251
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Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK, Gottrup F, Gurtner GC, Longaker MT. Human skin wounds: a major and snowballing threat to public health and the economy. Wound Repair Regen 2009; 17:763-71. [PMID: 19903300 PMCID: PMC2810192 DOI: 10.1111/j.1524-475x.2009.00543.x] [Citation(s) in RCA: 1806] [Impact Index Per Article: 120.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACT In the United States, chronic wounds affect 6.5 million patients. An estimated excess of US$25 billion is spent annually on treatment of chronic wounds and the burden is rapidly growing due to increasing health care costs, an aging population and a sharp rise in the incidence of diabetes and obesity worldwide. The annual wound care products market is projected to reach $15.3 billion by 2010. Chronic wounds are rarely seen in individuals who are otherwise healthy. In fact, chronic wound patients frequently suffer from "highly branded" diseases such as diabetes and obesity. This seems to have overshadowed the significance of wounds per se as a major health problem. For example, NIH's Research Portfolio Online Reporting Tool (RePORT; http://report.nih.gov/), directed at providing access to estimates of funding for various disease conditions does list several rare diseases but does not list wounds. Forty million inpatient surgical procedures were performed in the United States in 2000, followed closely by 31.5 million outpatient surgeries. The need for post-surgical wound care is sharply on the rise. Emergency wound care in an acute setting has major significance not only in a war setting but also in homeland preparedness against natural disasters as well as against terrorism attacks. An additional burden of wound healing is the problem of skin scarring, a $12 billion annual market. The immense economic and social impact of wounds in our society calls for allocation of a higher level of attention and resources to understand biological mechanisms underlying cutaneous wound complications.
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Affiliation(s)
- Chandan K Sen
- Department of Surgery, The Ohio State University Comprehensive Wound Center, Columbus, Ohio 43210, USA.
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252
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Savastano DM, Gorbach AM, Eden HS, Brady SM, Reynolds JC, Yanovski JA. Adiposity and human regional body temperature. Am J Clin Nutr 2009; 90:1124-31. [PMID: 19740972 PMCID: PMC2762153 DOI: 10.3945/ajcn.2009.27567] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Human obesity is associated with increased heat production; however, subcutaneous adipose tissue provides an insulating layer that impedes heat loss. To maintain normothermia, therefore, obese individuals must increase their heat dissipation. OBJECTIVE The objective was to test the hypothesis that temperature in a heat-dissipating region of the hand is elevated in obese adults. DESIGN Obese [body mass index (in kg/m(2)) > or = 30] and normal-weight (NW; body mass index = 18-25) adults were studied under thermoneutral conditions at rest. Core body temperature was measured by using ingested telemetric capsules. The temperatures of the third fingernail bed of the right hand and of abdominal skin from an area 1.5 cm inferior to the umbilicus were determined by using infrared thermography. Abdominal skin temperatures were also measured via adhesive thermistors that were placed over a prominent skin-surface blood vessel and over an adjacent nonvessel location. The groups were compared by analysis of covariance with age, sex, race, and room temperature as covariates. RESULTS Core temperature did not differ significantly between the 23 obese and 13 NW participants (P = 0.74). However, infrared thermography-measured fingernail-bed temperature was significantly higher in obese subjects than in NW subjects (33.9 +/- 0.7 degrees C compared with 28.6 +/- 0.9 degrees C; P < 0.001). Conversely, infrared thermography-measured abdominal skin temperature was significantly lower in obese subjects than in NW subjects (31.8 +/- 0.2 degrees C compared with 32.8 +/- 0.3 degrees C; P = 0.02). Nonvessel abdominal skin temperatures measured by thermistors were also lower in obese subjects (P = 0.04). CONCLUSIONS Greater subcutaneous abdominal adipose tissue in obese adults may provide a significant insulating layer that blunts abdominal heat transfer. Augmented heat release from the hands may offset heat retention in areas of the body with greater adiposity, thereby helping to maintain normothermia in obesity. This trial was registered at clinicaltrials.gov as NCT00266500.
