The interaction between gut microbiome and nutrients on development of human disease through epigenetic mechanisms

Early environmental exposure is recognized as a key factor for long-term health based on the Developmental Origins of Health and Disease hypothesis. It considers that early-life nutrition is now being recognized as a major contributor that may permanently program change of organ structure and function toward the development of diseases, in which epigenetic mechanisms are involved. Recent researches indicate early-life environmental factors modulate the microbiome development and the microbiome might be mediate diet-epigenetic interaction. This review aims to define which nutrients involve microbiome development during the critical window of susceptibility to disease, and how microbiome modulation regulates epigenetic changes and influences human health and future prevention strategies.

A new 3, 4-epoxyfurocoumarin from Heracleum moellendorffii Roots

Activity-guided isolation of Heracleum moellendorffii roots led to four coumarin derivatives as acetylcholinesterase inhibitors. The structures of these isolates were characterized by spectroscopic method to be angelicin (1), isobergapten (2), pimpinellin (3), and (3S, 4R)-3, 4-epoxypimpinellin (4). All the isolated compounds 1, 2, 3, and 4 showed moderate inhibition activities against acetylcholinesterase with the IC₅₀ values of 10.2, 18.1, 21.5 and 22.9 µM, respectively. (3S, 4R)-3, 4-Epoxypimpinellin (4) was newly isolated from the plant source.

Full mouth rehabilitation on the patient with severe tooth wear and tooth fracture using reestabilishment of occlusal vertical dimension

Severe dental attrition causes pathological changes of the tooth, imbalanced occlusion, and functional and aesthetic complications and can also result in a decrease in occlusal vertical dimension that can incur temporomandibular joint and muscular complications. Before restoring the vertical dimension with full-mouth prosthetic restorations, it is important to determine the amount of vertical lifting through complete diagnosis. In this study, a 59 year-old male patient with generalized attrition and fracture of teeth was treated with full-mouth zirconia prosthetic restoration in order to recover vertical dimension and aesthetics. Through the analysis of physiologic rest position and inter-canine distance, the treatment was planned for lifting 3 mm in vertical dimension. Interim crown were fabricated after full-mouth wax up, having the patient use for 6 months. The final monolithic and bilayered zirconia restorations were completed. The patient showed satisfaction in function and aesthetics for 18 months of follow-up since delivering the final restorations.

Re-restoration of temporomandibular joint disorder acquired after implant prosthetic restoration using T-Scan: A case report / 대한치과보철학회지

In cases of extensive prosthetic restoration, correction of occlusal contact is often needed, as it is the essential component for a successful restoration. If occlusal contact is given incorrectly, various symptoms of occlusal trauma can occur of which temporomandibular joint disorder (TMD) is one of them. As one of the common symptoms of TMD, patients may suffer with masticatory muscle disorder and temporomandibular joint pain. This case presents satisfactory results for the improvement of masticatory muscles and temporomandibular joint pain of a TMD patient, caused by incorrect occlusal contact of the restoration, by replacing the prosthesis after occlusion correction.

An occlusal contact analysis of lateral mandibular movement using T-Scan system / 대한치과보철학회지

PURPOSE: Most of the former studies about the occlusal contact patterns during the mandibular movement focused on foreigner. The purpose of this study is analyzing the occlusal contacts of young Koreans by using T-Scan system. MATERIALS AND METHODS: The sample size was 87 and the occlusal contacts of each right and left lateral movements were measured from the maximum intercuspation to the 3mm excursive position for three times respectively. All of the occlusal contacts were double checked through the thin metal foil. The results were categorized as two; 1) considering occlusal contact patterns on working side only, 2) considering occlusal contact patterns on working and nonworking sides. RESULTS: The results showed that the nonworking side occlusal contacts play major roles in the lateral mandibular movement. In both cases of considering with and without the nonworking side occlusal contacts, the group function was the most prevalent. In the working side, the contacts were the most frequent in canine and the frequency of contacts was decreased as the distance was increased from canine to molar. In the nonworking side, the contacts were the most frequent in second molar. And the gender factor was statistically significant (alpha=.05), as females have more nonworking side occlusal contacts in this study. CONCLUSION: Among the three factors of anterior guidance, the group function was the most dominant factor. The analysis of 87 samples showed that canine contact was the most frequent in the working side and second molar contact was the most common in the nonworking side.

