Differential Expression Profiling of Salivary Exosomal microRNAs in a Single Case of Periodontitis - A Pilot Study

Exosomes are Nano-sized lipid vesicles secreted from mammalian cells containing diverse cellular materials such as proteins, lipids, and nucleotides. Multiple lines of evidence indicate that in saliva, exosomes and their contents such as microRNAs (miRNAs) mediate numerous cellular responses upon delivery to recipient cells. The objective of this study was to characterize the different expression profile of exosomal miRNAs in saliva samples, periodically isolated from a single periodontitis patient. Unstimulated saliva was collected from a single patient over time periods for managing periodontitis. MicroRNAs extracted from each phase were investigated for the expression of exosomal miRNAs. Salivary exosomal miRNAs were analyzed using Affymetrix miRNA arrays and prediction of target genes and pathways for its different expression performed using DIANA-mirPath, a web-based, computational tool. Following the delivery of miRNA mimics (hsa-miR-4487, -4532, and -7108-5p) into human gingival fibroblasts, the expression of pro-inflammatory cytokines and activation of the MAPK pathway were evaluated through RT-PCR and western blotting. In each phase, 13 and 43 miRNAs were found to be differently expressed (|FC| ≥ 2). Among these, hsa-miR-4487 (|FC|=9.292005) and hasmiR-4532 (|FC|=18.322697) were highly up-regulated in the clinically severe phase, whereas hsa-miR-7108-5p (|FC|= 12.20601) was strongly up-regulated in the clinically mild phase. In addition, the overexpression of miRNA mimics in human gingival fibroblasts resulted in a significant induction of IL-6 mRNA expression and p38 phosphorylation. The findings of this study established alterations in salivary exosomal miRNAs which are dependent on the severity of periodontitis and may act as potential candidates for the treatment of oral inflammatory diseases.

Rhamnogalacturonan II is a Toll-like receptor 4 agonist that inhibits tumor growth by activating dendritic cell-mediated CD8+ T cells

We evaluated the effectiveness of rhamnogalacturonan II (RG-II)-stimulated bone marrow-derived dendritic cells (BMDCs) vaccination on the induction of antitumor immunity in a mouse lymphoma model using EG7-lymphoma cells expressing ovalbumin (OVA). BMDCs treated with RG-II had an activated phenotype. RG-II induced interleukin (IL)-12, IL-1beta, tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) production during dendritic cell (DC) maturation. BMDCs stimulated with RG-II facilitate the proliferation of CD8+ T cells. Using BMDCs from the mice deficient in Toll-like receptors (TLRs), we revealed that RG-II activity is dependent on TLR4. RG-II showed a preventive effect of immunization with OVA-pulsed BMDCs against EG7 lymphoma. These results suggested that RG-II expedites the DC-based immune response through the TLR4 signaling pathway.

Portal Vein Thrombosis with a Lung Abscess / 대한내과학회지

Portal vein thrombosis (PVT) is an uncommon cause of presinusoidal hypertension and can result from cirrhosis, malignancy, infection, inflammation, and congenital and acquired thrombophilic states. Infectious and inflammatory causes include pylephlebitis, omphalitis, diverticulitis, pancreatitis, cholecystitis, appendicitis, and inflammatory bowel disease. However, PVT induced by a lung abscess has not been reported. We experienced a 50-year-old male complaining of right upper quadrant pain, fever, and coughing. A lung abscess and PVT were revealed by computed tomography and abdominal Doppler ultrasonography. The PVT resolved, in part, after an 8-day course of antibiotic therapy. We report a case of PVT as a complication of a lung abscess and review the literature.

Pneumothorax, Pneumomediastinum, Subcutaneous Emphysema, Pneumoretroperitoneum Secondary to Colonoscopic Perforation / 대한소화기내시경학회지

A colonoscopic perforation is rare but can cause a fatal outcome. A perforation can be intraperitoneal or retroperitoneal. Air in the retroperitoneal space by perforation can spread to the mediastinum, pleura, and subcutaneous tissue through the visceral space. Therefore, a colonoscopic perforation may manifest as a pneumomediastinum, a pneumothorax, or subcutaneous emphysema without a peritoneal irritation sign. Although a colonoscopic perforation is treated mainly with an operation, medical treatment may be possible in selected cases, especially for a perforation to the retroperitoneal area or that under peritoneal reflexion. Clipping of a perforation is effective for medical treatment. We experienced a case of pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumoretroperitoneum without peritoneal irritation following a diagnostic colonoscopy, which was diagnosed after 3 days because of atypical symptoms but was successfully managed with medical treatment and clipping.