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Affiliation(s)
- David M Savastano
- Unit on Growth and Obesity, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-1103, USA
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253
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Katz TM, Goldberg LH, Friedman PM. Nonablative Fractional Photothermolysis for the Treatment of Striae Rubra. Dermatol Surg 2009; 35:1430-3. [DOI: 10.1111/j.1524-4725.2009.01252.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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254
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Wenczl E. Skin manifestations, treatment and rehabilitation in overweight and obesity. Orv Hetil 2009; 150:1731-8. [DOI: 10.1556/oh.2009.28693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A túlsúly, az elhízás népbetegség Magyarországon és a nyugati világban. Igen fontos hangsúlyozni, hogy a kövérség betegség és egy lényeges rizikófaktor számos bőr- és egyéb betegséget tekintve. Az obesitas okozta és az általa súlyosbított bőrbetegségek (acathosis nigricans, acrochordonok, keratosis pilaris, hyperandrogenismus, striák, adiposis dolorosa, nyiroködéma, krónikus vénás elégtelenség, plantaris hyperkeratosis, lipödéma, bőrinfekciók, acne inversa, psoriasis, köszvényes csomók) áttekintése segít minket abban, hogy nézzünk és lássunk is. Fokozottan figyeljünk a bőrinfekciók lehetőségére, mert ez segíti a korai felismerést, a szövődmények elkerülését, és hívjuk fel a páciensek figyelmét a bőrkezelés preventív jelentőségére. Kövér páciens esetén a legtöbb helyi vagy szisztémás kezelés alkalmazásakor a megszokott adagolás módosítása szükséges. Gondolnunk kell arra is, hogy az elhízás közvetlenül vagy közvetve szinte minden szervrendszerben előnytelen folyamatokat indít el, ezért csak egy multidiszciplináris ellátástól remélhető az obes beteg gyógyítása és rehabilitációja. A rehabilitációnak gyakran része a bőrgyógyászati és lymphologiai gondozás.
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Affiliation(s)
- Enikő Wenczl
- 1 Fővárosi Önkormányzat Egyesített Szent István és Szent László Kórház és Rendelőintézet Bőrgyógyászati és Lymphológiai Rehabilitációs Osztály Budapest Nagyvárad tér 1. 1095
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255
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Piccardi N, Manissier P. Nutrition and nutritional supplementation: Impact on skin health and beauty. DERMATO-ENDOCRINOLOGY 2009; 1:271-4. [PMID: 20808515 PMCID: PMC2836433 DOI: 10.4161/derm.1.5.9706] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 07/30/2009] [Indexed: 11/19/2022]
Abstract
Skin acts as a natural barrier between internal and external environments thus plays an important role in vital biological functions such as protection against mechanical/chemical damages, micro-organisms, ultraviolet damage. Nutrition has a critical impact on strengthening skin's capabilities to fight against these multiple aggressions.Nutritional deficiencies are often associated with skin health disorders, while diets can either positively or negatively influence skin condition. More recently, the concept of nutritional supplementation has emerged as a new strategy in the daily practice of dermatology as well as a complementary approach to topical cosmetics in the field of beauty. Focusing on human clinical data, this paper proposes to illustrate the link between skin health and nutrition and to exemplify the beneficial actions of nutritional supplementation in skin health and beauty.
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256
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Rose MA, Pokorny M, Drake DJ. Preventing Pressure Ulcers in the Morbidly Obese: In Search of an Evidence Base. ACTA ACUST UNITED AC 2009. [DOI: 10.1089/bar.2009.9963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mary Ann Rose
- East Carolina College of Nursing, Greenville, North Carolina
| | - Marie Pokorny
- East Carolina College of Nursing, Greenville, North Carolina
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257
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Abstract
Obesity, especially visceral adiposity, is associated with morbidity and mortality through endocrine and mechanical processes. Clinical manifestations due to effects of obesity on the cardiovascular, respiratory, gastrointestinal, musculoskeletal, immune, and integumentary systems have been described. Further studies are needed to understand the pathologic processes underlying these clinical manifestations to improve disease prevention.
