Association between AMELX polymorphisms and dental caries in Koreans

OBJECTIVES

Dental caries is greatly influenced disease by environmental factors, but recently there are increasing evidences for a genetic component in caries susceptibility. AMELX is the gene coding amelogenin, which is the most important factor for normal enamel development. The aim of this study was to examine the relationship between dental caries and single nucleotide polymorphisms (SNPs) in AMELX.

SUBJECTS AND METHODS

For this study, we used DNA samples collected from 120 unrelated individuals older than 12 years of age. All of them were examined for their oral and dental status under the WHO recommended criteria, and clinical information such as DMFT and DMFS were evaluated. Individuals whose DMFT and DMFS index lower than 2 were designated 'very low caries experience' and higher than 3 were designated 'higher caries experience'. Genomic DNA was extracted from hair samples, and single nucleotide polymorphisms of AMELX were genotyped. Genotyping of three SNPs (rs17878486, rs5933871, rs5934997, intron) in AMELX gene was determined by direct sequencing and analyzed with SNPStats.

RESULTS

There were significant associations between rs5933871 and rs5934997 SNP and caries susceptibility in the water fluoridation group.

CONCLUSIONS

These results suggest that SNPs of AMELX might be associated with dental caries susceptibility in Korean population.

In vitro inhibitory effects of Wen-pi-tang-Hab-Wu-ling-san on human cytochrome P450 isoforms

WHAT IS KNOWN AND OBJECTIVE

Although Wen-pi-tang-Hab-Wu-ling-san (WHW), an oriental herbal medicine, has been prescribed for the treatment of chronic renal failure (CRF) in Korean clinics, no studies regarding WHW-drug interactions had been reported. The purpose of this study was to evaluate the possibility that WHW inhibits the catalytic activities of major cytochrome P450 (CYP) isoforms.

METHODS

The abilities of various WHW extracts to inhibit phenacetin O-de-ethylation (CYP1A2), tolbutamide 4-methylhydroxylation (CYP2C9), omeprazole 4'-hydroxylation (CYP2C19), dextromethorphan O-demethylation (CYP2D6), chlorzoxazone 6-hydroxylation (CYP2E1) and midazolam 1-hydroxylation (CYP3A4) were assessed using human liver microsomes.

RESULTS AND DISCUSSION

WHW extract at concentrations up to 100 μm showed negligible inhibition of the six CYP isoforms tested (CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1 and CYP3A4), with apparent IC(50) values (concentration of the inhibitor causing 50% inhibition of the original enzyme activity) of 817.5, 601.6, 521.7, 310.2, 342.8 and 487.0 μg/mL, respectively.

WHAT IS NEW AND CONCLUSION

Our in vitro findings suggest that WHW extract at concentrations corresponding to a clinically recommended dosage range has no notable inhibitory effects on CYP isoforms. Therefore, we believe that WHW extract may be free of drug-herb interactions when co-administered with other medicines. However, in vivo human studies are needed to confirm these results.

Plasmon resonances on gold nanowires directly drawn in a step-index fiber

We report the successful production of high-quality gold wires, with diameters down to 260nm, by direct fiber drawing from a gold-filled fused-silica cane. The stack-and-draw technique makes it straightforward to incorporate a conventional step-index core, adjacent to the gold wire, in the cane. In the drawn fiber, strong coupling of light from the glass core to SPP resonances on the gold wire is observed at specific well-defined wavelengths. Such embedded wires have many potential applications, for example, as nanoscale electrodes, in nonlinear optical plasmonics, and as near-field scanning optical microscope tips.

The Effects of Combination Perianal-Intrarectal Lidocaine-Prilocaine Cream and Periprostatic Nerve Block for Pain Control during Transrectal Ultrasound Guided Biopsy of the Prostate: A Randomized, Controlled Trial

PURPOSE

Prostate biopsy for diagnosing cancer can be painful. The efficacy and safety of combination perianal-intrarectal lidocaine-prilocaine (PILP) cream and periprostatic nerve block were compared with nerve block alone during transrectal ultrasound guided prostate biopsy (TRUS-Bx).

MATERIALS AND METHODS

From October 2007 to August 2009, 74 men undergoing a transrectal prostate biopsy were randomized into two groups. In group 1, 36 patients received a combination of PILP cream and a periprostatic nerve block; and in group 2, 38 patients received lubricant jelly and a periprostatic nerve block. Thirty minutes later, the TRUS-Bx was performed. Pain was evaluated by a 10-point visual analogue scale (VAS) after the biopsy.

