Burning mouth syndrome: a systematic review of treatments

Burning mouth syndrome (BMS) is a chronic oral pain syndrome that primarily affects peri- and postmenopausal women. It is characterized by oral mucosal burning and may be associated with dysgeusia, paresthesia, dysesthesia, and xerostomia. The etiology of the disease process is unknown, but is thought to be neuropathic in origin. The goal of this systematic review was to assess the efficacy of the various treatments for BMS. Literature searches were conducted through PubMed, Web of Science, and Cochrane Library databases, which identified 22 randomized controlled trials. Eight studies examined alpha-lipoic acid (ALA), three clonazepam, three psychotherapy, and two capsaicin, which all showed modest evidence of potentially decreasing pain/burning. Gabapentin was seen in one study to work alone and synergistically with ALA. Other treatments included vitamins, benzydamine hydrochloride, bupivacaine, Catuama, olive oil, trazodone, urea, and Hypericum perforatum. Of these other treatments, Catuama and bupivacaine were the only ones with significant positive results in symptom improvement. ALA, topical clonazepam, gabapentin, and psychotherapy may provide modest relief of pain in BMS. Gabapentin may also boost the effect of ALA. Capsaicin is limited by its side effects. Catuama showed potential for benefit. Future studies with standardized methodology and outcomes containing more patients are needed.

Peroxisome proliferator-activated receptor δ inhibits Porphyromonas gingivalis lipopolysaccharide-induced activation of matrix metalloproteinase-2 by downregulating NADPH oxidase 4 in human gingival fibroblasts

We investigated the roles of peroxisome proliferator-activated receptor δ (PPARδ) in Porphyromonas gingivalis-derived lipopolysaccharide (Pg-LPS)-induced activation of matrix metalloproteinase 2 (MMP-2). In human gingival fibroblasts (HGFs), activation of PPARδ by GW501516, a specific ligand of PPARδ, inhibited Pg-LPS-induced activation of MMP-2 and generation of reactive oxygen species (ROS), which was associated with reduced expression of NADPH oxidase 4 (Nox4). These effects were significantly smaller in the presence of small interfering RNA targeting PPARδ or the specific PPARδ inhibitor GSK0660, indicating that PPARδ is involved in these events. In addition, modulation of Nox4 expression by small interfering RNA influenced the effect of PPARδ on MMP-2 activity, suggesting a mechanism in which Nox4-derived ROS modulates MMP-2 activity. Furthermore, c-Jun N-terminal kinase and p38, but not extracellular signal-regulated kinase, mediated PPARδ-dependent inhibition of MMP-2 activity in HGFs treated with Pg-LPS. Concomitantly, PPARδ-mediated inhibition of MMP-2 activity was associated with the restoration of types I and III collagen to levels approaching those in HGFs not treated with Pg-LPS. These results indicate that PPARδ-mediated downregulation of Nox4 modulates cellular redox status, which in turn plays a critical role in extracellular matrix homeostasis through ROS-dependent regulation of MMP-2 activity.

Ligand-activated peroxisome proliferator-activated receptor-δ and -γ inhibit lipopolysaccharide-primed release of high mobility group box 1 through upregulation of SIRT1

Peroxisome proliferator-activated receptors (PPARs) inhibit lipopolysaccharide (LPS)-primed release of high mobility group box 1 (HMGB1), a late proinflammatory mediator, but the underlying molecular mechanism is not completely understood. In this study, we demonstrated that the inhibition of HMGB1 release by PPAR-δ and -γ is associated with the deacetylase activity of SIRT1. Ligand-activated PPAR-δ and -γ inhibited LPS-primed release of HMGB1, concomitant with elevation in SIRT1 expression and promoter activity. These effects were significantly reduced in the presence of small interfering (si)RNAs against PPAR, indicating that PPAR-δ and -γ are involved in both HMGB1 release and SIRT1 expression. In addition, modulation of SIRT1 expression and activity by siRNA or chemicals correspondingly influenced the effects of PPARs on HMGB1 release, suggesting a mechanism in which SIRT1 modulates HMGB1 release. Furthermore, we showed for the first time that HMGB1 acetylated in response to LPS or p300/CBP-associated factor (PCAF) is an effective substrate for SIRT1, and that deacetylation of HMGB1 is responsible for blockade of HMGB1 release in macrophages. Finally, acetylation of HMGB1 was elevated in mouse embryonic fibroblasts from SIRT1-knockout mice, whereas this increase was completely reversed by ectopic expression of SIRT1. These results indicate that PPAR-mediated upregulation of SIRT1 modulates the status of HMGB1 acetylation, which, in turn, has a critical role in the cellular response to inflammation through deacetylation-mediated regulation of HMGB1 release.

