Dermoscopic Features of Subcorneal Hematoma on the Palms and Soles: Differences from Acral Melanoma

BACKGROUND

The diagnosis of subcorneal hematoma (SH) can be challenging because the clinical presentation of SH can resemble melanocytic lesions. Few studies have examined the characteristic dermoscopic features of SH, but a more detailed large-scale study is needed to overcome the diagnostic challenge of differentiating it from acral melanoma.

OBJECTIVES

To describe the dermoscopic features of SH.

METHODS

We evaluated the clinical and dermoscopic features of 50 SH lesions from 43 patients at the Pusan National University Hospitals (Busan and Yangsan).

RESULTS

In the color analysis, 86% of cases showed the bruise color sign; 7 cases had a single color (red to purple: 2; black: 1; brown: 4). Typical dermoscopic features of SH, acral nevi, and acral melanoma-associated patterns were observed in 60%, 0%, and 72% of lesions, respectively. Hematoma-associated patterns were homogenously red-to-black with or without satellite globules (32%) and pebbles on the ridges (28%). Acral melanoma-associated patterns showed a parallel ridge pattern (PRP) (52%), irregular dots and globules (50%), polychromia (34%), asymmetry (24%), irregular blotches (10%), and ulcers (10%). No case showed blue-white veils, regression structures, atypical vascular patterns, or irregular fibrillar patterns. The bruise color sign was positive in most cases, with acral melanoma-associated patterns (88.9%).

Predictors of Psoriasis Area and Severity Index 100 response in Korean patients with moderate-to-severe plaque psoriasis receiving biologics

The Psoriasis Area and Severity Index (PASI) 100 response rate after treatment with biologics is reportedly lower in Asians than non-Asians. Large-scale studies evaluating predictors of PASI 100 response in Korean patients with psoriasis are yet to be conducted. To identify predictors of patients achieving PASI 100 response after 48-52 weeks of treatment with a biological agent. We retrospectively reviewed the medical records of 145 patients with psoriasis treated with a single biological agent for over one year. Clinical features were compared between super-responders (defined as achieving PASI 100 at 48-52 weeks) and non-super-responders. Among the patients included in the study, 61 (42.1%) were super-responders. No statistical difference in demographics and face, scalp, or nail involvement was observed. However, the mean body mass index (BMI) and baseline PASI were lower in super-responders (24.3 kg/m2, 14.3) than in non-super-responders (26.1 kg/m2, 16.2). There were more biologically naïve patients among the super-responders (85.2%) than the non-super-responders (67.9%). In Korean patients with moderate-to-severe psoriasis, a better PASI 100 response is expected for patients who are biologically naïve with a relatively lower baseline BMI and PASI.

Which Areas Are Still Left in Biologics Responsive Korean Patients with Moderate to Severe Plaque Psoriasis

BACKGROUND

Psoriasis localized to certain body areas, such as the scalp, nails, palms, soles, intertriginous regions, and genital regions, is reportedly difficult to treat.

OBJECTIVE

To investigate the biologics-resistant areas in South Korean patients with psoriasis treated with biologics.

METHODS

The study included 50 patients with chronic moderate to severe plaque psoriasis from the Pusan National University Hospital and Chosun University Hospital between October 2019 and September 2020. The patients had at least one psoriatic lesion, were treated with biologics for more than six months, and exhibited a partial or good response (reaching a Psoriasis Area and Severity Index [PASI] score of 1~5 after biologics treatment).

RESULTS

A total of 50 patients with psoriasis (32 male, mean±standard deviation 47.8±11 years), with a median PASI score of 1.8, were included. The most common biologics-resistant areas were the anterior lower leg (56.0%), followed by the knee (48.0%) and posterior lower leg (42.0%). The proportion of biologics-resistant areas were obtained for body regions traditionally considered as difficult-to-treat entities, including the fingernails (10.0%), toenails (14.0%), scalp (38.0%), palm (12.0%), sole (14.0%), and genital areas (10.0%).

CONCLUSION

This study determined the biologics-resistant areas in South Korean patients, successfully treated with biologics, in a real-world clinical setting.

The association between season of birth, age at onset, and clozapine use in schizophrenia

OBJECTIVE

This study aimed to determine whether the rate of clozapine use, an indicator of refractoriness in schizophrenia, is associated with the season of birth and age at onset in patients with schizophrenia based on nationwide data.

