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Background: Although sunscreen is used as a primary strategy to prevent sunburn, photoaging and skin cancer, only a few people regularly use sunscreen. Objectives: To investigate the awareness of effects of sunlight, the extent of sun exposure, and the behaviors about sunscreen uses in Korean. Methods: A questionnaire was administered 255 adult patients visited Dermatology Department at Seoul National University Boramae Hospital. It included questions about the awareness of benefit or harm of sunlight, perceived and actual extent of sun exposure, the use of sun-protective methods including sunscreen. Results: Sun exposure was chosen as the major cause of dyschromia (61.2%), skin cancer (62.8%) and wrinkle (28.6%). Respondents were likely to underestimate the extent of sun exposure. On average, quite a few respondents stated that they were exposed to sunlight more than one hour per day (23.1% on weekdays, 53.4% on weekends). But, only 8.7% thought that their sun exposures were problematic and 62.2% of respondents considered moderate sunlight exposure good for health. People`s sun protective behaviors were inadequate: only 30.8% used sunscreen regularly; 18.4% have never used sunscreen. SPF was the most important factor choosing sunscreen and 86.0% used sunscreen labeled SPF over 30. In contrast, only 40.3% used PA+++ sunscreen. Conclusion: Despite a fairly good knowledge about harmful effects of sunlight, people underestimated the risks of their sun exposure and behaviors were suboptimal.
Background: Although sunscreen is used as a primary strategy for the prevention of sunburn, photoaging, and skincancer, few people regularly use sunscreen. Objective: To investigate awareness regarding the effects of sunlight, the extent of sun exposure, and sunscreen usebehaviors in Korean subjects. Methods: A questionnaire was administered to 467 adult patients who visited the Dermatology Department at SeoulNational University Boramae Hospital. The questionnaire covered demographic characteristics, causes of wrinkles,sunspots, and skin cancer, awareness of the harmful effects of sun exposure, perceived and actual extent of sunexposure, and the use of sun-protective methods including sunscreen. Results: Sun exposure was selected as the major cause of age spots (60.6%), skin cancer (60.9%), and wrinkles(25.9%). Respondents were likely to underestimate the extent of sun exposure. On average, quite a few respondentsstated that they were exposed to sunlight for more than one hour per day (22.7% on weekdays, 52.4% onweekends). However, only 9.4% of respondents thought that their sun exposure was problematic and 62.7% ofrespondents considered moderate sunlight exposure healthy. Respondents`` sun-protective behaviors were inadequate:only 29.8% used sunscreen regularly, and 16.5% have never used sunscreen. SPF was the most important factor inchoosing sunscreen, and 83.3% used a sunscreen with a labeled SPF over 30. By contrast, only 34.6% ofrespondents used PA+++ sunscreen. Conclusion: Despite fairly good knowledge regarding the harmful effects of sunlight, subjects underestimated therisks of their sun exposure and sun-protective behaviors were suboptimal. Education on the risk of UV exposure andeffects of sunscreen is still needed. (Korean J Dermatol 2015;53(1):16∼22)
Long-term treatment of topical estrogen to the sun-exposed facial skin of postmenopausal women induced matrix metalloproteinase-1 expression, leading to facial wrinkles aggravation: 24-week results from a double-blind, vehicle-controlled, randomized study
Background: Actinic keratosis (AK) is a common sun-induced skin disorder of importance for the progression to invasive squamous cell carcinoma. However, there is still no good way to predict high risk AK. Objectives: To identify markers which reflect the biologic behavior of AK and to understand the pathogenesis of AK Methods: A total of 52 patients with AK and site-matched 17 normal controls were included. We evaluated solar elastosis and immunohistochemical features using the following antibodies: p53, vitamin D receptor (VDR), claudin-1, and Langerin. Results: Solar elastosis increased and Langerhans cell (LC) density decreased with aging in both patients and controls. Solar elastosis and p53 expression were higher and VDR expression was lower in patients than controls; however, they showed no statistical difference in relation to the pathologic grade of AK. Claudin-1 expression gradually decreased from normal control to severe AK and decreased in the areas with epidermal atypia. LC density in severe AK was significantly lower than in normal control and mild AK; no difference in LC density was seen among control, mild AK and moderate AK. Conclusion: Claudin-1 can be a useful marker of pathologic severity of AK. In contrast, p53 increases and VDR decreases in AK not in gradual manner but in the early steps of carcinogenesis. LC density is relatively maintained in AK until it reaches severe dysplasia.
