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The article describes the case of a 76-year-old woman who developed well-circumscribed erythematous depressed annular patches on palm. Topics discussed include histopathological findings which led to the diagnosis of circumscribed palmar/plantar hypokeratosis (CPH), the difference between CPH and Bowen disease (BD), and treatment options for CPH.

Background:Cervical sparganosis is a rare condition that presents as a lateral neck mass. Its radiological findings have not previously been investigated. Thus, the important radiological findings of cervical sparganosis are presented herein.Methods:We report two patients with cervical sparganosis who presented with cervical masses, and we review the relevant head and neck literature. Computed tomography was performed three times over 13 months of follow up for one patient.Results:On follow-up radiological examination, a migratory lesion with a tubular appearance, seen on serial images, should be considered significant for cervical sparganosis.Conclusion:Radiologically, a migratory cervical mass in the head and neck area with a tubular appearance is suggestive of cervical sparganosis. [ABSTRACT FROM PUBLISHER]

We describe three patients with acute encephalitis and motor-dominant polyneuropathy. All three patients were in their middle age and presented with features of encephalopathy with flu like illness. Cerebrospinal fluid (CSF) studies showed lymphocytic pleocytosis with increased protein. Brain magnetic resonance imagings (MRIs) showed symmetric high signal intensities in bilateral mesial temporal lobes and bilateral thalami in all patients. All three patients became quadriplegic and areflexic within two hospital days (HDs) and electrophysiologic studies revealed motor polyneuropathy. Viral or atypical bacterial infection was suspected, but no causative agent could be found. One patient expired on the twentieth hospital day, and the other two patients showed no or little improvement. To our knowledge, this combination of acute encephalitis with motor polyneuropathy has not been reported. [ABSTRACT FROM AUTHOR]

Summary: Background: During the coronavirus disease 2019 (COVID‐19) pandemic, various adverse skin reactions to long‐term mask wearing have been reported. Aim: To assess the clinical features of mask‐induced dermatoses and to recommend prevention and treatment options. Methods: From April to August 2020, questionnaires including topics such as demographic information, pre‐existing skin disorders, reported mask‐related symptoms, daily mask‐wearing duration and frequency, types of masks used and whether the participant was a healthcare worker, were distributed to patients in 12 hospitals. Dermatologists assessed skin lesions, confirmed diagnosis and recorded treatments. Results: Itchiness was the most frequent symptom, mostly affecting the cheeks. The most common skin disease was new‐onset contact dermatitis (33.94%), followed by new‐onset acne (16.97%) and worsening of pre‐existing acne (16.97%). Daily wearing of masks was significantly (P = 0.02) associated with new‐onset contact dermatitis. More than half of patients with pre‐existing skin problems experienced disease worsening while wearing masks. Longer duration of wearing (> 6 h/day, P = 0.04) and use of cotton masks (P < 0.001) significantly increased acne flare‐up. Healthcare workers had a higher incidence of skin disease. Skin lesions were generally mild and well tolerated with topical treatment. The study had some limitations: the effect of seasonal characteristics and other risk factors were not assessed, and the patients were visiting dermatological clinics and had interest in their skin status, thus, there may have been selection bias. Conclusion: Mask‐induced/‐triggered dermatoses contribute to increase the dermatological burden during the pandemic. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 14-year old girl presented with a 2-year history of gradual enlargement of both nipples and was diagnosed with atopic dermatitis (AD). It states that there was a presence of lichenification in the flexural areas, and the right nipple have an abscess formation spongiosis. It also says that the appearance of nipple eczema has developed reactive to hypertrophy and repetitive scratching.