RESULTS

Patients in group 1 showed a significantly lower VAS score than patients in group 2 (mean score 2.22+/-0.89 vs. 3.02+/-1.15, p<0.001). In addition, there was a difference in the number of patients that had a pain score of three or more, 44% in group 1, and 65% in group 2. The overall complication rate was similar in both groups (p=0.45).

CONCLUSIONS

A combination of PILP cream and periprostatic nerve block reduced pain compared to the periprostatic nerve block alone. This safe, simple technique can be considered prior to TRUS-Bx to reduce patient discomfort.

Falciform ligament abscess after omphalitis: report of a case

A falciform ligament abscess is a rare type of intra-abdominal abscess. A 2-yr-old male, who had omphalitis two months previously, presented with a fever and right upper quadrant abdominal pain. The ultrasound and CT scan showed an abdominal wall abscess located anterior to the liver, which was refractory to conservative management with percutaneous drainage and antibiotics. On the third recurrence, surgical exploration was performed and revealed an abscess arising from the falciform ligament; the falciform ligament was excised. A follow up ultrasound confirmed complete resolution of the abscess with no further recurrence.

Pulmonary artery embolotherapy in a patient with type I hepatopulmonary syndrome after liver transplantation

Although liver transplantation (LT) is the only effective treatment option for hepatopulmonary syndrome (HPS), the post-LT morbidity and mortality have been high for patients with severe HPS. We performed post-LT embolotherapy in a 10-year-old boy who had severe type I HPS preoperatively, but he failed to recover early from his hypoxemic symptoms after an LT. Multiple embolizations were then successfully performed on the major branches that formed the abnormal vascular structures. After the embolotherapy, the patient had symptomatic improvement and he was discharged without complications.

[An experience of ABO-incompatible kidney transplantation using plasmapheresis and anti-CD20 monoclonal antibody]

Due to an extreme shortage of cadaveric kidneys, many centers in Japan successfully performed ABO-incompatible kidney transplantations using plasmapheresis, splenectomy and immunosuppression. Recently, a protocol including anti-CD20 monoclonal antibody (rituximab) and antigen-selective immunoadsorption has been used for ABO-incompatible transplantation in Europe. In Korea, ABO-incompatible kidney transplantation has been rarely performed. We report an experience of successful ABO-incompatible kidney transplantation using plasmapheresis and rituximab. The patient was a 32-yr-old female suffering from chronic renal failure, and her blood type was O, Rh+. The donor was her husband, and his blood type was B, Rh+. A combination therapy including 5 times of plasmapheresis starting from 10 days before transplantation with 2-day interval, intravenous gammaglobulin, rituximab at 2 weeks before transplantation and potent immunosuppression successfully decreased the titers of anti-A and anti-B antibodies to 1:2 and 1:1, respectively. The kidney transplantation was successful without any sign of hyperacute or acute rejection.

Prognostic factors affecting survival after recurrence in adult living donor liver transplantation for hepatocellular carcinoma

Liver transplantation is regarded as an effective treatment for early hepatocellular carcinoma (HCC). However, some patients experience recurrence and subsequently rapid progression of the disease. We investigated prognostic factors affecting survival after recurrence in patients who underwent adult living donor liver transplantation (LDLT) for HCC. From October 1992 to December 2005, 138 adult patients underwent LDLT for HCC. Among these, 28 patients (20.3%) who suffered recurrence were retrospectively reviewed. Univariate and multivariate analyses were performed to analyze factors affecting survival after recurrence. The median time to recurrence was 7.9 months. The median survival time after recurrence was 11.7 months, and the 1- and 3-year survival rates after recurrence were 52.8% and 15.8%, respectively. Initially, 7 patients (25%) showed multiorgan involvement; however, in the follow-up, 21 patients (75%) had multiorgan involvement. On univariate analysis, a pretransplant alpha-fetoprotein level >1000 ng/mL, major vascular invasion, a poorly differentiated tumor, a time to recurrence < or =6 months, unresectable disease, and bony metastases were related to shorter survival after recurrence. The independent prognostic factors by multivariate analysis were major vascular invasion [hazard ratio (HR) = 7.6], a poorly differentiated tumor (HR = 4.3), unresectable disease (HR = 10.4), and bony metastases (HR = 3.2). Two patients survived more than 36 months. One of them underwent retransplantation and survived for 45 months without additional recurrences. In conclusion, after transplantation, recurrent HCC has a tendency to involve multiple organs, and the prognosis is very poor. However, some patients have a good prognosis, and the appropriate treatment can prolong their survival. If the recurrent lesion is locally controllable, surgical resection should be considered.

