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Oral candidiasis, a common fungal infection in humans, is characterized by the overgrowth of Candida species in the superficial oral epithelial mucosa. The condition is associated with multiple risk factors, including impaired salivary gland function, oral mucosal damage, and long-term antibiotic or corticosteroid use. Several treatment options are available; nystatin and amphotericin B are the most widely used local medications. Recently, fluconazole has emerged as the preferred systemic treatment. We report a case of oral candidiasis in an 83-year-old male diagnosed with bullous pemphigoid in 2017 and previously administered methylprednisolone. He developed oral candidiasis a few months before presentation and was treated with 10 mL nystatin suspension three times daily; unfortunately, the disease was recalcitrant to this treatment and his symptoms showed no improvement over two months. We discontinued nystatin in favor of fluconazole syrup (Diflucan®) administered by rinsing, then swallowing, 5 mL syrup once daily. The lesion improved after one month of treatment. This case demonstrates the efficacy of fluconazole as a primary treatment for oral candidiasis. The act of rinsing the mouth with syrup exposes the oral mucosa to drug, potentially producing a better treatment response than taking the syrup orally without rinsing.

PurposeThe purpose of this research was to develop a conceptualization and measure of workplace coachability.Design/methodology/approachUsing four independent samples of employed adults, we developed a short and long version of the Coachability Scale. We followed standard scale development practices, presenting evidence of the scales’ factor structure, reliability and validity.FindingsWith the first two samples, we derived an initial three-dimensional version of the Coachability Scale and provided evidence of convergent validity. With Samples 3 and 4, we expanded the scale with additional dimensions related to coaching feedback processes and accumulated additional evidence of the scale's validity, and provided evidence of convergence between the two versions of the Coachability Scale.Research limitations/implicationsWe encourage continued research on the Coachability Scale, as well as research on coachability in formal coaching relationships and with more diverse populations and cultures. It is also important to examine how coachability relates to specific coachee behaviors and outcomes. Although common method bias may be a limitation, we used temporally separated measurements to minimize method bias in Sample 4.Practical implicationsKnowledge about coachability can inform coaching practice decisions and help tailor the coaching engagement to better fit the coachee's needs.Social implicationsMeasuring how individuals respond to coaching and coaching relationships has important implications for managerial behavior and the quality of work life.Originality/valueThis is one of the first studies to develop valid scales for assessing workplace coachability.

The pathogenesis of chronic actinic dermatitis (CAD) is more complicated than other photodermatoses. However, the relationship between the clinical severity of CAD and the offending photocontact or contact allergens or both, and the correlations of CAD immunopathogenesis with the immunoregulatory molecules involved in adaptive immunity are yet to be investigated.We performed phototesting with broad-spectrum ultraviolet (UV) B, UVA, and visible light to establish the presence of photosensitivity in 121 patients with CAD, together with photopatch and contact patch testing. Nine patients with CAD were selected according to their clinical severity score for CAD (CSS-CAD), and triple direct immunofluorescence analysis was performed with paraffin-embedded skin biopsy samples.As CSS-CAD was closely correlated with the multiplicity of photo(contact) allergens, particularly photoallergens Three or more photoallergens were detected in the severe CAD group (52.5%); less in the moderate group (32.8%); and only one in the mild group (14.8%; P=0.025). In the groups showing greater severity of disease, the absolute numbers of IFN-γBased on the clinical analysis and immunopathogenic results, avoidance of excessive sun exposure, and topical and systemic blocking agents for photo(contact) allergens are recommended. Additionally, conventional immunomodulators and emerging agents including JAK-STAT inhibitors may be administered for CAD treatment in the future.

Background Topical calcineurin inhibitors have been used to treat vitiligo, either alone or in combination with phototherapy; however, the long-term safety of these agents remains controversial. Objective To investigate the risk of lymphoma and skin cancer in vitiligo patients who received topical calcineurin inhibitors or phototherapy. Methods A multicenter retrospective cohort study of 25,694 vitiligo patients who received topical calcineurin inhibitors or phototherapy for 6 weeks or more between 2001 and 2019 was performed. Cumulative doses of topical calcineurin inhibitors and total phototherapy sessions were determined. Outcomes were the development of lymphoma or skin cancer after enrollment, confirmed through chart review and pathology reports. Results During 95,203 person-years, 13 cases of lymphoma, 22 of actinic keratosis, 15 of nonmelanoma skin cancer, and 5 of melanoma were observed. The risk of lymphoma and skin cancer was not significantly increased by topical calcineurin inhibitor dose or phototherapy sessions. The interaction between the topical calcineurin inhibitors and phototherapy was not associated with an increased risk of skin cancer. Limitations Retrospective study, individual follow-up duration less than 4 years, and no adjustment for comorbidities and medication history. Not generalizable to other races. Conclusion The long-term risk of skin cancer or lymphoma was not associated with the use of topical calcineurin inhibitors, phototherapy, and both treatments in combination in patients with vitiligo.