Clinical Nutrition Services of a Long-term Care Hospital in Korea / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to investigate how clinical nutrition services is provided at a long term care hospital in Korea and to investigate job satisfaction levels of the clinical dietitians. METHODS: Survey questionnaire was sent to dietitians working at a long term care hospital in Korea. The participating hospitals (n=240) were randomly selected from 1,180 long- term care hospitals using a stratified sampling method. A total of 134 long term care hospital s and 223 dietitians completed the survey of clinical nutrition service s and job satisfaction questionnaires The job satisfaction questionnaire included 27 job satisfaction questions on task, stability vision, working conditions, and relationship areas. RESULTS: The average nutritional screening rate was 17.9% and the rate of computerized nutritional screening system was 9.7% in the participating hospitals. Nutritional intervention rate was only 3.2% of all patients. KOIHA (Korea Institute for Healthcare Accreditation) accreditated hospitals showed only 50% performance rate of nutrition service evaluation area. This shows that after achieving KOIHA accredition, many hospitals do not emphasize the performance of nutritional services. The job satisfaction scores in all four areas ranged from 2/5 to 3/5, implying generally low job satisfaction level in hospital dietitians. Linear regression analysis results showed that the "hospital adequacy grade" type was a significant predictor of job satisfaction level for two areas (working conditions & relationship). CONCLUSIONS: There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service s in long term care hospitals. Therefore, government and local hospitals have to work on implementing nutritional programs and policies for improved service and care.

Clinical Nutrition Service in Korean Tertiary Hospitals and General Hospitals: Result of Nationwide Cross-Sectional Survey

The purpose of this study was to investigate the status of clinical nutrition services provided at tertiary hospitals and general hospitals in Korea. In total, 157 questionnaires were distributed to the departments of nutrition at hospitals on September 2013. The results of this study are as follows. The median number of beds was 607 and average length of stay was 8 days. 63.1% of dietitians had over 5 years of career experience. Nutritional screening rate was 97% in tertiary hospitals but only 67.2% in general hospitals (P<0.001). The rate of equipment with computerized nutritional screening system was 100% in tertiary hospitals but 71.9% in general hospitals (P<0.001). Hospitals with the best regarding nutritional care were hospitals accredited by JCI (Joint Commission International). On the other hand, hospitals not accredited by the JCI but KOIHA (Korea Institute for Healthcare Accreditation) showed the lowest performance rate of nutritional care. Nutrition support teams (NSTs) were established in all tertiary hospitals but in only 73% of general hospitals (P<0.001). The rate of actively operating NSTs was 89% in tertiary hospitals but only 62% in general hospitals (P<0.001). There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service between hospitals. Therefore, local solutions are needed to implement nutritional programs and policies for improved service and care.

Changes in Nutrient Intake in Patients at Nutritional Risk

The purpose of this study was to examine changes in nutrient intake in patients at nutritional risk. We included 106 malnourished patients who were admitted to Severance Hospital from March to September 2014. The average age was 59.0+/-11.6 years old and 59 patients were male (59.7%). The majority of diagnosis was cancer (94.3%). We evaluated patients' nutritional status by scored patient-generated subjective global assessment (PG-SGA), anthropometric measurement (height, weight, body composition by Bioelectrical impedance analysis), hand grip strength, biochemical and dietary assessment. The patients' daily intakes of energy and protein (1,019.5+/-706.4 kcal, 40.4+/-27.7 g) during hospitalization were significantly lower than their usual intakes (1,382.0+/-499.8 kcal, 54.4+/-25.1 g, P<0.001). Serum levels of albumin, cholesterol, and total lymphocytes were significantly reduced during hospital stay. The negatively influencing factors for reduced dietary intake were anorexia (42.5%), abdominal distention (14.2%), pain (13.2%), and others. The results of this study could be used to establish baseline data for developing new strategies for nutritional intervention in malnourished patients.