Association between cigarette smoking history and mortality in 36,446 health examinees in Korea

BACKGROUND

It is well known that smoking is a preventable factor for all-cause mortality; however, it is still questionable how many years after smoking cessation that people will have reduced risk for mortality, in particular in those with a high interest in their own health. We aimed to examine the association between time since quitting smoking and total mortality among past-smokers relative to current smokers.

MATERIALS AND METHODS

We enrolled 36,446 health examinees that voluntarily taken with diverse health check-up packages of high cost burden in 1995-2003 and followed them till death by 2004. The history of cigarette smoking consumption was collected using a self-administrative questionnaire at the first visit time. Mortality risk by smoking cessation years was analyzed using Cox's proportional hazard model.

RESULTS

Compared to non-smokers, male smokers over 15 pack-years had higher risk for total mortality (HR=1.49, 95%CI 1.02-2.18). The mortality risk in female smokers with same pack-years was more pronounced than that in male smokers (HR=2.83, 95%CI 1.17-7.04) despite a small number of cases. Compared to current smokers, a decrease of total mortality was observed among those who ceased smoking, and inverse dose-response was found with years after cessation: RR 0.98 (95%CI, 0.64-1.41) (<2 yrs), 0.60 (95%CI, 0.43-0.83) (3-9 yrs), and 0.58 (95%CI, 0.43-0.79) (≥10 yrs).

CONCLUSIONS

A reduced risk of total mortality was observed after 3 years of smoking cessation. Our findings suggest that at least 3 years of smoking cessation may contribute to reduce premature mortality among Asian men.

Cut-off Point of BMI and Obesity-Related Comorbidities and Mortality in Middle-Aged Koreans

OBJECTIVE

The need for a lower BMI to classify overweight in Asian populations has been controversial. Using both disease and mortality outcomes, we investigated whether lower BMI cut-off points are appropriate for identifying increased health risk in Koreans.

RESEARCH METHODS AND PROCEDURES

We conducted a cohort study among 773,915 men and women from 30 to 59 years old with 8- to 10-year follow-up periods. Primary outcomes were change of obesity prevalence, obesity-related disease incidence, and all-cause mortality.

RESULTS

Prevalence of overweight (BMI of 25.0-29.9) has steadily increased (1.3% annually), whereas obesity (BMI > or = 30) showed a lower prevalence and only a slight increase (0.1%-0.2% annually). Our study revealed that dose-response relationships exist between obesity and related disease incidences (hypertension, type 2 diabetes, and hypercholesterolemia) beginning at lower BMI levels than previously reported. Compared with those in the healthy weight range, Koreans with a BMI > or = 25 were not at greater risk of hypertension, type 2 diabetes, or hypercholesterolemia than has been reported for whites in similar studies. Obesity-related all-cause mortality also did not seem so different from that of whites.

DISCUSSION

Our findings did not support the use of a lower BMI cut-off point for defining overweight in Koreans compared with whites for the purpose of identifying different risks. However, populations with BMI > or = 25 are rapidly increasing and have substantial risks of diseases. To preempt the rapid increases in obesity and related health problems that are occurring in Western countries, Korea should consider using a BMI of 25 as an action point for obesity prevention and control interventions.

Investigation of the association between 677C>T and 1298A>C 5,10-methylenetetra- hydrofolate reductase gene polymorphisms and normal-tension glaucoma

PURPOSE

Homozygous polymorphism of the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene and resultant hyperhomocysteinaemia have been established as an independent risk factor for vascular diseases. There are evidences that vascular abnormalities are involved in the pathogenesis and progression of normal-tension glaucoma (NTG). In the present study, we were to find out the associations between 677C>T and 1298A>C polymorphisms of the MTHFR gene and NTG.

