Role of nociceptin/orphanin FQ and nociceptin opioid peptide receptor in depression and antidepressant effects of nociceptin opioid peptide receptor antagonists

Nociceptin/orphanin FQ (N/OFQ) and its receptor, nociceptin opioid peptide (NOP) receptor, are localized in brain areas implicated in depression including the amygdala, bed nucleus of the stria terminalis, habenula, and monoaminergic nuclei in the brain stem. N/OFQ inhibits neuronal excitability of monoaminergic neurons and monoamine release from their terminals by activation of G protein-coupled inwardly rectifying K⁺ channels and inhibition of voltage sensitive calcium channels, respectively. Therefore, NOP receptor antagonists have been proposed as a potential antidepressant. Indeed, mounting evidence shows that NOP receptor antagonists have antidepressant-like effects in various preclinical animal models of depression, and recent clinical studies again confirmed the idea that blockade of NOP receptor signaling could provide a novel strategy for the treatment of depression. In this review, we describe the pharmacological effects of N/OFQ in relation to depression and explore the possible mechanism of NOP receptor antagonists as potential antidepressants.

Large-scale surveillance study of the safety and effectiveness of entecavir in Korean patients with chronic hepatitis B

BACKGROUND/AIMS@#Entecavir (ETV) is effective and safe antiviral agent against hepatitis B virus (HBV) in clinical and real-world setting but, most studies were performed in single institute or have limitation in patient's number. A large-scale nation-wide real-world surveillance study was carried out to investigate safety, efficacy and clinical effectiveness of ETV in Korean patients with chronic hepatitis B (CHB).@*METHODS@#Between 2006 and 2012, 3,444 patients were enrolled from 132 Korean institutions. For the safety assessment, investigators recorded the occurrence of observed and patient-reported adverse events (AEs), as well as laboratory abnormalities. Efficacy, which consisted of change in HBV DNA and alanine aminotransferase (ALT), was evaluated in patients who had received at least 16 weeks of ETV treatment. Overall clinical effectiveness, based on improvement of ALT, HBV DNA and patient's symptoms, was evaluated by physicians.@*RESULTS@#Of the patients, 3,367 were evaluated for safety and 3,115 for efficacy and clinical effectiveness. Three hundred and eighty AEs were reported in 255 cases (7.57%), and 67 adverse drug reactions in 54 cases (1.6%). Serious AEs (SAE) were 19 events in nine cases (0.27%). Serious adverse drug reactions (SADR) were three events in two cases (0.06%), and unexpected SAE/SADR were three events in two cases (0.06%). Medical history and concomitant medications were factors inf luencing incidence rates of AEs. Overall clinical effectiveness rate was 96.53%, which was clinically assessed as marked improved or improved state.@*CONCLUSIONS@#This study showed that ETV was well tolerated and clinically effective in Korean patients with CHB in a real-world nation-wide setting.

Effect of prosthetic designs and alveolar bone conditions on stress distribution in fixed partial dentures with pier abutments / 대한치과보철학회지

STATEMENT OF PROBLEM: Pier abutments act as a Class I fulcrum lever system when the teeth are incorporated in a fixed partial denture with rigid connectors. Therefore non-rigid connector incorporated into the fixed partial denture might reduce the stresses created by the leverage. PURPOSE: The purpose of this study was to evaluate, by means of finite element method, the effects of non-rigid connectors and supporting alveolar bone level on stress distribution for fixed partial dentures with pier abutments. MATERIAL AND METHODS: A 2-dimensional finite element model simulating a 5-unit metal ceramic fixed partial denture with a pier abutment with rigid or non-rigid designs, the connector was located at the distal region of the second premolar, was developed. In the model, the lower canine, second premolar, and second molar served as abutments. Four types of alveolar bone condition were employed. One was normal bone condition and others were supporting bone reduced 20% height at one abutment. Two different loading conditions, each 150 N on 1st premolar and 1st molar and 300N on 1st molar, were used. RESULTS: Two types of FPD were displaced apically. The amount of displacement decreased in an almost linear slope away from the loaded point. Non-rigid design tended to cause the higher stresses in supporting bone of premolar and molar abutments and the lower stresses in that of canine than rigid design. Alveolar bone loss increased the stresses in supporting bone of corresponding abutment. CONCLUSION: Careful evaluation of the retentive capacity of retainers and the periodontal condition of abutments may be required for the prosthetic design of fixed partial denture with a pier abutment.