Purpose: To investigate the effects of dose level and reconstruction method on density and texture based features computed from CT lung nodules. Methods: This study had two major components. In the first component, a uniform water phantom was scanned at three dose levels and images were reconstructed using four conventional filtered backprojection (FBP) and four iterative reconstruction (IR) methods for a total of 24 different combinations of acquisition and reconstruction conditions. In the second component, raw projection (sinogram) data were obtained for 33 lung nodules from patients scanned as a part of their clinical practice, where low dose acquisitions were simulated by adding noise to sinograms acquired at clinical dose levels (a total of four dose levels) and reconstructed using one FBP kernel and two IR kernels for a total of 12 conditions. For the water phantom, spherical regions of interest (ROIs) were created at multiple locations within the water phantom on one reference image obtained at a reference condition. For the lung nodule cases, the ROI of each nodule was contoured semiautomatically (with manual editing) from images obtained at a reference condition. All ROIs were applied to their corresponding images reconstructed at different conditions. For 17 of the nodule cases, repeat contours were performed to assess repeatability. Histogram (eight features) and gray level co-occurrence matrix (GLCM) based texture features (34 features) were computed for all ROIs. For the lung nodule cases, the reference condition was selected to be 100% of clinical dose with FBP reconstruction using the B45f kernel; feature values calculated from other conditions were compared to this reference condition. A measure was introduced, which the authors refer to as Q, to assess the stability of features across different conditions, which is defined as the ratio of reproducibility (across conditions) to repeatability (across repeat contours) of each feature. Results: The water phantom results demonstrated substantial variability among feature values calculated across conditions, with the exception of histogram mean. Features calculated from lung nodules demonstrated similar results with histogram mean as the most robust feature (Q = 1), having a mean and standard deviation Q of 0.37 and 0.22, respectively. Surprisingly, histogram standard deviation and variance features were also quite robust. Some GLCM features were also quite robust across conditions, namely, diff. variance, sum variance, sum average, variance, and mean. Except for histogram mean, all features have a Q of larger than one in at least one of the 3% dose level conditions. Conclusions: As expected, the histogram mean is the most robust feature in their study. The effects of acquisition and reconstruction conditions on GLCM features vary widely, though trending toward features involving summation of product between intensities and probabilities being more robust, barring a few exceptions. Overall, care should be taken into account for variation in density and texture features if a variety of dose and reconstruction conditions are used for the quantification of lung nodules in CT, otherwise changes in quantification results may be more reflective of changes due to acquisition and reconstruction conditions than in the nodule itself. [ABSTRACT FROM AUTHOR]

A quiz concerning a 69-year-old man with a two-year history of generalized weakness and a two-week history of blood-tinged sputum is presented.

Mittels sogenannter zellbasierter Assays konnte in den vergangenen Jahren durch zahlreiche Arbeitsgruppen unabhängig eine robuste Assoziation von Immunglobulin-G-Autoantikörpern gegen menschliches Voll-Längen-Myelin-Oligodendrozyten-Glykoprotein (MOG-IgG) mit - meist rezidivierender - Optikusneuritis (ON), Myelitis und Hirnstammenzephalitis sowie mit Fällen akuter disseminierter Enzephalomyelitis (ADEM) gezeigt werden. Die MOG-IgG-positive Enzephalomyelitis (MOG-EM) gilt den meisten Experten inzwischen als eigenständiges Krankheitsbild, das sich immunpathogenetisch sowohl von der klassischen multiplen Sklerose (MS) als auch von der Aquaporin-4(AQP4)-IgG-positiven Neuromyelitis-optica-Spektrum-Erkrankung (NMOSD) unterscheidet. Aufgrund erheblicher Übereinstimmungen der beiden Erkrankungen in klinisch-radiologischer Hinsicht wurde die MOG-EM in der Vergangenheit oft unbeabsichtigt als MS fehldiagnostiziert. Daher werden derzeit viele Patienten mit vermuteter oder etablierter MS auf MOG-IgG getestet. Das Screening von großen, nichtselektierten Kohorten auf seltene Biomarker kann jedoch den prädiktiven Wert eines Tests signifikant reduzieren. Um die damit verbundene Gefahr einer Überdiagnostizierung der MOG-EM zu verringern, werden dringend selektivere Kriterien für die Testung auf MOG-IgG benötigt. In der vorliegenden Arbeit schlagen wir, basierend auf Expertenkonsensus, Indikationen für die MOG-IgG-Testung vor. Zusätzlich wird dem Leser eine Liste mit sogenannten „red flags“ an die Hand gegeben, d. h. klinischen und paraklinischen Befunden, die für die MOG-EM eher atypisch sind und Anlass sein sollten, ein positives MOG-IgG-Laborergebnis kritisch zu hinterfragen. Zusätzlich geben wir Empfehlungen zur Testmethodik, zur Probenentnahme und zur Dateninterpretation und präsentieren erstmalig Diagnosekriterien für die MOG-EM. [ABSTRACT FROM AUTHOR]