METHODS

This was a retrospective, case-controlled study enrolling 78 NTG patients and 100 controls. DNA from peripheral blood lymphocytes was extracted and the genotypes of polymorphisms (677C>T and 1298A>C) in the MTHFR gene were determined using PCR followed by restriction enzyme digestion. The frequencies of the polymorphic genotypes in the patients with NTG and controls were compared.

RESULTS

The frequencies of the polymorphisms of the MTHFR gene (677C>T and 1298A>C) in the NTG patients were not significantly different from those of controls. But the younger NTG patients (age at diagnosis < or = 45 years) showed significantly higher prevalence of 677C>T polymorphism than the older NTG patients (age at diagnosis > 45 years) (TT genotype, 38.9 vs 11.9%, P=0.006, OR=4.71, 95% CI=1.49-14.9) and than the younger control subgroup (TT genotype, 38.9 vs 6.1%, P=0.001, OR=9.86, 95% CI=2.23-42.4).

CONCLUSIONS

The 677C>T polymorphism was significantly associated with NTG in the younger patients, while 1298A>C polymorphism was not. This suggests that 677C>T polymorphism of the MTHFR gene can be a genetic risk factor of NTG in Korean population.

Abdominal obesity, systolic blood pressure, and microalbuminuria in normotensive and euglycemic Korean men

OBJECTIVES

To evaluate the relationship between abdominal obesity and microalbuminuria (MA) in normotensive, euglycemic Korean men.

DESIGN

A cross-sectional study at a health screening center.

SUBJECTS

A total of 1321 healthy, normotensive Korean men, aged 20-78 years, with a fasting plasma glucose level <100 mg/dl.

MEASUREMENTS

Height, weight, and waist; systolic blood pressure (SBP); diastolic blood pressures (DBP); urinary albumin to creatinine ratio (ACR); fasting glucose, insulin, lipids, C-reactive protein (CRP), and white blood cell count. Waist circumference (WC) was used to indicate abdominal obesity and a single measurement of ACR was used to estimate MA. We also calculated body mass index (BMI) based on weight and height.

RESULTS

Mean BMI, WC, and SBP were significantly higher in subjects with MA than in those without (24.8+/-4.1 vs 23.8+/-2.7 kg/m2, 86+/-9 vs 83+/-8 cm, and 115+/-5 vs 112+/-7 mmHg, respectively). Multiple logistic regression analyses showed that only WC and SBP were independent predictors of MA.

CONCLUSION

WC and SBP were positively associated with MA in normotensive and euglycemic Korean men.

Investigations on the association between normal tension glaucoma and single nucleotide polymorphisms of the endothelin-1 and endothelin receptor genes

PURPOSE

In normal tension glaucoma (NTG), intraocular pressure is within normal the range; thus, some mechanism other than increased pressure contributes to the optic neuropathy. Endothelin may be an important contributor to the development of the optic neuropathy characteristic of glaucoma. We investigated whether polymorphisms of the endothelin-1, endothelin receptor type A, and endothelin receptor type B genes were associated with NTG.

METHODS

Sixty-seven Korean NTG patients and 100 healthy Korean subjects were enrolled. DNA from peripheral blood leukocytes was extracted and genotype distributions of six polymorphisms in genes encoding endothelin-1 (EDN1:c.-131dupA, EDN1:c.594G > T), endothelin receptor type A (EDNRA:c.-231G > A, EDNRA:c.*70C > G, EDNRA:c.*1222C > T), and endothelin receptor type B (EDNRB:c.831A > G) were determined. Genotype and allele distributions were compared between patients and controls. In NTG subjects, untreated baseline intraocular pressure and age at the time of diagnosis, as well as the mean deviation and pattern standard deviation values of automated static perimetry were examined for an association with these genetic polymorphisms.

RESULTS

The polymorphism of EDNRA:c.*1222C > T was significantly associated with NTG (p = 0.028, OR = 3.33, 95% CI 1.05-10.24). In addition, the AA genotype of the EDNRA:c.-231G > A polymorphism was associated with a lower baseline intraocular pressure than in the GG+GA genotype group (14.0 +/- 2.8 mm Hg versus 16.2 +/- 2.3 mm Hg, p = 0.047). No polymorphism was associated with visual field parameters.