Nurses' Perception on Clinical Nutrition Services by Types of Medical Institution and Area

The purpose of this study was to evaluate nurses' perception of clinical nutrition services. A cross-sectional survey design was performed. The research was accomplished by using questionnaires developed for this study and administered from September 12 to December 31, 2013 to 343 nurses at 43 tertiary hospitals and 20 general hospitals. The percentage of nurses who recognized clinical nutrition certificate as issued from nation was 27.8%. The mean scores of perceived usefulness on clinical nutrition services was 4.23/5.00, whereas that of perceived implementation was 3.76/5.00. The mean scores of necessity of disease-specialized clinical dietitian at capital hospitals were significantly higher for obesity (P<0.01), cancer (P<0.05), and infant & childhood disease (P<0.01) than at local hospitals. The rates of nurses' experience in group education on cancer at capital hospitals (21.7%) was significantly higher than that at local hospitals (10.3%) (P<0.05). The mean scores of perceived importance of clinical nutrition services were 4.46/5.00 for 'group nutrition education', 4.46/5.00 for 'individual consultation', and 4.40/5.00 for 'nutrition management for enteral nutrition (EN) patients'. The most common reason why clinical nutrition services are important was 'improving malnutritional status'. To activate clinical nutrition services especially at local hospitals, clinical dietitians should give systematic assistance to patients and also institutional supports are needed.

Job Satisfaction Level and Related Factors among Korean Hospital Dietitians

The objective of this study was to examine job satisfaction status and its related factors among dietitians working in hospitals. A survey questionnaire was sent to dietitians working in tertiary, general, and convalescent hospitals in Korea. The study sample hospitals included all tertiary hospitals (n=43), and the sample of general hospitals (n=114) and convalescent hospitals (n=240) was randomly selected using a stratified sampling method. A total of 665 dietitians completed the survey questionnaire. The questionnaire included 27 job satisfaction questions on task, stability.vision, working conditions, and relationship areas, and the questions on task improvement need. The job satisfaction scores in all four areas ranged from 2.53/5.00 to 3.89/5.00, implying generally low job satisfaction level in hospital dietitians. The job satisfaction levels in the convalescent hospital group were significantly lower compared to those in the tertiary and general hospital groups. Whereas job satisfaction levels of tertiary and convalescent hospital groups did not differ by number of beds, those of the general hospital group increased significantly with the number of beds for all four areas. Multivariate regression analysis results showed that hospital type was a significant predictor of job satisfaction level for all four areas. Job satisfaction of relationship area was also significantly affected by the number of beds, whereas that of working conditions was influenced by annual income and working experience. The study findings provide useful information in planning clinical dietitians' optimal supply outlook for the improvement of clinical nutrition services.

Incidence, Molecular Characteristics and Pathogenicity of Gibberella fujikuroi Species Complex Associated with Rice Seeds from Asian Countries

Gibberella fujikuroi species complex (GFSC) was isolated from rice (Oryza sativa L.) seed samples from ten Asian countries and investigated for incidence of GFSC, molecular characteristics, and pathogenicity. Regardless of geographic origin, GFSC was detected with incidences ranging from 3% to 80%. Four species, Fusarium fujikuroi, F. concentricum, F. proliferatum, and F. verticillioides, were found to show an association with rice seeds, with F. fujikuroi being the predominant species. In phylogenetic analyses of DNA sequences, no relationship was found between species, isolates, and geographic sources of samples. Unidentified fragments of the beta-tubulin gene were observed in ten isolates of F. fujikuroi and F. verticillioides. With the exception of three isolates of F. fujikuroi, F. fujikuroi, F. proliferatum, and F. verticillioides were found to have FUM1 (the fumonisin biosynthetic gene); however, FUM1 was not found in isolates of F. concentricum. Results of pathogenicity testing showed that all isolates caused reduced germination of rice seed. In addition, F. fujikuroi and F. concentricum caused typical symptoms of bakanae, leaf elongation and chlorosis, whereas F. proliferatum and F. verticillioides only caused stunting of seedlings. These findings provide insight into the characteristics of GFSC associated with rice seeds and might be helpful in development of strategies for management of bakanae.

Complex Partial Status Epilepticus Caused by Hyponatremia

A 67-year-old female presented with stuporous mentality. She ingested a bowel-preparation agent and 4 L of water in preparation for a colonoscopy the day before presentation, and subsequently developed severe diarrhea and vomiting. Laboratory tests demonstrated hyponatremia (120 mEq/L). Her EEG exhibited continuous spike- or polyspike-and-wave discharges on the left frontal area. We diagnosed complex partial status epilepticus caused by hyponatremia in this patient. Her mental status and EEG recovered completely after administration of an anticonvulsant and correction of hyponatremia.

Postpartum Relapse of Neuromyelitis Optica Spectrum Disorder after a Long Period of Spontaneous Remission

No abstract available.