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Affiliation(s)
- Kavitha Bhat Schelbert
- Department of Family Medicine, University of Pittsburgh School of Medicine, 3518 Fifth Avenue, Pittsburgh, PA 15261, USA
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258
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Binnebösel M, Junge K, Schwab R, Antony A, Schumpelick V, Klinge U. Delayed wound healing in sacrococcygeal pilonidal sinus coincides with an altered collagen composition. World J Surg 2009; 33:130-6; discussion 137. [PMID: 18839241 DOI: 10.1007/s00268-008-9748-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although patients with pilonidal sinus are young and, thus, are expected to heal well, a delayed healing with high risk of recurrence frequently is observed. This study was initiated to test whether disorders in the extracellular matrix (ECM) may be detected in patients with pilonidal sinus and delayed wound healing or recurrent disease, respectively. METHODS In 48 patients, tissue specimens were obtained at the index operation. All patients were treated by local excision and primary wound closure. The collagen type I/III ratio, the expression of matrix metalloproteinase (MMP)-1, -9, and -13, as well as the proliferation index (Ki67) and the macrophage infiltrate (CD68) were measured. Patients with an uneventful wound healing by primary intention were compared with those in which the healing by primary intention fails (secondary healing), and patients suffering first onset of pilonidal sinus or to those patients who had undergone previous surgery for pilonidal sinus. Clinical parameters and comorbidity were evaluated. RESULTS Patients with secondary healing, exhibited at the index operation a significantly lower collagen type I/III ratio (2.34+/-0.4) compared with patients with problem-free wound healing (3.04+/-0.7). Furthermore, significantly higher expression of MMP-1, -9, and 13, and a significantly higher proliferation index (Ki67) were found in the specimens of the patients with secondary healing. In patients in whom the operation was performed because of a recurrence expression of both Ki67 and CD68 were significantly higher. Smokers had an increased risk for suffering recurrent disease, but did not show differences in the collagen ratio. CONCLUSIONS As a novel finding, this study indicates that disturbances of the ECM may predict a delayed wound healing after pilonidal sinus surgery.
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Affiliation(s)
- Marcel Binnebösel
- Department of Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany.
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259
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Trasande L, Liu Y, Fryer G, Weitzman M. Effects of childhood obesity on hospital care and costs, 1999-2005. Health Aff (Millwood) 2009; 28:w751-60. [PMID: 19589800 DOI: 10.1377/hlthaff.28.4.w751] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Childhood obesity is increasingly recognized as an epidemic, but the economic consequences have not been well quantified. We evaluated trends in obesity-associated hospitalizations, charges, and costs using 1999-2005 data from a nationally representative sample of admissions to U.S. hospitals. We detected a near-doubling in hospitalizations with a diagnosis of obesity between 1999 and 2005 and an increase in costs from $125.9 million to 237.6 million (in 2005 dollars) between 2001 and 2005. Medicaid appears to bear a large burden of hospitalizations for conditions that occur along with obesity, while private payers pay a greater portion of hospitalization costs to treat obesity itself.
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260
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Manuskiatti W, Wachirakaphan C, Lektrakul N, Varothai S. Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot study. J Eur Acad Dermatol Venereol 2009; 23:820-7. [DOI: 10.1111/j.1468-3083.2009.03254.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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261
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Canoui-Poitrine F, Revuz JE, Wolkenstein P, Viallette C, Gabison G, Pouget F, Poli F, Faye O, Bastuji-Garin S. Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity. J Am Acad Dermatol 2009; 61:51-7. [PMID: 19406505 DOI: 10.1016/j.jaad.2009.02.013] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 02/08/2009] [Accepted: 02/08/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Factors associated with the severity of hidradenitis suppurativa (HS) are not known. OBJECTIVE We sought to identify factors associated with the severity of HS. METHODOLOGY The severity of disease in a series of 302 consecutive patients with HS was assessed using the Sartorius score. RESULTS Atypical locations were more common in men than in women (47.1% vs 14.8%; P < .001). Men also had more severe disease (median Sartorius score: 20.5 vs 16.5; P = .02). Increased body mass index (P < .001), atypical locations (P = .002), a personal history of severe acne (P = .04), and absence of a family history of HS (P = .06) were associated with an increased Sartorius score. The Sartorius score was highly correlated with the intensity and duration of pain and suppuration (all P values < .001). LIMITATIONS The referral center base of the study may have biased recruitment. CONCLUSION Our data showed a significant association between the severity of HS and several clinical and behavioral factors. Prospective studies are needed to confirm the prognostic role of these factors.