CONCLUSIONS

A polymorphism of the endothelin receptor type A gene is associated with NTG.

Sexual activity in Korean male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury

BACKGROUND

The aim of this study was to assess the sexual function and activity in male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury.

METHODS

Eighty-nine patients (mean age 37.6 years with a range of 18-66) were included in the study. We requested all subjects to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5).

RESULTS

Of 89 patients, 60 (67.4%) reported having attempted no sexual intercourse over the past 6 months and 28 (31.5%) presented with IIEF-5 scores less than or equal to 21 points. When subjects were stratified according to the years since injury, 50.0% (16 of 32) with less than 2 years post-injury had no sexual activity, while 77.2 (44 of 57) with 2 years or more post-injury did (P = 0.027). Patients with sexual activity were 40.4% (23 of 57) and 18.8% (6 of 32) in patients who were able and unable to perform self-catheterization, respectively (P = 0.037). Patients with less than 2 years post-injury had 3.3-fold higher risk (odds ratio 3.33; 95% confidence interval 1.01-10.97; P = 0.048) of no sexual activity than those with 2 years or more post-injury on the multivariate model. The other parameters were not appreciably related to sexual activity.

CONCLUSION

Our results demonstrate that sexual activity as well as erectile function is poor in this population. In addition, our findings suggest that years since injury may influence sexual activity of patients with spinal cord injury.

Depressive symptoms of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

STUDY DESIGN

Prospective, cross-sectional study, based on cases of spinal cord injury (SCI).

SETTING

Three outpatient medical departments in Seoul, Korea.

OBJECTIVES

To assess depressive symptoms in patients on clean intermittent catheterization after SCI.

METHODS

In total, 102 subjects (68 males and 34 females, mean age 39.5 with a range of 18-75 years) were included in the primary analysis. A control group of 110 was selected from the routine health checkup. All subjects completed the Beck Depression Inventory (BDI).

RESULTS

For patients and controls, the average total BDI scores were 20.3+/-1.0 and 11.4+/-0.5, respectively (P<0.001). With regard to severity of depression among patient groups, three (3.0%) reported normal; four (3.9%) reported mild to moderate depression; 24 (23.5%) reported moderate to severe depression; and 71 (69.6%) reported severe depression. On the multivariate logistic regression analysis, a positive association with the risk of depression was observed in gender and type of catheterization. Female patients had a 3.8-fold higher risk (odds ratio (OR) 13.83; 95% confidence interval (CI) 1.42-10.31; P=0.008) of depression than male patients. In the same model, patients who were unable to perform catheterization independently had a 4.6-fold higher risk (OR 4.62; 95% CI 1.67-12.81, P=0.003) of depression than those who were able to perform self-catheterization.

CONCLUSIONS

The results demonstrate that the patients with neurogenic bladder secondary to SCI have higher degrees of depression than normal population. In addition, our findings also suggest that depression is closely related to gender and patient's ability to perform self-catheterization.

Health-related quality of life of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

OBJECTIVES

To determine the psychological and social status of patients using clean intermittent catheterization for neurogenic bladder according to health-related quality of life (HRQOL).

METHODS

We conducted a prospective trial involving 132 patients (81 men and 51 women, mean age 41.8 years, range 18 to 80 years) using clean intermittent catheterization because of neurogenic bladder secondary to spinal cord injury. The 150 controls (90 men and 60 women) lived in the same region as the patients and were frequency matched to ensure equal age and sex distributions. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36).

RESULTS

The SF-36 scores did not reveal any significant differences between the men and women in the patient group. The SF-36 scores of the patients were significantly lower than those of the general population. When patients and controls were divided into two groups according to sex and age, the SF-36 scores of the patients were significantly lower than the controls across both sex and all age groups, other than the energy and vitality scale, the differences for which were not statistically significant in women and those younger than 50 years.