Nutritional status of patients treated with radiotherapy as determined by subjective global assessment

PURPOSE: The purpose of this prospective multi-institutional study was to evaluate the nutritional status of patients undergoing radiotherapy (RT) for treatment of head and neck, lung, or gastrointestinal cancer. MATERIALS AND METHODS: A total of 1,000 patients were enrolled in this study at seven different hospitals in Seoul, Korea between October 2009 and May 2010. The nutritional status of patients after receiving 3 weeks of RT was evaluated using subjective global assessment (SGA). The nutritional status of each patient was rated as well nourished (A), moderately malnourished (B), or severely malnourished (C). RESULTS: The mean age of patients in this study was 59.4 +/- 11.9 years, and the male to female ratio was 7:3. According to the SGA results, 60.8%, 34.5%, and 4.7% of patients were classified as A, B, or C, respectively. The following criteria were significantly associated with malnutrition (SGA B or C; p or =5% (OR, 2.299). CONCLUSION: SGA was applied successfully to assess the nutritional status of most patients. The prevalence of malnutrition in a radiation oncology department was 39.2%. The results of this study serve as a basis for implementation of nutrition intervention to patients being treated at radiation oncology departments.

A Case of Scopolamine-Induced Central Anticholinergic Syndrome / 영남의대학술지

Central anticholinergic syndrome occurs when an anticholinergic substance works in vivo or as a result of the insufficient release of acetylcholine. Its symptoms include confusion, agitation, behavioral change, hallucination, blurred vision, and dysarthria. Occasionally, these symptoms occur with the use of a scopolamine patch. A 54-year-old female complained of behavioral change and confused mentality. She attached a scopolamine patch at the postauricular area in the morning of the day before her hospital visit. Neurological examination revealed bilateral symmetric mydriasis without light reflex. The brain MRI was normal, and electroencephalography showed nonspecific abnormalities. The patient recovered completely after the removal of the scopolamine patch.

The Safety of Early Enteral Feeding after Emergency Gastrointestinal Surgery / 대한소화기학회지

BACKGROUND/AIMS: Postoperative early feeding has many advantages, and current guidelines recommend the early diet or enteral feeding after gastrointestinal surgery. However, there are controversies in emergency situation. The aim of this study was to assess the safety of early enteral feeding in patients underwent emergency gastrointestinal (GI) surgery. METHODS: We reviewed the patients underwent emergency GI surgery by single surgeon from March 2008 to December 2010, retrospectively. The early feeding was defined when feeding was started within 72 hours after operation. RESULTS: Fifty-three patients were enrolled. Men were 31, with mean 60.6 (+/-18.5) years old age. Thirty-three patients were treated in the intensive-care unit after operation. The most common cause of operation was bowel perforation, and followed by intestinal obstruction. Segmental resection with primary anastomosis of small bowel is the most common operation. Thirty-two of them started the diet within 48 hours postoperatively. Twenty-nine patients had post-operative complications. Wound complications were the most common, and followed by the abdominal pain, and ileus. Wound complications were developed in 18 patients, and the post-feeding abdominal pain was in 7 patients. Anastomotic leakage and intraabdominal abscess were developed in 2 patients, and 1 patient required reoperation to treat the anastomotic disruption. One patient developed pneumonia and sepsis, and resolved under conservative treatment. There was no mortality in these patients. CONCLUSIONS: Early enteral feeding may be safe in cases of emergency GI surgery. However, it may require further studies to confirm the safety and feasibility of the early feeding in emergency situations.

Correlation between Dose of Ethacrynic Acid and Weight of Cat in the Cat Deafening Procedure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Co-administration of kanamycin (KM) with the loop diuretic ethacrynic acid (EA) has been known to produce a rapid and profound hearing loss in adult animals. The objective of this study was to see if monitoring the hearing status during intravenous infusion of EA could minimalize individual variability and to evaluate the correlation between the dose of EA and the body weight (wt). MATERIALS AND METHOD: Twenty cats with the mean age of 24 weeks+/-3.7 (range, 20.6-28.3 weeks) and the mean weight of 3.27 kg+/-0.75 (range 2.4-4.75 kg) received a subcutaneous injection of KM (300 mg/kg) followed by an intravenous infusion of EA (1 mg/min). Click evoked auditory brainstem responses (ABRs) were recorded to monitor the hearing during the infusion. When the ABR thresholds rose to levels in excess of 90 dB SPL, the infusion of EA was stopped. The histopathologies for sections of apex, middle, base of cochlea were examined after 6 months. RESULTS: There was a significant positive correlation (p<.001, r2=.583) between the EA dose and body weight. Cochlear histopathology showed an absence of organ of Corti and decrease of spiral ganglion cells in the majority of cochleas, especially in the basal turn. The extent of loss of spiral ganglion cells was dependent on their distance from the round window. CONCLUSION: Monitoring the animal's hearing status during the procedure ensured that the dose of EA was optimized for individual animals. Thus, the positive correlation between the EA dose and body weight should be considered should in designing the animal models of controlled high frequency hearing loss.