The article presents a study examining the erythrocyte sedimentation rate (ESR) in patients with monoclonal gammopathy when measured wit the modified Westergren and microhemagglutination method (TEST1). The authors go on to explain how ESR does not correlate with a specific plasma protein and conclude that the presence of MG is an independent factor for ΔESR (microhemagglutination ESR—Westergren ESR).

The objectives of this study is to compare the efficacy between repetition of Epley maneuver and switch to alternate Semont maneuver in treating posterior canal benign paroxysmal positional vertigo (PC-BPPV) that does not respond to the initial Epley maneuver. In the nationwide, seven dizziness clinics of Korea, 506 consecutive patients (303 women, age range 22-87, mean age ± SD = 64 ± 12, median = 61) with idiopathic PC-BPPV were initially treated with a single Epley maneuver. Of those, 144 (28.5%) patients, who did not respond to the therapy, were randomized to the repetition of Epley maneuver ( n = 70) or switch to Semont maneuver ( n = 74). The therapeutic efficacy was determined within 1 h by a blinded examiner after the trial of each second maneuver. The efficacy did not differ between the repetition of Epley maneuver and switch to Semont maneuver groups (38.6 vs. 27.0%, p = 0.14, Chi-square test). However, the patients with a long duration ( p < 0.001, linear regression) and latency ( p = 0.01) of the positional nystagmus during Dix-Hallpike maneuver showed a higher rate of the initial and second treatment failures. Either Epley or Semont maneuver may be applied as a second treatment to the patients with PC-BPPV refractory to the initial Epley maneuver. This study provides Class I evidence that repeated Epley and switch to Semont maneuver shows a similar efficacy in treating PC-BPPV that does not respond to the initial Epley maneuver. Clinical trial registration: NCT01822002. [ABSTRACT FROM AUTHOR]

Background and purpose: The occult changes in normal-appearing white matter (NAWM) were investigated and compared amongst patients with neuromyelitis optica spectrum disorder (NMOSD), patients with multiple sclerosis (MS) and healthy controls (HCs) by applying tract-based spatial statistics to diffusion tensor imaging (DTI) data. Methods: Diffusion tensor imaging was performed with a 3-T scanner in 93 patients with NMOSD, 53 patients with MS and 43 HCs. Voxel-wise statistical analyses of the DTI data were performed using tract-based spatial statistics. Results: Compared to HCs, patients with NMOSD had significantly lower mean global fractional anisotropy, higher mean diffusivity and radial diffusivity, and no significant differences in axial diffusivity in their NAWM. Patients with MS demonstrated significantly lower mean global fractional anisotropy and higher mean diffusivity, axial diffusivity and radial diffusivity in the NAWM than did patients with NMOSD and HCs. Compared to patients with NMOSD, patients with MS had NAWM damage that was more extensive, particularly in the inferior cerebellar peduncle, external capsule, cingulum, superior fronto-occipital fasciculus and uncinate fasciculus. Conclusions: Using DTI, widespread occult damage was demonstrated in the NAWM of patients with NMOSD. However, the NAWM was less affected in patients with NMOSD than it was in patients with MS; specifically, the axonal injuries and diffusion abnormalities in the association fibers were more severe in patients with MS than they were in patients with NMOSD. [ABSTRACT FROM AUTHOR]

