Effect of 1,25(OH)2 D3 and 20(OH)D3 on interleukin-1ß-stimulated interleukin-6 and -8 production by human gingival fibroblasts.

BACKGROUND AND OBJECTIVE: Vitamin D-1,25(OH)2 D3 or 1,25D3-maintains healthy osseous tissue, stimulates the production of the antimicrobial peptide cathelicidin and has anti-inflammatory effects, but it can cause hypercalcemia. Evidence links diminished serum levels of 1,25D3 with increased gingival inflammation. Periodontitis progression is associated with increased local production of inflammatory mediators by immune cells and gingival fibroblasts. These include interleukin (IL)-6, a regulator of osteoclastic bone resorption, and the neutrophil chemoattractant IL-8, both regulated by signaling pathways, including NF-κB and MAPK/AP-1. The objectives were to determine the effects of 1,25D3 or a non-calcemic analog, 20-hydroxyvitamin D3 -20(OH)D3 or 20D3-on IL-1ß-stimulated IL-6 and IL-8 production, and NF-κB and MAPK/AP-1 activation, by human gingival fibroblasts. MATERIAL AND METHODS: Human gingival fibroblasts were incubated ± IL-1ß, with or without exposure to 1,25D3 or 20D3. IL-6 and IL-8 in culture supernatants were measured by enzyme-linked immunosorbent assay. NF-κB (p65) and AP-1 (phospho-cJun) and were measured in nuclear extracts via binding to specific oligonucleotides. Data were analyzed using ANOVA and Scheffe's F procedure for post hoc comparisons. RESULTS: IL-1ß-stimulated IL-6 and IL-8 levels were both significantly inhibited (40%-60%) (P<.045) by 1,25D3, but not 20D3 (0%-15% inhibition, not statistically significant). Both 1,25D3 and 20D3 significantly and similarly inhibited IL-1ß-stimulated nuclear levels of p65 and phospho-cJun (P<.02). CONCLUSION: Reduction of the activation of NF-κB and AP-1 alone is not able to inhibit strongly the IL-1ß stimulated IL-6 and IL-8 gene expression. 1,25D3 but not 20D3 may affect some of the many other factors/processes/pathways that in turn regulate the expression of these genes. However, the results suggest that topical application of ligands of the vitamin D receptor may be useful in the local treatment of periodontitis while reducing adverse systemic effects.

An eight-year study of internet-based remote medical counselling.

We carried out a prospective study of an Internet-based remote counselling service. A total of 15456 Internet users visited the Website over eight years. From these, 1500 users were randomly selected for analysis. Medical counselling had been granted to 901 of the people requesting it (60%). One hundred and sixty-four physicians formed project groups to process the requests and responded using email. The distribution of patients using the service was similar to the availability of the Internet: 78% were from the European Union, North America and Australia. Sixty-seven per cent of the patients lived in urban areas and the remainder were residents of remote rural areas with limited local medical coverage. Sixty-five per cent of the requests were about problems of internal medicine and 30% of the requests concerned surgical issues. The remaining 5% of the patients sought information about recent developments, such molecular medicine or aviation medicine. During the project, our portal became inaccessible five times, and counselling was not possible on 44 days. There was no hacking of the Website. Internet-based medical counselling is a helpful addition to conventional practice.

Expectations and perceptions of Greek patients regarding the quality of dental health care.

OBJECTIVE: The aim of this study was to investigate the perceptions and expectations of patients regarding the quality of dental health care they received and the criteria they used to select a dentist. DESIGN: Descriptive study. METHODS: Two questionnaires referring to the expectations and the perceptions of dental health care were handed to patients. Likert-type scales were used to evaluate the characteristics examined. These characteristics have been classified in four quality dimensions: 'assurance', 'empathy', 'reliability' and 'responsiveness'. STUDY PARTICIPANTS AND SETTING: Two hundred consecutive patients who visited the Dental Clinic of the School of Dentistry, University of Athens, Greece, in 1998-1999. RESULTS: The patients' top priority was adherence to the rules of antisepsis and sterilization. Women of the middle and lower socio-economic groups were more demanding than men of the same groups, while men of the upper socio-economic group appeared to be more demanding than women (P = 0.02). Their perceptions of the dental service provided reflected their satisfaction regarding the adherence to the rules of antisepsis and sterilization, but also showed their moderate satisfaction regarding most of the other characteristics and their dissatisfaction regarding information on oral health and hygiene. CONCLUSION: Expectations and demands regarding empathy (approach to the patient) and assurance were placed at the top of the patients' priorities. A highly significant quality gap was observed between the desires of the patients and their perceptions (P< 0.01) and the largest gap was noted concerning information they received about oral health diseases. The largest quality gap was also observed in characteristics regarding responsiveness.