Evaluation of enteral formulas for nutrition, health, and quality of life among stroke patients

Enteral nutritional support has been used via tube feeding for dysphagic stroke patients. We performed long and short term trials to evaluate the effects of commercial enteral nutritional supports on nutrition and health in stroke patients (mRS = 3~5) and quality of life in their caregivers. For a long term study, we recruited chronic (> or = 1 yrs) stroke patients (n = 6) and administered them 6 cans/day (1,200 kcal) of the commercial enteral formula N for 6 months according to IRB-approved protocol. We collected peripheral blood at 0, 2, 4 and 6 months. For a short term study, we recruited acute (< or = 3 months) stroke patients (n = 12) and randomly administered them two different commercial enteral formulas, N or J, for 2 weeks. We collected their blood at 0, 4, 7 and 14 day of the administration. Blood samples were analyzed to quantify 19 health and nutritional biomarkers and an oxidative stress biomarker, malondialdehyde (MDA). In order to evaluate quality of life, we also obtained the sense of competence questionnaire (SCQ) from all caregivers at 'before' and 'after trials'. As results, the enteral formula, N, improved hemoglobin and hematocrit levels in the long term trial and maintained most of biomarkers within normal ranges. The SCQ levels of caregivers were improved in the long term treatment (P < 0.05). In a case of the short term study, both of enteral formulas were helpful to maintain nutritional status of the patients. In addition, MDA levels were decreased in the acute patients following formula consumption (0.05 < P < 0.1). Most of health and nutrition outcomes were not different, even though there is a big difference in price of the two products. Thus, we evaluate the formula N has equal nutritional efficacy compared to the formula J. In addition, long term use of enteral formula N can be useful to health and nutrition of stroke patients, and the quality of life for their caregivers.

Applications of CYP-450 expression for biomonitoring in environmental health

Cytochrome P450s (CYPs) are one of the first steps in the metabolism of xenobiotics, such as polycyclic aromatic hydrocarbons (PAHs), which are bioactivated into carcinogens. As such, changes in CYP expression are potential biomarkers in human biomonitoring applications. For the proper biomonitoring of environmental toxicants, it is important to understand the biological relevance of each biomarker and the associations among the biomarkers for uses as exposure, effects, and susceptibility biomarkers. Here, we have reviewed various aspects of CYPs for biomonitoring environmental health in terms of the CYP substrates, such as PAHs, aromatic amines, benzene/toluene, and tobacco smoking-related nitrosamines. This review also includes association studies between CYP phenotypical alterations and other exposure, susceptibility, and effect biomarkers. The association studies were mainly performed in CYP gene-transfected cells and noninvasive human biospecies, such as urine and peripheral blood. In conclusion, we suggest that phenotypical alterations in CYPs with exposure to environmental toxicants are useful as susceptibility or effect biomarkers, particularly when the phenotype-related genotypes are unknown.

A Temporal Bone Study of Insertion Trauma and Intracochlear Position of Straight Type Electrode for Cochlear Implant / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The goal of this study was to examine insertion depth, intracochlear position and insertion trauma with the stimulation electrode of the Nurobiosys cochlear implant. SUBJECTS AND METHOD: Four electrodes were implanted in fresh temporal bones of the human cadavers using realistic surgical procedures. Plain film X-ray images were taken from the electrode inserted in the specimens to estimate the insertion depth. After the electrode implantation, all human temporal bones were trimmed to extract the cochleae. The extracted cochleae from the temporal bone were immersed in acrylic resin to fix the position of electrode placed in the scala tympani. The resin treated cochleae were cut in radial section and polished. All crosssections were imaged with a microscope to assess the trauma by the electrode implantation. RESULTS: The mean insertion depth was about 300degrees with the cochlea angle. The insertion trauma was observed in one section of a temporal bone. The mean distance from electrode to modiolus was about 0.75 millimeter. CONCLUSION: The incidence, severity of trauma and insertion depth of the studied electrode showed similar results with that of other straight type electrode in literature.