CONCLUSIONS

Our findings suggest that patients using clean intermittent catheterization because of neurogenic bladder secondary to spinal cord injury generally exhibit a reduced quality of life in all health domains as assessed by the SF-36.

Investigation of the Association between OPA1 Polymorphisms and Normal-Tension Glaucoma in Korea

PURPOSE

OPA1, the gene responsible for autosomal dominant optic atrophy, represents a good candidate gene for normal-tension glaucoma (NTG). Single nucleotide polymorphisms on intervening sequence (IVS) 8 of the OPA1 gene (IVS8+4C>T; +32T>C) were recently found to be strongly associated with NTG in a Caucasian population. We investigated whether these polymorphisms in the OPA1 gene were associated with NTG in Korea.

PATIENTS AND METHODS

Sixty-five Korean NTG patients and 101 healthy Korean subjects were enrolled. DNA from peripheral blood leukocytes was extracted and the genotypes of two polymorphisms (IVS8+4C>T; +32T>C) in the OPA1 gene were determined using the restriction fragment length polymorphism method. The genotype and allele frequencies of two polymorphism in patients with NTG and normal controls were compared using the Fisher exact test and the chi test. Frequencies of haplotypes and haplotypes groups were also analyzed to assess the combined effect of two polymorphisms.

RESULTS

The frequencies of the CT genotype of IVS8+4C>T, CC genotype of IVS8+32T>C, and TT genotype of IVS8+32T>C were not significantly different between NTG patients and controls (4.6% versus 0.0%, P = 0.058 by the Fisher exact test; 10.8% versus 4.0%, P = 0.11 by the Fisher exact test; 61.5% versus 67.3%, P = 0.45 by the chi test, respectively). Any haplotype or haplotype group of IVS8+4C>T and IVS8+32T>C was not associated with NTG, and the C allele of IVS8+32T>C was not a significant modifier of IVS8+4C>T.

CONCLUSIONS

There were no significant associations between IVS8+4C>T; +32T>C polymorphisms and NTG in the Korean population. These results do not support the results in Caucasians and indicate that ethnic differences may exist in the association between polymorphisms in the OPA1 gene and NTG.

Cigarette smoking and cancer incidence risk in adult men: National Health Insurance Corporation Study

We analyzed risk while adjusting for age, body mass index, frequency of moderate physical activity, alcohol consumption, preference for vegetables versus meats, and frequency of meat consumption in a multivariate analysis and based our findings on not mortality data but incidence data. 733,134 Korean men who were 30 years old or older, insured by the National Health Insurance Corporation, and had a medical evaluation in 1996 were included in the study and followed up through 2000. During the 4-year follow-up period of 3,590,872 person-years, we identified 7204 new cases. We used the Cox proportional hazards model to estimate adjusted relative risks (aRRs), 95% confidence intervals (CIs). The association of current cigarette smoking was significantly stronger as compared with never smokers; aRR was 1.49 (95% CI=1.39-1.59) for all cancers, 4.46 (2.32-8.57) for esophageal, 3.83 (2.97-4.94) for lung, 3.01 (1.58-5.72) for laryngeal, 2.24 (1.48-3.39) for urinary bladder, 1.62 (1.42-1.84) for gastric, 1.75 (1.12-2.74) for oral and pharyngeal, 1.58 (0.97-2.27) for pancreatic, and 1.50 (1.29-1.74) for liver cancer. Our findings, based on incidence data, confirmed that differences in smoking habit were responsible for most of the differences observed in smoking-related cancers.

Development of a Cancer Pain Assessment Tool in Korea: A Validation Study of a Korean Version of the Brief Pain Inventory

OBJECTIVE

The aim of this study was to validate the Korean version of the Brief Pain Inventory (BPI-K), a pain assessment tool that has been validated in several languages.

METHODS

The sample consisted of 132 patients in Seoul who had recurrent or metastatic cancer and who expressed pain. The Korean version of the Beck Depression Inventory (BDI-K), the Eastern Cooperative Oncology Group (ECOG) performance status score, the Pain Management Index (PMI), and the PMI-Revised (PMI-R) were used to further validate the BPI-K.