The Effect of Hormone Replacement Therapy and Related Factors on the Change of Bone Mineral Density in Early Postmenopausal Women in Ulsan-si, Korea

BACKGROUND: Hormone replacement therapy (HRT) has been used as a effective therapeutic strategy of postmenopausal osteoporosis. However, the studies on HRT are insufficient, particularly in early postmenopausal women in Korea. This study was designed as a community based clinical trial and was conducted for 1 year. METHODS: One hundred and forty early postmenopausal women aged 49 to 54 years who resided in Ulsan in Korea were enrolled in this study. The osteoporosis prone life style and general characteristics of the participants and their measured BMD were investigated. The therapy groups included 45 women who were assigned to one of the following regimens in 28 day cycles for 1 year: (1) conjugate equine estrogen (CEE), 0.625 mg/d daily, medroxyprogesterone acetate (MPA) 2.5 mg/d daily and calcium 500 mg/d daily (2) CEE 0.625 mg/d daily, MPA 10 mg/d for days 1 through 12 and calcium 500 mg/d daily. RESULTS: The women in the therapy groups had an average gain of 5.4%, 4.2%, 2.1%, 4.9% in BMD in the lumbar spine, femur total, femur neck and ward's area, respectively. HRT has significantly influenced the BMD after controlling age, month since menopause, alcohol intake, smoking, calcium intake, exercise, body mass index and baseline BMD. The baseline BMD and the BMI were factors that influenced the effect of HRT in BMD. CONCLUSION: HRT had positively influenced the BMD in Korean women. The baseline BMD and the BMI were predictors of the effect of HRT in BMD change.

The comparison of bacterial infection rate in the patients with alcoholic and viral cirrhosis / 대한내과학회지

BACKGROUND: Liver cirrhosis may be considered one of the most common cause of acquired immunodeficiency. Alcohol abuse may be predisposing factor to infections in patients with liver cirrhosis, so we compared the rate of spontaneous bacterial peritonitis (SBP) and other bacterial infections in alcoholic and viral liver cirrhosis. METHODS: We studied 188 patients who had been diagnosed with liver cirrhosis from January 1995 to June 2000 and evaluated the frequency of bacterial infections (SBP, pneumonia, urinary track infection, bacteremia, infectious colitis) retrospectively according to cause and degree of cirrhosis. RESULTS: Among 188 patients (alcoholic 76, viral 112), 64 patients (34%) presented with bacterial infection at hospitalization, 33 (43%;33/76) of 64 subjects were alcoholic and 31 (28%;31/112) of 64 subjects were viral liver cirrhosis. The rate of bacterial infections was higher in alcoholic liver cirrhosis than viral cirrhosis (p0.05). CONCLUSION: This results suggest that the rate of bacterial infections are more common in alcoholic than viral liver cirrhosis in relatively early stage and it may be influence the prognosis of liver cirrhosis.

Correlation of Helicobacter pylori Serology Titer with Endoscopic and Histologic Findings / 대한소화기내시경학회지