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262
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Rongioletti F, Donati P, Amantea A, Ferrara G, Montinari M, Santoro F, Parodi A. Obesity-associated lymphoedematous mucinosis. J Cutan Pathol 2009; 36:1089-94. [PMID: 19222694 DOI: 10.1111/j.1600-0560.2008.01239.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Mucin deposition on the shins is considered as an indicator of pretibial myxoedema, which is typically seen in patients with Graves' disease. OBJECTIVE The purpose of this study was to report the clinical and histopathological features of a group of patients with pretibial mucinosis in the absence of thyroid disease. METHODS Five patients are included in this series and studied both clinically and histologically and compared with similar cases in the literature. RESULTS All patients were middle aged or elderly. Four patients were women. They were characterized clinically by morbid obesity and bilateral lower extremity pitting oedema sparing the feet. Semitranslucent papules and/or nodules and sometimes vesicles were found on the shins. Characteristic histological features include (i) hyperorthokeratosis with epidermal atrophy and effacement of the rete ridge pattern, (ii) oedema in the papillary and upper part of the reticular dermis with mucin deposition stained positively with alcian blue and colloidal iron, (iii) angioplasia in the upper part of dermis with upward-running, increased and thickened capillary vessels and (iv) variable fibrosis in the reticular dermis with separation of collagen bundles and increased stellate or linear fibroblasts. A hypocaloric diet was given in two cases, and an important weight loss was observed, which was accompanied by a marked improvement of the pretibial mucinosis. CONCLUSIONS Pretibial mucinosis is a histological feature associated with morbid obesity and lymphoedematous features of the legs that should be distinguished from true pretibial myxoedema. The term of 'obesity-associated lymphoedematous mucinosis' seems to be appropriate for this condition.
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263
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264
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Bibliography. Current world literature. Obesity and nutrition. Curr Opin Endocrinol Diabetes Obes 2008; 15:470-5. [PMID: 18769222 DOI: 10.1097/med.0b013e328311f3cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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265
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Methicillin-Resistant Staphylococcus aureus as a Common Cause of Vulvar Abscesses. Obstet Gynecol 2008; 112:538-44. [DOI: 10.1097/aog.0b013e3181827829] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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266
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Lower extremity lymphedema. J Am Acad Dermatol 2008; 59:324-31. [DOI: 10.1016/j.jaad.2008.04.013] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 04/03/2008] [Accepted: 04/08/2008] [Indexed: 11/18/2022]
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267
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Corstjens H, Dicanio D, Muizzuddin N, Neven A, Sparacio R, Declercq L, Maes D. Glycation associated skin autofluorescence and skin elasticity are related to chronological age and body mass index of healthy subjects. Exp Gerontol 2008; 43:663-667. [DOI: 10.1016/j.exger.2008.01.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 01/29/2008] [Accepted: 01/31/2008] [Indexed: 10/22/2022]
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268
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Affiliation(s)
- Marie E. Pokorny
- East Carolina University College of Nursing, Greenville, North Carolina
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269
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Emtestam L, Sartorius K, Lapins J. Viewpoint 2. Exp Dermatol 2008. [DOI: 10.1111/j.1600-0625.2008.00712_3.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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270
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Ralf Paus L, Kurzen H, Kurokawa I, Jemec GBE, Emtestam L, Sellheyer K, Giamarellos-Bourboulis EJ, Nagy I, Bechara FG, Sartorius K, Lapins J, Krahl D, Altmeyer P, Revuz J, Zouboulis CC. What causes hidradenitis suppurativa? Exp Dermatol 2008. [DOI: 10.1111/j.1600-0625.2008.00712.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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271
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Sellheyer K, Krahl D. Viewpoint 5. Exp Dermatol 2008. [DOI: 10.1111/j.1600-0625.2008.00712_6.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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272
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Wollina U. What a difference an image makes. J Am Acad Dermatol 2007; 57:730; author reply 730-1. [PMID: 17870443 DOI: 10.1016/j.jaad.2007.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2007] [Revised: 07/08/2007] [Accepted: 07/08/2007] [Indexed: 11/18/2022]
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273
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Chueh HW, Cho GR, Yoo J. Clinical significance of acanthosis nigricans in children and adolescents with obesity induced metabolic complications. KOREAN JOURNAL OF PEDIATRICS 2007. [DOI: 10.3345/kjp.2007.50.10.987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hee Won Chueh
- Department of Pediatrics, College of Medicine, Dong-A University, Pusan, Korea
| | - Gyu Rang Cho
- Department of Pediatrics, College of Medicine, Dong-A University, Pusan, Korea
| | - Jaeho Yoo
- Medical Sciences Research Institute, College of Medicine, Dong-A University, Pusan, Korea
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