Basal Cell Carcinoma, the most common type of skin cancer in humans, usually develops in the sun-exposed area of head and neck. A 63-year-old woman presented with 1-year history of a bean-sized, slightly protruded bluish dermal patch in her right para-nasal area, and it gradually increased in size after she perceived its presence. It looked like traumatic pigmented tattoo because of bluish color and flat patchy features. A punch biopsy was performed, and the lesion was diagnosed as a basal cell carcinoma (BCC). Histopathologically, melanophages were seen scattered between typical basaloid BCC tumor nests in the reticular dermis, making the lesion appear similar to a traumatic pigmented tattoo by Tyndall effect. Typically pigmented BCC appears as a hyperpigmented, translucenet papule which may also have eroded borders. The patient only showed bluish colored patch without eroded borders, making it appear clinically similar to a pigmented tattoo. Herein, we report an interesting case of pigmented BCC which mimicked traumatic pigmented tattoo but was confirmed to be a BCC by biopsy.
The diagnosis of classic Spitz nevus with characteristic histopathologic findings is often straightforward, but unusual variants can cause diagnostic difficulties. Desmoplastic Spitz nevus (DSN) is of particular importance, as its differential diagnosis from other diseases, including desmoplastic malignant melanoma (DMM), is essential but often difficult<sup>1</sup>. A 38-year-old Caucasian woman presented with a 6-mm brownish papule of unknown onset on the dorsum of her left hand (Fig. 1A). She did not report any change in the papule size, trauma history, or related symptoms, but she wanted to have the lesion removed. Punch excision of the specimen revealed proliferation of individual spindle and epithelioid cells with scanty pigmentation within dense colla-genous dermal stroma (Fig. 1B, C). The specimen was focal positive for S-100 and HMB-45, positive for Melan-A, and 1% positive for Ki-67 (Fig. 2A∼C). The lesion did not recur after punch excision at the 1-year follow-up. Since its first report in 1975, there have been only a few case series of DSN owing to the rarity of this disease and its under-recognition, except for intermittent case reports<sup>1-3</sup>. DSN usually presents as a small red-brown papule on the trunk and extremities. It can occur at any age, but is mostly observed in young adults, with a slight female predominance. The distinctive histopathologic features of DSN―an intradermal growth pattern of large spindle or epithelioid nevus cells embedded in a fibrotic stroma, sparse melanin pigment, no junctional activity, no Kamino bodies, no prominent nest formation―can aid its differentiation from clinical simulators. Additionally, immunohistochemistry is essential for a differential diagnosis. DSN tests positive for S-100, Melan-A, and HMB-45, whereas dermatofibroma is negative for all three<sup>3</sup>. Hypomelanotic blue nevus shows uniform positivity for HMB-45, whereas DSN shows differential expression in most spindled cells3. The distinction between DSN and DMM is the most important. DMM is more common in elderly patients and tends to occur on sun-damaged head and neck areas. It also shows cellular atypia, strong mitotic activity and Ki-67 expression, less frequent S-100 and Melan-A positivity, and almost exclusive negativity for HMB-45<sup>2,3</sup>. Some researchers regarded DSN as an end stage of Spitz nevus that had lost continuity with the epidermis and undergone fibrosis. Paniago-Pereira et al.<sup>2</sup> also reported that DSNs occurred in patients older than 30 years. These findings suggest that desmoplasia might be an aging process of Spitz nevus. However, Barr et al.1 found no significant difference in patient age, disease duration, or trauma history between patients with DSN and common variants of Spitz nevus, and suggested that desmoplasia may be a tumor-induced reactive stromal induction rather than a regressive phenomenon. The pathogenesis of desmoplasia has not yet been clearly elucidated. Moreover, it is controversial whether DSN should be regarded as a variant of Spitz nevus or whether it belongs to a spectrum of desmoplastic nevus as a distinctive entity<sup>3,4</sup>. Some researchers5 suggested strict diagnostic criteria for de-smoplastic nevus, including greater cellularity in the super-ficial portion, and a mixture of melanocytic nevus cells, ovoid and dendritic melanocytes, and spitzoid melanocytes. Further, they mentioned that lesions in which one particular type of melanocyte predominates over others are more likely to represent DSN. Dermoscopic findings can also aid the distinction, because DSN shows dotted vessels and reticular depigmentation whereas desmoplastic nevus demonstrates a delicate pigment network over a pinkish background<sup>4</sup>. Although it is regrettable that we did not acquire dermoscopic image to support the diagnosis, our case overall seems more com-patible with DSN. However, the probability of a morphologic spectrum that embraces DSN and desmoplastic nevus cannot be excluded, and requires further studies. Here, we report an unusual desmoplastic variant of Spitz nevus with a literature review, and propose keynotes for differential diagnosis from its simulators, especially DMM.