Correlation between hippocampal volumes and proton magnetic resonance spectroscopy of the posterior cingulate gyrus and hippocampi in Alzheimer's disease

Prior studies have reported hippocampal volume loss, decrease in N-Acetylaspartate (NAA) concentration and increased myo-inositol (mI) concentration in patients with Alzheimer’s disease (AD). The purpose of this study was to evaluate hippocampal volumes of AD patients and their correlation with metabolic changes detected by proton spectroscopy (1H MRS) of hippocampal formations and the posterior cingulate region.

A Comparison of Consumption and Recovery Profiles According to Anaesthetic Circuit Mode using a New Multifunctional Closed-Circuit Anaesthesia System during Desflurane Anaesthesia: A Clinical Study

This clinical study compared induction time, consumed anaesthetic dose, and haemodynamic and recovery profiles when using a new type of multifunctional anaesthesia machine (Zeus®) in semi-closed or closed circuit modes. Sixty female patients undergoing gynaecological surgery were randomly assigned to three groups and received desflurane anaesthesia through a semi-closed circuit (SCC) at fresh gas flow rates of 4 l/min (SCC 4 l/min) or 2 l/min (SCC 2 l/min), or through a closed circuit (CC). Anaesthesia was maintained at the minimum alveolar concentration for blocking the adrenergic response to painful stimulus (MACBAR) (4.6% end-tidal desflurane) during each operation. The time required to reach MACBAR was significantly shorter and the dose of desflurane was significantly smaller in the CC group compared with the other groups. There were no differences in haemodynamic and recovery profiles between the groups. It is concluded that the CC mode allowed a faster and more reliable induction, lower anaesthetic consumption and stable haemodynamic and recovery profiles.

Expansion of hepatic progenitor cell in fatty liver graft after living donor liver transplantation

Although it is known that steatotic livers have a reduced ability to regenerate, most individuals with steatosis show generally benign prognosis. We hypothesized that a proliferative blockade in steatotic hepatocytes results in the compensatory expansion of hepatic progenitor cells (HPC) during fatty liver regeneration. Fifty-four cases of living donor liver transplantation (LDLT) with a liver biopsy performed at the postoperative 10th day were examined. HPC were counted by immunofluorescence histochemical dual-staining technique using cytokeratin 7 and Ki-67, and the replicative arrest of hepatocytes was assessed by p21 immunohistochemistry. The degree of ductular proliferation during regeneration 10 days after LDLT correlated both with the degree of steatosis and the number of HPC (P < 0.001). There was no difference in the average number of HPC and the replicative arrest index between donors with or without steatosis before LDLT (P = 0.111 and P = 0.062). However, degree of steatosis correlated with both the expansion of HPC and the replicative arrest index during liver regeneration 10 days after LDLT (P < 0.001 and P < 0.001, respectively). Moreover, increased replicative arrest was strongly associated with HPC expansion (P < 0.001). In conclusion, the compensatory expansion of HPC as a result of impaired hepatocyte replication occurred during steatotic liver regeneration after LDLT.

Preventive effects of COX-2 inhibitor, celecoxib on renal tubular injury induced by shock wave lithotriptor

Our study was designed to investigate the protective effect of the COX-2 inhibitor, celecoxib, on renal tubules against shock wave lithotripsy (SWL). Sprague-Dawley rats were randomly divided into three groups: sham, control, and COX-2 groups. The control group was administrated normal saline. The COX-2 group was administered celecoxib (10 mg/kg). After administration for 1 week, the control and COX-2 groups received 1,000 shock waves. Before and after SWL, 24-h urine was collected. CCr was measured to assess renal function. To determine the renal tubular injury, N-acetyl glucosaminidase (NAG) and beta-2 microglobulin levels in urine were quantified. The COX-2 gene expression was compared between the three groups. Prior to SWL, all groups had similar levels of NAG and beta-2 microglobulin. After SWL, all groups showed similar CCr. Compared with the sham group, control and COX-2 groups produced increase of NAG and beta-2 microglobulin excretion. However, NAG and beta-2 microglobulin excretions were significantly lower in the COX-2 group than control group. The COX-2 gene expression did not increase in the sham group. However, the COX-2 gene expression was significantly increased in the control group, which was prevented by celecoxib in COX-2 group. Biochemical findings supported a renal protective effect of celecoxib on SWL. This study suggests that celecoxib would be useful prior and after SWL because of renal protective effects.