RESULTS

Cronbach alphas, computed for the pain interference and pain severity item, were 0.93 and 0.85, respectively. Confirmatory factor analysis of the BPI-K items showed a two-common-factor solution for the BPI-K, consistently demonstrated in other language versions of the BPI. The mean pain interference score was more correlated with the BDI-K scale (r = 0.44) and ECOG (r = 0.39) than the mean pain severity score. Seventy-four percent of the patients in the Seoul sample had inadequate analgesia using the PMI.

CONCLUSION

The BPI-K is a valid and useful instrument for assessing cancer pain and pain impact in Korea.

A common haplotype of interleukin-4 gene IL4 is associated with severe respiratory syncytial virus disease in Korean children

Respiratory syncytial virus (RSV) is a major health problem in young children, and host response to severe disease favors a Th2 immune response. To investigate the genetic basis for RSV disease severity, linked variants of 3 Th2 cytokine genes, IL4, IL13, and IL5 (which are clustered on chromosome 5q31.1) were characterized in 105 children who were hospitalized with severe RSV infection and 315 Korean control subjects in a pilot study. A common IL4 haplotype defined at 5 loci, which includes the -589T promoter variant, previously shown to be associated with increased interleukin (IL)-4 transcriptional activity and predisposition to asthma, was overrepresented in patients with severe RSV disease (odds ratio, 1.63; P=.02). These results support the hypothesis that severe RSV disease might be related to increased Th2 response, which is perhaps mediated by overexpression of IL-4, and provide preliminary evidence for a genetic link between severe RSV disease and subsequent wheezing.

Hepatitis B virus infection and B-cell non-Hodgkin's lymphoma in a hepatitis B endemic area: a case-control study

Several studies have reported a higher prevalence of chronic hepatitis C virus (HCV) infection in patients with B-cell non-Hodgkin's lymphoma and suggested a pathogenic role for HCV, but studies on hepatitis B virus (HBV) infection and non-Hodgkin's lymphoma are limited. To determine the association between HBV infection and non-Hodgkin's lymphoma, we performed a case-control study in Korea, a hepatitis B endemic area. We recruited 222 patients newly diagnosed with non-Hodgkin's lymphoma at Seoul National University Hospital between January 1997 and December 1998 as cases. Four age- and sex-matched controls were selected for each case, and the control groups comprised of 439 patients with non-hematological malignancy (control group 1) and 444 subjects with non-malignant conditions (control group 2). Relative risk of developing non-Hodgkin's lymphoma among individuals tested positive for hepatitis B surface antigen was calculated after controlling for other potential risk factors of lymphoma, such as smoking, alcohol drinking, transfusion history and HCV infection. Hepatitis B surface antigen was positive in 28 of 222 patients (12.6%) with non-Hodgkin's lymphoma compared with 32 of 439 (7.3%) in control group 1, and 21 of 444 (4.7%) in control group 2 (P = 0.001). The crude odds ratio for B-cell non-Hodgkin's lymphoma among the HBV carriers was 2.54 (1.46 - 4.45) and the adjusted odds ratio was 3.30 (1.69 - 6.45) by multivariate analysis. The present study suggests that the risk of B-cell non-Hodgkin's lymphoma is increased in HBV carriers and warrants further investigation of the possible role of hepatitis B virus in the pathogenesis of B-cell non-Hodgkin's lymphoma.

From data to knowledge--the Visible Human Project continues

The U. S. National Library of Medicine (NLM) has long been a world leader in the archiving and distribution of the print-based images of biology and medicine. NLM has also been a pioneer in the use of computer systems to encode and distribute textual knowledge of the life sciences. NLM's Long Range Planning effort of 1985-86 foresaw a coming era where NLM's Bibliographic and factual database services would be complemented by libraries of digital images, distributed over high speed computer networks. The NLM Planning Panel on Electronic Imaging recommended that NLM should undertake the building a digital image library consisting of computerized tomography (CT) and magnetic resonance (MR) images, and cryosection images of a representative, carefully selected and prepared male and female cadaver--the "Visible Human Project ." The male and female Visible Human data sets are now being made available through a license agreement with the NLM. The data sets are supporting a wide range of educational, diagnostic, treatment planning, and commercial uses. The NLM, in partnership with other U.S. government research agencies has begun a three prong effort within the Visible Human Project to address: the creation of a new online, interactive, digital head-and-neck atlas; the development of a tool kit of computational programs capable of automatically performing many of the basic data handling functions required for using Visible Human data in applications; and the improved resolution of future Visible Human data sets through the reduction of the anatomical artifacts introduced by the methods used to stabilize and section the anatomical materials and the development of staining and wide-spectrum methods for increasing tissue contrast.