항생물질 cefazolin(CZH)의 산-염기 해리반응에 관해 실험하여 다음과 같은 결론을 얻었다. 1. 전위차법으로 25℃에서 측정한 CZH의 pKa 값은 3.78(±0.05) 이었다. 전도도법으로 측정한 경우 pKa=3.75였으며, [CZNa]/[CZH] = 1.00의 완충용액으로 측정하였을 때에는 pKa = 3.41이었다. 2. CZNa+CZH 혼합용액의 전기 전도도는 [CZNa] 농도가 증가될수록 공통이온외 영향으로 약간씩 감소되었다. 3. CZH의 용해도는 92.8mg/100mL이고, 해리도는 0.4650으로 산출되었다. 4. CZH의 pKa 값은 5~50℃ 범위에서 커다란 변화가 없었다. 5. CZH 산해리반응을 열역학적으로 고찰할 때, ΔG°=+19.995kJ/mol이었다. 따라서 CZH 외 난용성을 증명할 수 있었다. 6. 산-염기 분율조성을 고찰한 결과 pH<3.78의 수용액중에서는 산성형 CZH가 주된 화학종이고 pH>3.78인 용액중에서는 염기형인 CZ^(-)가 주된 화학종임을 알았다. 7. 5% 포도당 주사액중에서는 CZH가, Hartman용액중에서는 CZ^(-)가 주된 화학종이며, 생리식염 주사액중에서는 두 화학종이 비숫하게 분포하였다. 8. 생체액중에서의 CZH거동을 고찰한 결과 동맥혈, 정맥혈, 안방수, 누액, 십이지장, 회장, 소장 등에서는 99%이상 CZ^(-)형태로 분포하고, 위장에서는 약 99%가 CZH형태로 분포하리라 추정되었다. 9. UV 및 IR 흡광특성은 CZNa가 CZH에 비하여 장파장 이동을 나타내었다. The purpose of this study was to determine the acid dissociation constant of cefazolin antibiotics potentiometrically and conductometricaliy, and to identify the principal species in parenteral infusions and body fluids with different pH values. The pKa of cefazolin was 3.78(±0.05) at 25℃, and the pKa value of cefazolin was almost constant at temperature range of 5~50℃. As the concentration of basic form in the mixture of cefazolin(CZH) and cefazolin sodium(CZNa) increased the conductance decreased still further because of the common ion effect. The computed solubility of CZH was 92.8mg/100mL, the fractrion of dissociation a was found 0.4650. The low solubility was demonstrated thermodynamically. The Gibb's energy change for the dissociation was +19.995kJ/mol, reaction is disfavored. The acidic species(CZH) was the predominant form at pH<3.78, the basic species(CZ^(-)) was the principal form at pH>3.78. The results of pH measurement it was assumed that CZH was major in 5% dextrose inj., CZ^(-) in Hartman's solution, and CZH and CZ^(-) existed almost equally in saline solution. It was also assumed that the major form was basic in aqueous humor, blood venous, duodenum, ileum distal, lacrimal fluids, and intestine microsurface, while acidic in the stomch. UV and IR spectra of the basic form, CZ was showed bathochromic shift.
Background : Mortality from paraquat intoxication depends upon plasma paraquat concentration. To know the severity of paraquat intoxication is important for directing therapeutic modality and predicting prognosis. Sodium dithionite test for urinary paraquat provides an easy and simple method to determine the severity of paraquat intoxication in emergency department. purpose : To determine whether the result urinary paraquat test by sodium dithionite can predict outcome in patients with paraquat intoxication in emergency department. Subjects : 48 patients(male 31, female 17, mean age 37 years) who had exposure to paraquat and presented within 24 hours after exposure. Result : Thirty five patients were positive in paraquat urine test and thirteen patients were negative. Clinical manifestations were more severe in positive patients than in negatives. Complication was much more in positives than in negatives. 28 of 35 patients(80%) in positives and 2 of 13 patients(15%) in negatives died. Conclusion : Positive test for urinary paraquat is associated with high mortality and morbidity from paraquat intoxication, and qualitative test for urinary paraquat by sodium dithionite is an useful method to determine the severity of paraquat intoxication in emergency department.
ATHB12, an ABA-lnducible Homeodomain-Leucine Zipper (HD-Zip) Protein of Arabidopsis, Negatively Regulates the Growth of the Inflorescence Stem by Decreasing the Expression of a Gibberellin 20-Oxidase Gene