Background/purpose Vitiligo remains a major challenge in dermatology. However, much of the treatment remains unclear, because little evidence is available. We sought to answer some critical questions pertaining to management of vitiligo patients. Methods A modified Delphi process among 31 vitiligo experts was conducted. A total of 12 clinical vitiligo treatment questions without clear answers were collected via a vote. To address each question, two members performed systematic literature reviews and prepared draft statements along with the levels of evidence and strength of recommendation. After reviewing the draft, all expressed their extent of agreement from 1 (strong disagreement) to 9 (strong agreement) for each item. The drafts were revised to reflect suggested comments. Discussion continued until all members agreed with the ultimate decision. Results The consensus process was completed after five rounds. We identified the best answers to 12 key questions, including issues on long-term phototherapy, systemic and topical corticosteroids, topical calcineurin inhibitors, immunosuppressants, excimer laser treatment, and surgical interventions. Conclusion This consensus would complement current guidelines and aid both physician and patient decision-making in the treatment of vitiligo.

Background Vitiligo is a skin depigmentation disorder, for which, repigmentation treatment with combined follicular unit extraction (FUE) graft and narrowband ultraviolet B (NBUVB) is considered superior to micro-punch graft therapy. BMP4 can induce MITF expression in Neural crest stem cells (NCSCs), and α-MSH subsequently promotes the differentiation of MITF-expressing cells along the melanocyte lineage. Objective To investigate why FUE grafting is superior to epidermal mini grafting in promoting hair follicles (HF) melanocyte cell survival and longevity, we planned the in vitro experiments HF bulge NCSCs differentiate into melanocyte precursors under the co-treatment of BMP4 and α-MSH. Methods Cells that migrated from the HF bulge of scalp were cultured and assessed using immunofluorescence. Transcriptome analysis was performed on RNA sequencing results. Results Basic fibroblast growth factor promotes the proliferation and survival of NCSCs, with spontaneous differentiation into SOX10+/SOX2+ glial progenitors, but not into SOX10+/MITF+ precursor melanocytes. Both BMP4 and α-MSH promoted the differentiation into MITF-expressing cells. RNA sequencing revealed a downregulation in neuregulin-1 (NRG1) and sermaphorin 3C (SEMA3C), and upregulation in WNT10A. Furthermore, FUE grafting had a source of reservoir melanocytes superior to mini- grafting in treatment for vitiligo. Conclusion We obtained SOX10+/MITF+ precursor melanocytes through an induction of differentiation along the melanocyte lineage by BMP4 and α-MSH. According to the RNA sequencing results that NRG1 and SEMA3C were downregulated and WNT10A was upregulated, we postulated that HF NCSCs differentiated into melanocyte by co-treatment of BMP4 and α-MSH. Overall, FUE grafting is a more robust and substitutive treatment option for vitiligo.

PurposeThe primary purpose of this article is to develop and test a model of the antecedents and consequences (Cho et al., 2016) of bullying in Korean hotel kitchens.Design/methodology/approachCross-sectional survey data were collected from 288 kitchen workers at 12 upscale Korean hotels. Proposed path models were tested using Hayes' (2013) PROCESS syntax in SPSS for mediation and moderated mediation analyses.FindingsThe empirical results indicated that an employee's acquiescent silence behavior increases the likelihood of being bullied. As a result, bullied employees are more likely to respond by engaging in a person-related counterproductive work behavior (CWB-P) or in defensive silence out of fear with temporary employees reacting less aggressively compared to regular employees.Research limitations/implicationsCross-sectional design and self-report data risk common method variance and attributions of causality. Future research should use longitudinal designs to avoid common method bias and make causal inferences. Theoretical and practical implications for kitchen productivity are presented. The study should offer valuable insights for prospective employers to develop on-going training and create a positive working environment within the organization.Originality/valueWhile bullying is a widespread and even an epidemic problem for the commercial kitchen environment, research into abusive behavior among chefs has been limited. By utilizing a specific segment of the hospitality industry, this research identified different behavioral aspects of bulling between temporary and regular employees in the commercial kitchen environment.