Pharmacokinetics of prothionamide in patients with multidrug-resistant tuberculosis

SETTING

National Masan Tuberculosis Hospital, Masan, South Korea.

OBJECTIVE

To evaluate the pharmacokinetics of prothionamide (PTH) in South Korean patients with multidrug-resistant tuberculosis (MDR-TB) and to investigate whether differences in body mass index (BMI) could explain observed differences in PTH disposition.

DESIGN

Seventeen patients participated in the study; all had MDR-TB and had received combination anti-tuberculosis treatment, including PTH, cycloserine, ofloxacin, para-aminosalicylic acid and streptomycin or kanamycin, for at least 2 weeks. The patients were divided into two groups based on BMI: Group A (18.5 < or = BMI<23), and Group B (BMI<18.5). Serum samples were collected over 24 h, and the plasma PTH concentration was determined by a validated high-performance liquid chromatography assay.

RESULTS

After steady-state administration of PTH, the mean area under the plasma concentration-time curve from time 0 to 12 h (AUC(0-12h)) was 11.0 +/- 3.7 microg h/ml. The mean T(max) and t(1/2) were respectively 3.6 h and 2.7 h. No significant difference in PTH disposition was observed between groups A and B, except for ke and t(1/2).

CONCLUSION

In the pharmacokinetic parameter estimates for PTH in MDR-TB patients during routine treatment, the pharmacokinetics of PTH did not appear to correlate with extent of emaciation in MDR-TB patients.

The effect of increasing operating room capacity on day-of-surgery cancellation

Several studies have been conducted to evaluate the utilisation of the operating room, a fixed resource, in terms of conditions that prevent day-of-surgery cancellation due to deficient operative capacity. In this study, we surveyed the causes and overall rates of elective surgery cancellation and then compared the number of cancellations that occurred before and after the installation of additional operating rooms. We surveyed all patients undergoing elective surgery for 100 days prior to and after the installation of additional operating rooms. The causes for cancellations were divided into six categories: departmental issues, abnormal laboratory results, patient denial, inadequate preparation, over-booking and other issues. The departmental causes were further divided into four categories: ward overflow, scheduling date errors, unavailable surgeons and other issues. The number of overall cancelled cases and scheduled cases increased following the increase in operating room capacity, although this increase was not statistically significant. However; the cancellation ratio rose significantly after the operating room capacity was increased. The primary reasons for cancellation prior to the increase in operating room capacity were departmental issues, over-booking and abnormal laboratory data, in that order. After the operating room capacity was increased, the primary reasons for cancellation were departmental issues, abnormal laboratory data and over-booking, in that order Taken together the results of this study indicate that increased operating room capacity can prevent cancellation due to over-booking. However; the numbers of cancellations due to ward overflow exceeded the numbers of cancellations that occurred as a result of over-booking. In conclusion, increasing the operating room capacity is not an appropriate option for preventing the cancellation of operations.

Improved outcome of adult recipients with a high model for end-stage liver disease score and a small-for-size graft

Although adult-to-adult living donor liver transplantation (ALDLT) has shown comparable outcomes to deceased donor liver transplantation, the outcome of patients with a high MELD score (>25) and a small-for-size graft (SFSG<0.8% of graft-to-recipient weight ratio) is not known. For 7 years, 167 consecutive hepatitis B virus-infected recipients underwent ALDLT at our institution. Based on their MELD score without additional score for hepatocellular carcinoma (HCC), the recipients were divided into Group L (low MELD score, n = 105) or Group H (high MELD score, n = 62). To analyze the risk of the graft size, the patients were further stratified as follows: Group Hs (high MELD score and SFSG, n = 11), Hn (high MELD score and normal size graft, n = 51), Ls (low MELD score and SFSG, n = 18), and Ln (low MELD score and normal size graft, n = 87). The primary endpoint was one-year patient survival rate (1-YSR). The mean follow-up period was 32.6 months. The mean MELD scores were 17.1 in Group L and 32.6 in Group H. Group H had more patients with the complications of cirrhosis but less patients with HCC than Group L (p < 0.05). However, major morbidity rates and 1-YSR were similar in comparisons between Group L (46.7% and 86.7%) and H (59.7% and 83.8%) (p > 0.05). 1-YSR was similar among Group Hs (72.7%), Hn (86.3%), Ls (83.3%), and Ln (88.5%) groups (p = 0.278). The multivariate analysis revealed accompanying HCC and the year of transplant were risk factors for poor 1-YSR. However, 1-YSR without HCC patients was also similar in comparisons between group L (90.2%) and H (91.7%) (p = 0.847), and among Group Hs (80.0%), Hn (94.7%), Ls (72.7%), and Ln (96.7%) (p = 0.072). In conclusion, high MELD score (>25) didn't predict 1-YSR in ALDLT. Improvement of the 1-YSR might be affected by center's experience as well as the selection of patients with low risk of recurrence of HCC.