The clinical characteristics of elderly onset rheumatoid arthritis / 대한내과학회지

BACKGROUND: Elderly-onset rheumatoid arthritis (EORA) is considered to be different from younger-onset rheumatoid arthritis (YORA) in clinical manifestations, laboratory indices, and in prognosis. However, the differences between these two diseases have not been clearly defined. The aim of this study was to more clearly define the clinical characteristics of EORA. METHODS: We retrospectively reviewed 50 EORA and 58 YORA patients who met the classification criteria established by the American College of Rheumatology (ACR). The two groups (EORA and YORA) were compared by three criteria. First, we considered the patterns of the joints involved and the presence of rheumatoid nodules. Second, we compared the disease activity indices and the level of auto-antibodies. Finally, we compared the use of medications. RESULTS: The mean age-of-onset and the women-to-men ratio in the EORA group was 66.2+/-5.5 years and 2.1:1, respectively. There was more large joint involvement seen in the EORA group. The titer of disease activity indices (ESR, CRP) and positive rate of auto-antibodies (rheumatoid factor, ANA, but not anti-CCP antibody) were also higher in the EORA group. We found no differences in the prescribed medications between the two groups. CONCLUSIONS: From these studies, we believe that EORA has higher disease activity indices at onset and greater joint involvement, along with higher titers of auto-antibodies as compared to YORA.

A Prospective Randomized Trial Comparing Divided Dose of Polyethylene Glycol Solution with Stimulant Laxative Plus Low Dose Polyethylene Glycol Solution for Colon Cleansing / 대한소화기내시경학회지

BACKGROUND/AIMS: This study compared the efficacy and patient's tolerance between those given a divided dose of a polyethylene glycol solution (PEG) and those given a stimulant laxative plus a reduced dose of PEG. METHODS: 190 consecutive patients for colon cleasing were randomized into 3 groups. In group A, 2 L of PEG was administered on the evening prior to the colonoscopy followed by 2 L of the same solution on the morning of colonoscopy. In group B, 2 L of PEG was administered in the morning only. In group C, 2 bisacodyl tablets (10 mg) were administered on the evening prior to colonoscopy and 2 L of PEG was administered in the morning. The patients completed a questionnaire to assess their tolerance to the bowel preparation before the colonoscopy. The endoscopists scored the adequacy of the bowel preparation using the Ottawa scale along with their satisfaction with the quality of the procedure. RESULTS: While 4 patients (6.7%) could not completely take the recommended dose in group A, all patients in groups B and C could take the recommended dose (p=0.012). The patients in Group B had a better tolerance and fewer side effects than those in Group A (p=0.01). A higher adequacy of bowel preparation was observed in group A than in group B (p=0.000) and there appeared to be a higher adequacy of bowel preparation in Group C than in Group B (p=0.06). CONCLUSIONS: The 2 L PEG solution only does not appear to be as effective as a bowel cleansing agent for colonoscopy compared with the divided 4 L PEG solution. No statistical difference in the side effects and efficacy was observed between the divided 4 L PEG solution and the combination of bisacodyl 10 mg with 2 L of a PEG solution.

Comparison of Early and Six Month Outcomes of Direct Stenting vs. Conventional Stenting in Patients with Angina Pectoris

