samples, 11 (26%) were inadequate to perform IS ELISPOT. Of 32 adequate sputum samples, the proportion of determinate results was significantly higher in the TB group (75%, 15/20) than in the non-TB group (17%, 2/12) (p=0.002). The status of active TB was a unique predictor but smear positivity was not a significant predictor for determinate results. In addition, sensitivity of IS ELISPOT (75%, 9/12) in smear negative TB was higher than that of TB-polymerase chain reaction (25%, 3/12). CONCLUSION IS ELISPOT showed relatively high diagnostic value and accuracy in the TB group, independent of smear positivity. IS ELISPOT may provide additional diagnostic yield for microbiological tools in the rapid diagnosis of smear-negative TB.

Histoplasmosis is a common endemic mycosis in North, Central, and South America, but Korea is not known as an endemic area. We treated an immunocompetent Korean patient who had histoplasmosis. A 65-year-old Korean man presented with multiple pulmonary clumps of tiny nodules in the both lungs. He had been diagnosed 40 years earlier with pulmonary tuberculosis (TB) and a fungus ball had been diagnosed 4 years earlier. He denied any history of overseas travel. The patient visited our hospital with dyspnea, blood-tinged sputum, and weight loss, which had appeared 2 months earlier. The patient underwent video-assisted thoracic surgery (VATS) lung biopsy. The biopsy sample showed necrotizing granuloma and the presence of multiple small yeast-like fungi. Tissue culture confirmed Histoplasma capsulatum, and he was finally diagnosed with pulmonary histoplasmosis. Therapy was initiated with 200 mg itraconazole orally once per day. The symptoms disappeared 1 week after the start of treatment. After 4 months, low-dose chest computed tomography showed improvement in the ground glass opacity and size of the lung lesions. In conclusion, we report a case of an immunocompetent patient who developed histoplasmosis in Korea. When a patient shows unexplainable progressive infiltrative lung lesions, histoplasmosis should be considered as one of differential diagnoses although Korea is not an endemic area., Graphical Abstract

Noma is an opportunistic infection characterized by devastating gangrenous stomatitis leading to severe tissue destruction that predominantly affects malnourished children in sub-Saharan Africa. Only a few cases have been reported in immunocompromised patients from developed countries. We present an unusual case of nomalike necrotizing stomatitis in a previously healthy child with Crohn's disease in Korea.

We present a middle aged pregnant woman who developed signs and symptoms of acute liver failure and was found to have herpes simplex virus hepatitis. Patient had an emergent delivery and was started on antiviral therapy, but unfortunately due to the severity of her liver failure, she passed away. The importance of reporting this case is to emphasize on the importance of considering herpes simplex infection in pregnant women who present with acute liver failure, and the importance of early administration of antiviral therapy.

Background: Eosinophilic oesophagitis (EoO) has been associated with allergic disorders as well as aeroallergens. The current literature has shown a possible association between seasonal variation, mainly in the spring, and the incidence of EoO. However, this data was based on small population studies that did not exclude proton-pump inhibitor (PPI)-responsive oesophageal eosinophilia (PPI-ROE) in their cohort. Aim: The aim of this study was to determine if there is a seasonal variation associated with the diagnosis of EoO in patients that had been treated with high-dose PPI prior to diagnosis. Methods: Oesophageal biopsies were obtained from a cohort of patients who presented with symptoms of dysphagia, odynophagia, and heartburn during a 10-year period. Symptomatic patients who had biopsies from the mid and distal oesophagus with � 20 eosinophils per high-power field (hpf) while on high-dose PPI treatment for at least 5 weeks were diagnosed as having EoO. The monthly and seasonal incidences were determined (winter, January–March; spring, April– June; summer, July–September; Autumn, October–December). Results: A total of 20,718 patients were identified and their records evaluated. From this cohort, 193 (0.93%) symptomatic patients had biopsy-proven oesophageal eosinophilia (� 20 eosinophils/hpf) and no seasonal variation was seen in this group. However, only 57 (0.28%) had been adequately treated with PPI prior to diagnosis (i.e. non-PPI-ROE biopsy-proven EoO; � 20 eosinophils/hpf: 39 males, 18 females; age 29.5 years). The most common medical history components included asthma (12.3%) and food allergies (3.5%), and the most common presenting symptoms included dysphagia (50.9%) and heartburn (26.3%). The monthly and seasonal incidences in our cohort were with no apparent trend (p ¼0.713 and 0.703, respectively). Conclusions: The incidence of EoO was consistent across all 12 months as well as during the four seasons. Our data does not support a seasonal variation in relation to the incidence of EoO in the US midwestern non-PPI-ROE population.