BACKGROUND/AIMS: In clinical practice, among the technique to detected Helicobacter pylori (H. pylori) infection, IgG serological test is noninvasive, safe, quick, widely available, and inexpensive. We studied that whether the titers of anti-H. pylori IgG antibody were correlated with endoscopic finding, and the degree of microscopic gastric damage and H. pylori density in dyspeptic patients. METHODS: Gastric biopsy specimens were obtained in 109 patients with H. pylori infection undergoing upper gastric endoscopy. The titers of serum IgG antibodies to H. pylori were measured by enzyme immunoassay. Macroscopic gastric damages and histologic grades were scored by the Sydney system. RESULTS: Endoscopic findings showed no significant association with H. pylori antibody titers (p=0.111). There was significant correlation between H. pylori antibody titers and lymphocyte infiltration (p=0.002), neutrophil infiltration (p=0.002), H. pylori density (p=0.0001), respectively. There was no significant correlation between H. pylori antibody titers and atropy (p=0.142), intestinal metaplasia (p=0.368), respectively. CONCLUSIONS: H. pylori antibody titer has significant association with the H. pylori density, neutrophil and lymphocyte infiltration. The serological test using EIA method is a useful in detecting H. pylori infection and it may be used as a predictor for the H. pylori density and degree of inflammation.

A case of eosinophilic gastroenteritis with diffuse small bowel edema and ascites / 대한내과학회지

Eosinophilic gastroenteritis is an uncommon disorder of stomach, small bowel and colon characterized by peripheral blood eosinophilia, eosinophilic infiltration of the gut wall, and variable clinical symptoms. This disease was first described by Kaijser in 1937, and its cause was poorly understood. It may be related to allergy, which combines allergic rhinitis, allergic asthma, atopic dermatitis, food allergy and elevated IgE. The clinical symptoms and signs are variable according to the extents and depths of the eosinophilic infiltration. Endoscopic findings may show normal, nodular, ulcerative, or hemorrhagic mucosal changes, and biopsy findings reveal eosinophilic infiltration of mucosal and muscular layer. We diagnosed and treated a case of diffuse serosal eosinophilic gastroenteritis associated with ascites in a patient with allergic asthma who had severe abdominal pain, distention and watery diarrhea, and she dramatically responded to corticosteroid therapy.

COLORIMETRIC ANALYSIS OF COLOR DIFFERENCES BETWEEN DENTIN PORCELAINS / 대한치과보철학회지

The purpose of this study is to evaluate the color differences that can exist between differnet brands of dentin porcelain having identical shade designations. The instrumental colorimetric technique was used to determine these differences. The three brands of dentin porcelain used were Vita VMK-68, Shofu Vintage, and Ceramco II. The three shades selected were the Vita Lumin shades A2, B2, and C2. The color difference values were compared with each other using L*, a*, b*, three variables of the CIELAB color system, and E. The results of this study were as follows: 1. Corresponding shades of different brands of dentin porcelain produced different L*, a*, b* values. 2. The greatest E value in corresponding shade was found to exist between Ceramco II and Shofu Vintage, followed by between Vita VMK-68 and Ceramco II, and then between Vita VMK-68 and Shofu Vintage. 3. The E values in shade C2 were mainly influenced by L* value ; however none of L*, a*, b* values had greater influence on E values than the others in shade A2, B2. 4. Shofu Vintage had the highest b* value, followed by Vita VMK-68, and then Ceramco II.

Antibiotic Prophylaxis in Endoscopic Retrograde Cholangiopancreatography / 대한소화기내시경학회지

BACKGROUND AND AIMS: Prophylactic antibiotics are used in an attempt to avoid the septic complications of endoscopic retrograde cholangiopancreatography (ERCP). But, there is individual tendency to choose prophylactic antibiotics due to a lack of definite guidelines for prophylactic antibiotics. Therefore, the effectiveness of ciprofloxacin to prevent post ERCP infectious complications was evaluated. METHODS: One hundred patients underwent 75 diagnostic ERCPs and 25, therapeutic ERCPs. They were classified randomly into a group of 51 prophylaxis (ciprofloxacin 200 mg i.v. 30 min before the procedure) and 49 controls. Pre- and post-ERCP blood cultures were prospectively performed and surveyed for infectious complications. RESULTS: Sepsis was detected in 4 patients in each group (p>0.05). Two cases were related to diagnostic ERCP and the remaining six cases, therapeutic ERCP (p<0.01). Bacteremia was found in 6 cases, but only two cases (Escherichia coli, Citrobacter freundii) were clinically significant. CONCLUSIONS: The frequency of sepsis following ERCP was not significantly reduced by antibiotic prophylaxis (7.8% vs. 8.2%).