Background Superficial fungal infections are a very common problem in dermatological clinics. The diagnostic method of fungal culture is time-consuming and has inconsistent sensitivity. Therefore, a practical method for rapid and accurate identification of the species causing superficial fungal infections is needed. Aim To compare PCR-reverse blot hybridization assay ( PCR- REBA) with conventional fungal diagnostic methods so as to determine the reliability of PCR- REBA for the diagnosis and species identification in superficial fungal infections. Methods Potassium hydroxide ( KOH) preparation, fungal culture, conventional real-time PCR and PCR- REBA were used to assess 83 specimens, and the results from each method were compared. Results Of the 83 specimens, 44 specimens that were positive by fungal culture had 62.7% agreement with PCR- REBA. Compared with real-time PCR, there was 68.7% agreement with fungal culture, but 91.6% agreement with PCR- REBA. When the comparison was made using the 55 specimens that gave positive results in both KOH preparation and fungal culture, there was 85.5% agreement with real-time PCR for fungal culture, but 94.5% agreement with PCR- REBA. Conclusions Compared with KOH preparation or fungal culture, PCR- REBA has higher sensitivity and specificity. Therefore, PCR- REBA could be a useful method in clinical settings because it can identify species quickly and accurately, and can also determine the existence of pathogens. [ABSTRACT FROM AUTHOR]

Background and purpose Recent studies have demonstrated an association between increased insulin secretion and cognitive impairment. However, there is no previous study that directly evaluates the association between increased insulin secretion and cortical thickness to our knowledge. Therefore, our aim was to evaluate the effect of hyperinsulinemia, as measured by C-peptide level, on cortical thickness in a large sample of cognitively normal individuals. Methods Cortical thickness was measured in 1093 patients who visited the Samsung Medical Health Promotion Center and underwent brain magnetic resonance imaging ( MRI) and a blood test to measure C-peptide concentration. Automated surface-based analyses of the MRI data were used to measure cortical thickness. C-peptide levels were divided into quartiles for comparison. Patients in the first to third quartiles were used as the reference category. Results Patients in the highest quartile group (Q4) of C-peptide levels showed cortical thinning, predominantly in both medial temporal lobes, the right inferior temporal gyrus, both medial prefrontal lobes and the right superior parietal lobule, compared with the lower quartile groups (Q1-Q3) after controlling for age, gender, body mass index, history of hypertension, hyperlipidemia, previous stroke, cardiovascular disease and fasting glucose level. Conclusions A higher C-peptide level is associated with regional cortical thinning, even in cognitively normal individuals. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the diagnostic performance of gadoxetic acid-enhanced MRI with an emphasis on the usefulness of the hepatobiliary phase (HBP) in T-staging of gallbladder carcinoma. Methods: 66 patients with surgically confirmed gallbladder carcinoma underwent MRI. Two radiologists independently reviewed two sets of gadoxetic acid-enhanced MRI with-out and with the HBP. Local tumour spread was evaluated according to T-staging, and the results were compared with pathological findings. The diagnostic performance of two image sets to differentiate each 1-stage was compared. Results: The sensitivities of MRI with the HBP to differentiate T1 vs ≧ T2 lesions, ≦ T2 vs ≧ T3 lesions and ≧ T3 vs T4 lesions were 96.3%, 85.7% and 100% for Observer i and 92.6%, 95.2% and 100% for Observer 2, respectively (p<0.000i). By adding the HBP, the sensitivities to differentiate ≦ T2 vs ≧ T3 lesions were increased from 66.7% to 85.7% for Observer i and from 81.0% to 95.2% for Observer 2, although there was no significant difference (p>0.05). The overall accuracies for 1-staging were increased from 80.3% to 86.4% for Observer i, a statistically significant degree (p = 0.046), and from 83.8% to 87.9% for Observer 2 (p> 0.05). The k-value for the two observers indicated excellent agreement. Conclusion: Gadoxetic acid-enhanced MRI provided acceptable diagnostic performance for T-staging of gall-bladder carcinoma. Addition of the HBP aids in the detection of liver invasion. Advances in knowledge: In the T-staging of gallbladder carcinoma, gadoxetic acid-enhanced MRI with the HBP may enhance detection of liver invasion. [ABSTRACT FROM AUTHOR]