METHODS

Patients with schizophrenia (n = 114 749) who received prescriptions for antipsychotic medication between 2008 and 2014 were retrospectively identified from the Korean National Health Insurance Service database. The study population was divided into three groups based on their age at the onset of schizophrenia (early, middle, and late onset). We assessed differences in the month of birth between patients and the general population. In addition, the cumulative clozapine use was calculated.

RESULTS

Compared to the late-onset schizophrenia group, the early- and middle-onset groups showed a higher probability of birth during the winter season. In addition, the early-onset group showed the highest cumulative clozapine use rate. In the middle-onset group, the initiation of clozapine use was significantly earlier for patients born in winter compared to those born in summer.

CONCLUSION

Our results indicate that the age at onset is an important factor in predicting the prognosis of schizophrenia patients. The season of birth also affects the prognosis, but with less robustness. Specifically, it appears that early disease onset and winter birth might be associated with poor outcomes in Korean patients with schizophrenia.

Ankle fractures have features of an osteoporotic fracture

We report the bone attenuation of ankle joint measured on computed tomography (CT) and the cause of injury in patients with ankle fractures. The results showed age- and gender-dependent low bone attenuation and low-energy trauma in elderly females, which suggest the osteoporotic features of ankle fractures.

INTRODUCTION

This study was performed to investigate the osteoporotic features of ankle fracture in terms of bone attenuation and cause of injury.

METHODS

One hundred ninety-four patients (mean age 51.0 years, standard deviation 15.8 years; 98 males and 96 females) with ankle fracture were included. All patients underwent CT examination, and causes of injury (high/low-energy trauma) were recorded. Mean bone attenuations of the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis were measured on CT images. Patients were divided into younger age (<50 years) and older age (≥50 years) groups, and mean bone attenuation and causes of injury were compared between the two groups in each gender.

RESULTS

Proportion of low-energy trauma was higher in the older age group than in the younger age group, but the difference was only significant in female gender (p = 0.011). The older age group showed significantly lower bone attenuation in the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis than the younger age group in both genders. The older age group showed more complex pattern of fractures than the younger age group. With increasing age, bone attenuations tended to decrease and the difference of bone attenuation between the genders tended to increase in the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis.

CONCLUSIONS

Ankle fracture had features of osteoporotic fracture that is characterized by age- and gender-dependent low bone attenuation. Ankle fracture should not be excluded from the clinical and research interest as well as from the benefit of osteoporosis management.

An Ochrobactrum anthropi gene conferring paraquat resistance to the heterologous host Escherichia coli

A new gene, pqrA, conferring paraquat resistance to the heterologous host Escherichia coli, from a chromosomal DNA library of Ochrobactrum anthropi JW2, was cloned and analyzed. Cells of E. coli transformed with a plasmid carrying the pqrA gene showed elevated resistance to paraquat, but not to hydrogen peroxide. The predicted amino acid sequence of the PqrA polypeptide showed 71% identity with mll7495 hypothetical membrane protein in Mesorhizobium loti, 49% identity with PA2269 protein in Pseudomonas aeruginosa, and significant identity with other previously reported drug transport proteins. The hydropathy pattern of the PqrA polypeptide showed a significant homology to those of 12-transmembrane-segment (TMS) family export proteins. Immunoblot analysis demonstrated that the PqrA protein found in the membrane protein fraction of O. anthropi JW2 has a molecular mass of 42 kDa. These results suggest that the PqrA protein is a membrane protein that plays an important role in protecting cells against paraquat toxicity.

Expression of the chloroplast-localized small heat shock protein by oxidative stress in rice

A rice (Oryza sativa L. cv. Nakdong) cDNA clone, Oshsp26, encoding the chloroplast-localized small heat shock protein (smHSP) was isolated. Southern blot analysis of genomic DNA and the result of screening of a cDNA library indicated that the Oshsp26 gene is encoded by a single gene in the rice genome. The Oshsp26 gene was expressed following heat stress: the transcript level was highest when rice leaves were treated at high temperatures for 2h at 42 degrees C, and the transcripts became detectable after 20min and reached a maximum level after 2h. It was also found that the Oshsp26 gene was expressed following oxidative stress even in the absence of heat stress. Treatment of rice plants with methyl viologen (MV) in the light and treatment with hydrogen peroxide (H(2)O(2)), either in the light or in the dark, both caused a significant accumulation of the transcripts and the protein. Since MV treatment in the light leads to the generation of H(2)O(2) inside the chloroplast, it is likely that H(2)O(2) by itself acts to induce the expression of the Oshsp26 gene. These results suggest that the chloroplast smHSP plays an important role in protecting the chloroplast against damage caused by oxidative stress as well as by heat stress.