BACKGROUND AND OBJECTIVES: Direct stenting (DS) has been shown to be safe and feasible, with demonstrable reductions in cost, procedural time and radiation exposure, and may also result in less vessel injury. The aim of this study was to compare the immediate and six month clinical and angiographic outcomes of direct stent (DS) with stent implantation implantation following balloon predilatation (conventional stenting, CS). SUBJECTS AND METHODS: Between July 2001 and June 2004, 266 patients (293 lesions) with angina pectoris were included in this study. Patients having lesion characteristics with excessive calcification, left main lesion, chronic total occlusion, severe proximal tortuosity and a bifurcated lesion were excluded. Follow up angiography was performed about six months after the initial procedure. RESULTS: Direct (73 lesions) and conventional stenting (220 lesions) were performed respectively. In the DS group, the minimal luminal diameter was larger (0.36+/-0.18 vs. 0.31+/-0.19 mm, p=0.036) and diameter stenosis lower than in the CS group (89.1+/-5.1 vs. 90.6+/-3.9%, p=0.026). However, no difference was found in the reference vessel diameter between the two groups. From the immediate angiographic results, the CS group showed a longer stent length than the DS group (18.84+/-5.61 vs. 16.16+/-3.67 mm, p=0.000), but the DS group had a higher balloon inflation pressure than the CS group (12.25+/-1.71 vs. 11.35+/-1.72 atm, p=0.000). However, no difference was found in the post-stent minimal luminal diameter, acute gain and angiographic success rates. Follow up angiography was performed in 68.6% (201/293) of lesions. The angiographic restenosis rate was similar between the two groups (DS, 19.6 vs. CS, 19.3%, p=0.966), as were the other angiographic findings. The rates of in-hospital and 6 month follow up major adverse cardiovascular events (MACE) were similar between the two groups. CONCLUSION: Direct stenting showed similar rates of angiographic restenosis as well as inhospital and 6 months MACE (death, myocardial infarction, target lesion revascularization, cerebrovascular accident) compared with conventional stenting.

Candida guilliermondii Endophthalmitis in a Patient with Mixed Gastrointestinal Stromal Tumor and Stomach Adenocarcinoma

Candida is the most common etiologic agent causing endogenous endophthalmitis resulting due to hematogenous spread from a remote primary focus. Risk factors for the infection include intravenous drug use, hyperalimentation, surgery, malignancy, diabetes, neutropenia, and the use of broad- spectrum antibiotics and immunosuppressive agents, especially corticosteroids. The outcome of candida endophthalmitis is disappointing. One main problem in the management of this infection is that early diagnosis is difficult. Thus, treatment may be delayed and this which often leads to a poor outcome. Candida endophthalmitis, particularly candida guilliermondii endophthalmitis, is extremely rare, although it is becoming more common as the number of chronically debilitated patients and the use of invasive procedures increase. It is an ophthalmologic emergency and commonly takes a tragic course. Therefore, early suspicion and aggressive management are imperative to prevent visual loss. The authors report a case of candida endophthalmitis caused by Candida guilliermondii in a 65-year-old man with mixed gastrointestinal stromal tumor(GIST) and stomach adenocarcinoma.

Candida guilliermondii Endophthalmitis in a Patient with Mixed Gastrointestinal Stromal Tumor and Stomach Adenocarcinoma

Candida is the most common etiologic agent causing endogenous endophthalmitis resulting due to hematogenous spread from a remote primary focus. Risk factors for the infection include intravenous drug use, hyperalimentation, surgery, malignancy, diabetes, neutropenia, and the use of broad- spectrum antibiotics and immunosuppressive agents, especially corticosteroids. The outcome of candida endophthalmitis is disappointing. One main problem in the management of this infection is that early diagnosis is difficult. Thus, treatment may be delayed and this which often leads to a poor outcome. Candida endophthalmitis, particularly candida guilliermondii endophthalmitis, is extremely rare, although it is becoming more common as the number of chronically debilitated patients and the use of invasive procedures increase. It is an ophthalmologic emergency and commonly takes a tragic course. Therefore, early suspicion and aggressive management are imperative to prevent visual loss. The authors report a case of candida endophthalmitis caused by Candida guilliermondii in a 65-year-old man with mixed gastrointestinal stromal tumor(GIST) and stomach adenocarcinoma.

A Case of Splenic Non-Hodgkin's Lymphoma in Rheumatoid Arthritis / 대한류마티스학회지

Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder of unknown etiology. Inflammation may usually extend beyond the joints and involve other organs. Clinically detectable splenomegaly is present in 5~10% of RA. Methotrexate (MTX) is a structural analog of folic acid that inhibits the enzyme dihydrofolate reductase, so cellular proliferation is reduced. MTX has been proven to be effective in treating RA and is believed to be nononcogenic at low, weekly dose employed in the patients with RA. However, recently there has been increased concern about the oncogenic potential of MTX because of several case reports describing the occurrence of non-Hodgkin's Lymphoma (NHL) in the patients with RA treated with MTX. A 65-year-old woman with RA was treated with low dose MTX (i.e. 10 mg/week) for 3 years. Because of prolonged left upper abdominal pain and thrombocytopenia associated with huge splenomegaly, splenectomy was performed. Biopsy revealed splenic B-cell NHL. We report a case of RA with splenomegaly who developed B-cell NHL in spleen during low dose MTX therapy.