Early graft loss in islet transplantation means that a large amount of donor islets is required. Endothelial cells and endothelial colony-forming cells (ECFCs) have been reported to improve instant blood-mediated inflammatory reaction (IBMIR) in vitro. In this study, we examined if ECFC-coated porcine islets would prevent early graft loss in vivo. Human ECFCs were prepared from cord blood and cocultured with islets to make composite grafts. Diabetic nude mice underwent intraportal transplantation. Blood glucose levels were monitored, and morphological examination of the grafts along with analysis of the components of IBMIR and inflammatory reaction were performed with the liver tissues. The ECFC-coated islets significantly decreased blood glucose levels immediately after transplantation compared to the uncoated islets. Composite ECFC islet grafts were observed in the liver sections, associated with a more insulin+ area compared to that of the uncoated group within 48 h after transplantation. Deposition of CD41a, C5b-9, and CD11b+ cells was also decreased in the ECFC-coated group. Expression of porcine HMGB1 and mouse TNF-α was increased in the transplantated groups compared to the sham operation group, with a trend of a decreasing trend across the uncoated group, the ECFC-coated group, and the sham group. We demonstrated that the composite ECFC porcine islets transplanted into the portal vein of nude mice improved early graft loss and IBMIR in vivo.

Erosive arthritis in Behcet's disease (BD) is rare and confused with infectious diseases such as osteomyelitis. Clinical course and imaging may be similar in BD-related arthritis and osteomyelitis. A 48-year woman diagnosed with BD developed recurrent pain in both feet. Magnetic resonance imaging of her feet showed bony erosions and suggested osteomyelitis with myositis or septic arthritis, but the response to antibiotics was equivocal. We diagnosed BD-related arthritis and started treatment with methotrexate, and increased azathioprine and sulfasalazine, and her joint symptoms improved. BD-related arthritis should be considered in the differential diagnosis of BD patients with articular manifestations that may mimic septic arthritis.

In recent years, technological mergers and acquisitions (M&As) have become important strategic tools for enterprises to access and utilize new external knowledge. In particular, in the biopharmaceutical industry, M&A activities are actively being progressed due to an increase in new drug development costs, a decrease in R&D productivity, and the patent expiration of blockbuster drugs. However, there is a lack of research on the integrated view of (1) the acquirer’s capability and (2) the dyadic relationship of the knowledge base between the acquirer and target on the innovation performance of the acquirer. Furthermore, there are few empirical studies on the impact of these factors on ambidextrous innovation; that is, exploitative and explorative innovation. Therefore, with this integrated view in mind, this study analyzed the effect of each factor on the exploitative and exploratory innovation performance of the acquirer. A negative binomial regression was conducted using patent data to measure the innovation outcome of the acquirer after M&A. The findings suggest that (1) the acquisition experience of the acquirer and (2) the technological commonness between the acquirer and the target both had a significant impact on the exploitation and exploration innovation performance.

The livestock manure is a good source of major plant nutrients such as nitrogen, phosphorus and potassium and micronutrient that plants require. As aspect of establishment of nutrient management policy in nation scale, the use of livestock manure for agricultural purpose is a key factor for improving national nutrient balance. In this study, we evaluated the tendency of livestock manure production and amount of chemical fertilizer used in Korea from 1990 to 2011. The number of pig and chicken has been increased about two times in 2011 compared with 1990 and therefore livestock manure continually increased with the lapse of year, but cattle and dairy was not changed significantly. The chemical fertilizer consumption of nitrogen, phosphorus and potassium per hectare arable land was decreased by 54.6, 66.0 and 63.2% in 2011 compared with 1990, respectively. In contrast, the potential input of nitrogen, phosphorus and potassium to arable land through livestock manure was increased by 220, 210 and 210% during this period, respectively. Therefore we need a reasonable strategy for nutrient management such as combination of both manure and chemical fertilizers in near future.

The clinical features of localized nasal rosacea have not been described in detail. This study was designed to analyze the subtypes and severity of localized nasal rosacea. Our present study included 30 patients with localized nasal rosacea. The erythematotelangiectatic subtype (13/30, 43.3%) was the most common type, followed by the phymatous subtype (9/30, 30%). The duration of rosacea was shorter and the severity of localized nasal rosacea was lower in the erythematotelangiectatic subtype cases compared with the patients with mixed or phymatous subtypes. Almost all of the papulopustular eruptions or phymatous lesions were associated with erythematotelangiectatic lesions. These findings suggest that the erythematotelangiectatic subtype may be considered the initial phase of localized nasal rosacea.

The importance of environment-friendly agriculture is being magnified as a new growth engine industry in pursuit of low carbon, green growth policies. Since 2010, the Korean government has been promoting the supply of customized fertilizers which were manufactured based on chemical properties of agricultural soils. This aims focused to improve the efficiency of fertilizer used and to protect the agricultural environment. In order to provide technical supports for pushing ahead with the environment-friendly agriculture policies, we have estimated the effects of customized fertilization (CF) on growth and yield of rice and fertilizer reduction compared to conventional fertilization (farm practice fertilization) and single-element fertilization. In rice plant growth and rice yield, no statistically significant difference between the three fertilization treatments was observed. The fertilizer reduction rate with CF compared to conventional fertilization of investigated farms was on average 17%, which covered 6% through 33%. With split ratio, CF 70 reduced the amounts of fertilizer ingredient by 5% compare to CF 50. This paper shows that the customized fertilizer application reduced the amounts of fertilizer used in rice cultivation without decrease of yields.