Risk factors for ascitic fluid infection in cirrhotic patients with variceal bleeding / 대한내과학회지

BACKGROUND: Ascitic fluid infection is frequently associated with gastrointestinal bleeding and heralds poar prognosis in patients with liver cirrhosis. The aims of this study were to assess the incidence of ascitic fluid infection and to determine the risk factors associated with ascitic fluid infection in cirrhotic patients with variceal bleeding. METHODS: Total 148 bleeding cirrhotic patients receiving endoscopic variceal ligation were evaluated. Characteristics of patients and bleeding were compared between the infected group (with ascitic fluid infection) and non-infected group (without ascitic fluid infection). RESULTS: Ascitic fluid infection was detected in 22 (14.9%) of 148 patients. Child-Pugh class B or C (90.9% vs 61.9%, p<0.001), diabetes melitus (36.4% vs 12.7%, p=0.01), systolic blood pressure lower than 90 mmHg (40.9% vs 17.5%, p=0.02), active bleeding (68.1% vs 31.9%, p=0.02), transfusion of 4 pints or more (54.5% vs 20.6%, p=0.002) were more frequently found in infected group compared to non-infected group (n=126). Multivariate analysis showed that Child-Pugh class (p=0.03, R=0.21) and transfusion amount (p=0.02, R=0.34) were independent risk factors of ascitic fluid infection. CONCLUSION: In bleeding cirrhotics with Child-Pugh class B or C or transfusion of 4 pints or more, risk for ascitic fluid infection was high and antibiotic prophylaxis should be considered.

Anorexia Nervosa with Autonomic Dysfunction / 대한소화관운동학회지

Anorexia nervosa is characterized by distortion of body image and profound weight loss due to self starvation. So, the patients are easily diagnosed with history and interview. We experienced a patient who had suffered for prolonged vomiting and profound weight loss without definite distorted body image, but had accompanied by autonomic dysfunction. Thus, we report a case with a brief review of literatures.

Three Cases of Coexistence of Gastric Cancer and Duodenal Ulcer / 대한소화기내시경학회지

Both duodenal ulcer and gastric cancer are common, and it is well known that the pathophysiology of the two is different. The presence of a duodenal ulcer is believed to protect against the development of a gastric malignancy. However gastric cancer may occur in the presence of active or chronic duodenal ulcer disease. Although rare in incidence of coexistence of duodenal ulcer and gastric cancer, physician must be alert to the strange association of duodenal ulcer and gastric cancer. Here, we present 3 cases with coexistence of duodenal ulcer and gastric cancer, diagnosed by endoscopy.

Endoscopic Treatment of Biliary Ascariasis with a Common Bile Duct Stone: A case report / 대한소화기내시경학회지

Biliary ascariasis is a rare complication of intestinal ascaris infestation. Retrograde migration of the adult worm through the papilla of Vater causes biliary colic, and may give rise to pancreatic and biliary obstruction, choledocholithiasis, cholecystitis, cholangitis, hemobilia, and if the worm lodges in intrahepatic bile ducts, to liver absceases. In the past, treatment of biliary ascariasis has usually involved the direct removal of ascaris throagh a surgical choledochatomy and subsequent saline lavage of the common duct through an indwelling T tube. Recently, the worm in the bile duct can be seen by ERCP and it can be removed during the endoscopic procedure. A 55-year-old woman with intermittent colicky right upper quadrant abdominal pain was admitted to out hospital. Abdominai sonogram disclosed an echogenic structure within a mildly dilated common bile duct and a high ehogenic structure with acoustic shadowing in the distal common bile duct(CBD), which suggests a CBD stone. ERCP after obtaining the sonogram revealed a thick, long, linear, smooth filling defect in the CBD with a distal CBD stone. A distal CBD stone was removed by sphinctetotomy and lithotripsy, then we directly extracted ascaris with a tripod forcep without any complication.