The Asia Pacific Association for Medical Informatics (APAMI) and World Organisation of Family Doctors (WONCA) Consortium on General and Family Practice Informatics--a statement of intent

This paper describes the establishment of a consortium to advance health and medical informatics in general/family practice in the Asia Pacific Region. The objectives, current activities currently taking place in the region and key activities planned will be outlined.

Home telecare system integrated with periodic health reminder and medical record & multimedia health information

The necessity of home telecare system is growing due to increase in desire for health promotion owing to increase in chronic diseases, aged population and medical expenses. Already, we computerized patient's data and offer periodic health reminder to patients for health promotion by using Life-time Health Monitoring Program (LHMP). Our study connected LHMP to the Web on internet by CGI as an electronic medical record; enabling reference to patient's medical records anywhere. The study also made possible video teleconsultation and constructed multimedia database to provide health-related information to the patients. On these bases, a flow chart was developed using the home telecare to practice manage patients with chronic diseases, old patients, and the handicapped. Further standardization in data, establishment of law bases for home telecare system, development of rules for medical fees and active utilization of biomedical telemetry will be needed to extend home telecare system.

Standardization of the nationwide health examination in Korea

The Korea Medical Insurance Corporation has held the periodic Health Examination for the public servants and teachers from 1977 as a nationwide health preventive task. But the Health Examination result is not computerized rather than paperwork, so the use of the Health Examination is limited and the results of Health Examination can not be stored or interchangeable between hospitals or health examination centers in this system. So we planed the Standardization of the Nationwide Health Examination project and developed the Health Examination computer program in 1996. The object of standardized program is to contribute to cost-effective analysis of each item or other studies about the factors influences development of diseases. And now, an Exhibition work for the standardization is being held with the Health Examination computer program. At the ending of the Exhibition work, we will evaluation and revision the computerized program for standardization process.

Features for a B-ISDN telemedicine system and its application

Telemedicine technology is emerging as a new way of medical practice. It will provide more cooperative activity between departments and more comfortable access for disabled patients home. We developed two types of telemedicine system: a telediagnosis system and a home care system. Our telemedicine application is aimed to be run on the broadband-integrated services digital network (B-ISDN). The legacy network is also considered. The user interface is designed to help doctors to communicate easily. The key elements of telemedicine systems are user friendly interface, medical multimedia database design highly refined display technique.

Information system for a periodic examination and health promotion center

The periodic examination and health promotion center (PEHPC) in Seoul National University Hospital has developed and adopted an information system supported by computers which use an electronic medical record to improve the quality of patient care, advance the science of medicine, lower health care costs, and enhance the education of health care professionals. This information system adopted the concept of incomplete and evolutionary systems to conduct the pursuit of practicalness and efficacy. It has increased efficiency to save costs and to enhance the quality of the medical service. It has also activated clinical research due to ease of managing data. We are also preparing for telecare. Telecare and WWW-using information system is postponed because the protection of a patients privacy is not established.

[Clinical experience with cefbuperazone in complicated urinary tract infection]

Cefbuperazone (CBPZ) was administered to inpatients with complicated urinary tract infections (UTI) at our department. Clinical efficacy and safety were evaluated in 22 chronic cases by the criteria for evaluation of clinical of antimicrobial agents on urinary tract infection. Overall clinical efficacy was excellent in 8 cases, moderate in 9 cases and poor in 5 cases with an effectiveness rate of 77%. Twenty-four of the 34 strains isolated from the patients were eradicated and eradication rate was 71%. Neither subjective nor objective adverse reactions were observed. Abnormal changes in laboratory tests were found in 9 patients, but were probably not related to CBPZ administration. Judging from these results, CBPZ is considered to be an effective and safe antibacterial for the treatment of complicated UTI.