Endoscopic treatment for biliary stricture after adult living donor liver transplantation

Endoscopic intervention is considered to be the primary treatment for biliary stricture after adult living donor liver transplantation (LDLT) with duct-to-duct biliary reconstruction. The aim of this study was to investigate the risk factors of biliary stricture and the clinical outcomes and predictors of failure after endoscopic retrograde cholangiography with balloon dilation (ERC-D). We enrolled 239 adult patients who underwent LDLT between 2000 and 2006. Sixty-eight patients (28.4%) developed biliary stricture. Twenty-nine patients with anastomotic biliary stricture were treated with ERC-D and stenting. We retrospectively analyzed the risk factors of biliary stricture and the clinical outcomes of ERC-D. The median follow-up period was 31 months. The risk factors of biliary stricture on multiple logistic regression analysis were a graft with multiple bile ducts, a previous history of bile leakage, and hepatic artery stenosis. The overall success rate of ERC-D was 64.5%. On simple logistic regression, the failure of primary ERC-D was associated with late biliary stricture over 24 weeks and more than 8 weeks between a 2-fold increase of serum alkaline phosphatase from the stable level and ERC-D, even though these were not statistically significant on multiple logistic regression. The relapse rate of stricture after successful ERC-D was 30%. The duration of stenting in the recurrence group was shorter than that in the nonrecurrence group (11.8 +/- 5.03 versus 29.0 +/- 11.6 weeks, P = 0.004). ERC-D is effective for the management of anastomotic biliary stricture. However, the failure rate of primary ERC-D may be high in patients with late onset and delayed diagnosis of biliary stricture. The recurrence seems to occur frequently in patients with a short duration of stenting.

CO2 laser writing of long-period fiber grating in photonic crystal fiber under tension

We demonstrate that the efficiency of CO(2) laser writing of long-period fiber gratings in a solid-core photonic crystal fiber (PCF) can be enhanced greatly by applying tension to the fiber during the writing process through the mechanism of frozen-in viscoelasticity. Using this mechanism, we are able to write strong gratings in PCFs with a dosage of CO(2) laser radiation low enough not to cause any significant fiber structure deformation.

Reorganisation of cortical motor and language distribution in human brain

BACKGROUND

The locations of cortex controlling motor, sensory, or language functions can change in adult humans under some circumstances, such as expanding tumours, trauma or continuous focal seizures. It is not clear what other circumstances might result in changes in cortical functional maps.

METHODS

The results of extraoperative cortical mappings of motor, sensory, and language functions were compared in two epilepsy patients who underwent cortical resections on two separate occasions and who did not have brain tumours.

RESULTS

It was found that the locations of motor functions could differ between the first and second procedures, but the locations of language functions were quite similar. The changes were not necessarily in or adjacent to epileptogenic regions or adjacent to resection boundaries.

CONCLUSIONS

These findings support previous evidence indicating that cortical functional representations can change over time in humans, and suggest that these changes cannot be explained solely by lesion effects.

Laparoscopic hepatectomy for a modified right graft in adult-to-adult living donor liver transplantation

BACKGROUND

We performed a modified right hepatectomy completely by laparoscopic techniques preserving the middle hepatic vein (MHV) branches in adult-to-adult living donor liver transplantation (LDLT).

PATIENTS AND METHODS

Two young women (24 and 25 years old) volunteered to be live donors for their parents who had hepatocellular carcinomas. As the donors expressed concerns about scarring, we performed a laparoscopic procedure using a hand port device. Mobilization of the right liver and the hepatic parenchymal transection were performed under pneumoperitoneum. Parenchymal transection was performed using a laparoscopic ultrasonic aspirator without the Pringle maneuver. During parenchymal transection, major MHV branches >5 mm were preserved using Hem-o-lock clips. The graft was extracted through the hand port site. On the back table, the 3 MHV branches were reconstructed using an artificial vascular graft. The livers were transplanted without complications.

RESULTS

The operative times for the donors were 765 and 898 minutes. The donors did not require transfusions or reoperation; they were discharged on postoperative days 10 and 14 with normal liver functions.

CONCLUSION

A hepatectomy performed completely by laparoscopic techniques for a right graft with preservation of the MHV branches was technically feasible.