This study aimed to investigate the correlation between lower urinary tract symptoms (LUTSs) and falls considering places where falls can occur in adult males. We analyzed 101 862 males in the 2011 Korean Community Health Survey. LUTSs were assessed using the International Prostate Symptom Score system. The rate of total and indoor falls significantly increased with the LUTS severity, respectively. After adjusting for age and other confounding variables, the odds ratios (ORs) for total falls were significantly high for the mild (OR = 1.63, 95% confidence interval [CI] = 1.54-1.71), moderate (OR = 2.35, 95% CI = 2.16-2.56), and severe groups (OR = 2.83, 95% CI = 2.49-3.22), relative to the normal group. Indoor fall experience was the same for the mild (OR = 1.56, 95% CI = 1.36-1.79), moderate (OR = 2.37, 95% CI = 1.97-2.85), and severe groups (OR = 3.77, 95% CI = 3.00-4.72). Nocturia, hesitancy, and urgency were significantly associated with indoor falls. The association between falls and the degree of LUTS was observed in both the young and the elderly. Therefore, further studies are needed to determine the effects of treatment of LUTS on the risk of falls and the effectiveness of the fall prevention program.

Background: We hypothesized that prostatic anatomical factors may affect the progression of benign prostatic hyperplasia (BPH) and analyzed whether prostatic anatomical factors could be predictive of the risk of surgery. Materials and methods: From February to October 2014, 679 men older than 40 years who had lower urinary tract symptoms and enlarged prostates were enrolled from five medical centers. Patients' medical characteristics, serum prostate-specific antigen levels, transrectal ultrasound (TRUS) results, and uroflowmetry were analyzed. Using TRUS in all patients, the total prostate volume, transitional zone volume, prostatic urethral length, transitional zone urethral length, intravesical prostatic protrusion, and prostatic urethral angle were measured. Logistic regression analysis was used to determine factors associated with the risk of surgery. Receiver operating characteristic curves were used to determine cutoff values for significant variables. Results: Of 679 patients, 37 (5.4%) underwent BPH-related surgery. Prostatic urethral length and transitional zone urethral length were independently associated with the risk of surgery. Age, serum prostate-specific antigen levels, peak flow rate, postvoid residual urine, and other anatomical factors determined by TRUS were not statistically significant with respect to the risk of surgery. Using receiver operating characteristic curve–based predictions, the best cutoff values for prostatic and transitional zone urethral length were 4.53 cm (sensitivity: 83.3%, specificity: 61.6%) and 3.35 cm (sensitivity: 83.3%, specificity: 77.9%), respectively. Conclusions: This study showed that patients with BPH with longer prostatic and transitional zone urethral lengths had a higher risk of surgery. Prostatic and transitional zone urethral length may be useful predictive factors for medical treatment failure in patients with BPH. Keywords: Benign prostatic hyperplasia, Risk factors, Treatment failure, Ultrasonography

Background: It is important to differentiate between primary cutaneous anaplastic large cell lymphoma (PC-ALCL) and ALK-negative systemic ALCL with skin involvement, as the prognoses and treatments for these two diseases are considerably different. Objective: This study aimed to compare the expressions of multiple myeloma oncogene 1 (MUM-1) and B-cell lymphoma 6 (Bcl-6) in PC-ALCL and ALK-negative systemic ALCL. Methods: This retrospective qualitative study investigated the clinical features of 7 patients with ALK-negative PC-ALCL, 5 patients with ALK-negative systemic ALCL with skin involvement, and 6 patients with ALK-positive systemic ALCL with skin involvement. The MUM-1 and Bcl-6 expressions were evaluated using immunohistochemistry. Results: The MUM-1 expression rates were 85.7% in the PC-ALCL cases and 100% in the ALK-negative systemic ALCL with skin involvement cases. The Bcl-6 expression rates were 28.5% in the PC-ALCL cases and 20% in the ALK-negative systemic ALCL cases with skin involvement. Conclusion: Although the cutaneous manifestations of ALK-negative systemic ALCL and PC-ALCL are similar, the prognoses and treatment approaches are considerably different. Our results indicate that MUM-1 expression is commonly expressed in both types of ALCL, but Bcl-6 is less commonly expressed in PC-ALCL cases and systemic ALCL with skin involvement cases.