The prognosis for patients with myelodysplastic syndrome with hypomethylating treatment failure (MDS-HTF) has been known to be poor. However, the clinical outcomes and optimal treatment options for secondary AML evolving from MDS-HTF (sAML/MDS-HTF) are not well known. This retrospective analysis was conducted to evaluate the clinical outcomes and influences of treatment options on survival in 46 consecutive patients with sAML/MDS-HTF. The median OS rates were 1.4 months in the best supportive care group (n=15) and 9.4 months in the active treatment group (n=31). One-year OS rates were 13.3% and 36.8%, respectively (P=0.001). Active treatment (P<0.001), lower BM blast (<33%) at sAML (P=0.007), non-poor NCCN (National Cancer Comprehensive Network) cytogenetics (P=0.001) and good performance status (ECOG (Eastern Cooperative Oncology Group) 1) (P=0.024) were significant predictors affecting favorable OS in a multivariate analysis. Of the active treatment options, allo-SCT with prior chemotherapy (CTx) showed better OS compared with CTx only or SCT without CTx (P=0.019). Our analyses suggest that active treatment, particularly SCT following CTx, should be considered in patients with sAML/MDS-HTF if the patient is medically fit. [ABSTRACT FROM AUTHOR]

Background Vitiligo is a pigmentary skin disorder characterized by a chronic and progressive loss of melanocytes. Although the aetiology of vitiligo is currently unknown, several theories have been proposed to explain the pathogenesis of this disease, including autoimmune, neural, self-destruction, oxidative stress, and genetic theories. Thioredoxin domain containing 5 (TXNDC5) is a newly identified member of the thioredoxin family. TXNDC5 has a protein disulphide isomerase-like domain which plays an important role in protein folding and chaperone activity, against endoplasmic reticulum (ER) stress induced by oxidative stress within the ER. Objectives To determine whether variation in the TXNDC5 gene contributes to the risk of developing nonsegmental vitiligo (NSV) in the Korean population. Methods We conducted a case–control association study of 230 patients with NSV and 417 matched, unaffected controls. Seven single nucleotide polymorphisms (SNPs) in the TXNDC5 gene were selected for study. Results Of the selected SNPs, three exonic SNPs (rs1043784, rs7764128 and rs8643) were statistically associated with NSV. Among them, rs1043784 remained a statistically significant association following Bonferroni correction. These three SNPs were located within a block of linkage disequilibrium; the haplotypes AGG and GAA, consisting of rs1043784, rs7764128 and rs8643, demonstrated a significant association with NSV. Conclusions These results suggest that TXNDC5 gene polymorphisms are associated with the development of NSV in the Korean population. [ABSTRACT FROM AUTHOR]

Over the past few years, new-generation cell-based assays have demonstrated a robust association of autoantibodies to full-length human myelin oligodendrocyte glycoprotein (MOG-IgG) with (mostly recurrent) optic neuritis, myelitis and brainstem encephalitis, as well as with acute disseminated encephalomyelitis (ADEM)-like presentations. Most experts now consider MOG-IgG-associated encephalomyelitis (MOG-EM) a disease entity in its own right, immunopathogenetically distinct from both classic multiple sclerosis (MS) and aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorders (NMOSD). Owing to a substantial overlap in clinicoradiological presentation, MOG-EM was often unwittingly misdiagnosed as MS in the past. Accordingly, increasing numbers of patients with suspected or established MS are currently being tested for MOG-IgG. However, screening of large unselected cohorts for rare biomarkers can significantly reduce the positive predictive value of a test. To lessen the hazard of overdiagnosing MOG-EM, which may lead to inappropriate treatment, more selective criteria for MOG-IgG testing are urgently needed. In this paper, we propose indications for MOG-IgG testing based on expert consensus. In addition, we give a list of conditions atypical for MOG-EM ("red flags") that should prompt physicians to challenge a positive MOG-IgG test result. Finally, we provide recommendations regarding assay methodology, specimen sampling and data interpretation. [ABSTRACT FROM AUTHOR]