IMPORTANCE: Narrowband UV-B (NBUVB) phototherapy has been the mainstay in the treatment of vitiligo, but its long-term safety in terms of photocarcinogenesis has not been established. OBJECTIVES: To investigate the risks of skin cancer and precancerous lesions among patients with vitiligo undergoing NBUVB phototherapy, based on the number of NBUVB phototherapy sessions. DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based retrospective cohort study enrolled 60 321 patients with vitiligo 20 years or older between January 1, 2007, and December 31, 2017. Patients and outcomes were identified through nationwide cohort data from the Korean national health insurance claims database, and frequency matching by age and sex was performed. EXPOSURES: The number of phototherapy sessions each patient received between 2008 and 2017. Patients were classified into 5 groups according to the number of phototherapy sessions (0 sessions, 20 105 patients; 1-49 sessions, 20 106 patients; 50-99 sessions, 9702 patients; 100-199 sessions, 6226 patients; and ≥200 sessions, 4182 patients). We also identifed patients who underwent at least 500 phototherapy sessions (717 patients). MAIN OUTCOMES AND MEASURES: Primary outcomes were the development of actinic keratosis, Bowen disease, nonmelanoma skin cancer, or melanoma after enrollment. RESULTS: Among the 60 321 patients with vitiligo in this study (33 617 women; mean [SD] age, 50.2 [14.9] years), the risks of Bowen disease (

The characteristics of large logistics buildings are their long spans and the ability to take heavy loads. Usually, PC components are used for their frames to ensure quick construction. However, the erection of most pin jointed PC structures increases the time and the cost incurred for ensuring structural stability and construction safety. To solve this problem, “smart” frames have been developed, which have tapered steel joints at both ends of the PC components. A smart frame with the moment frame concept not only assures structural stability and construction safety, but it also simplifies and quickens the erection because of its tapered joint detail. The purpose of this study is to compare the erection time and cost effects of the steel connected PC components for heavily loaded long-span logistics buildings with the existing PC frames. For this study, we selected a logistics building constructed with PC components and redesigned it as the smart frame, and the erection simulations were performed. We analyzed the time reduction effects of the smart frame. Our results confirmed that the use of the smart frame reduced the erection time and cost practically. Our investigations will help develop the erection simulation algorithms for smart frames.

Pediatric alopecia areata (AA) can affect the quality of life (QoL) of patients and their family members. Research on the QoL and burden on family members in pediatric AA is limited.This nationwide multicenter questionnaire study described the QoL and burden of the family members of patients with pediatric AA.This nationwide multicenter questionnaire study enrolled AA patients between the ages of 5 and 18 years from March 1, 2017 to February 28, 2018. Enrolled patients and their parents completed the modified Children's Dermatology Life Quality Index (CDLQI) and the modified Dermatitis Family Impact (mDFI). The disease severity was measured using the Severity of Alopecia Tool (SALT) survey scores.A total of 268 patients with AA from 22 hospitals participated in this study. Our study found that the efficacy and satisfaction of previous treatments of AA decreased as the severity of the disease increased. The use of home-based therapies and traditional medicines increased with the increasing severity of the disease, but the efficacy felt by patients was limited. CDLQI and mDFI scores were higher in patients with extensive AA than those with mild to moderate AA. The economic and time burden of the family members also increased as the severity of the disease increased.The severity of the AA is indirectly proportional to the QoL of patients and their family members and directly proportional to the burden. Physicians need to understand these characteristics of pediatric AA and provide appropriate intervention to patients and their family members.

This paper presents a dual-loop two-step ZQ calibration scheme with a 20-nm DRAM process to support dedicated supply voltages ( $V_{DD}$ and $V_{DDQ}$ ). The proposed calibration scheme improves system signal integrity by maintaining the targeted output level ( $V_{\mathrm {OH}}$ ) in dynamic voltage–frequency scaling (DVFS) function, where $V_{DD}$ and $V_{DDQ}$ can be independently controlled to save system power. A two-step conversion algorithm alleviates the increase in calibration time, which is caused by an additional on-die termination (ODT) calibration for command/address (CA). The offset of a dynamic comparator in a ZQ calibration engine is averaged by a fraction-referred input switching-then-averaging (FISA) scheme which minimizes the effect of kickback noise. A code-referred periodic ZQ update (CPZU) scheme tracks the voltage and temperature variation during the background mode while minimizing the chance of malfunction by interference of both DRAM internal noise and external power noise. By applying the DVFS function based on the device usage by the user scenario in this design ( $V_{DD} =1.1$ V and $V_{DDQ} = 0.95$ V) at 1.6 Gbps, the read and the write operating power consumption can be saved by 17.7% and 18.2%, respectively, without a dynamic drop in performance. Therefore, the proposed dual-loop two-step ZQ calibration design improves the overall DRAM power efficiency based on the existing LPDDR4 SDRAM architecture without circuit overhead.