A combination of excimer laser treatment and topical tacrolimus is more effective in treating vitiligo than either therapy alone for the initial 6 months, but not thereafter.

BACKGROUND: There are insufficient data on the long-term outcome of a combination therapy that comprises phototherapy and topical administration of tacrolimus. AIM: To evaluate the clinical efficacy according to the duration of treatment and in vitro results of a combination therapy involving topical tacrolimus and an excimer laser in the treatment of vitiligo. METHODS: In total, 276 patients with nonsegmental vitiligo were treated with an excimer laser twice weekly, or with tacrolimus ointment twice daily, or both. The melanin contents and levels of melanogenic enzymes were measured in cultured human melanocytes treated with tacrolimus and/or excimer laser. RESULTS: After adjusting for potential confounders, the combination of tacrolimus plus excimer laser was significantly more effective than either tacrolimus or excimer laser alone (P < 0.001 and P < 0.01, respectively) for the first 6 months. However, this superiority was not observed after the initial 6 months of treatment. In vitro, the combination of tacrolimus plus excimer laser led to a higher level of melanogenesis than with either treatment alone. CONCLUSIONS: A combination treatment with topical tacrolimus and an excimer laser may be useful as an induction therapy for up to 6 months, but continuation of this therapy for > 6 months might not provide a better final outcome than monotherapy.

Pyrosequencing Analysis of Subgingival Microbiota in Distinct Periodontal Conditions.

Subgingival microorganisms are potentially associated with periodontal diseases. However, changes in the subgingival microbiota during the progress of periodontal diseases are poorly understood. In this study, we analyzed bacterial communities in the subgingival paper point samples from 32 Korean individuals with no sign of disease, gingivitis, or periodontitis using 454 FLX Titanium pyrosequencing. A total of 256,113 reads representing 26 phyla, 433 genera, and 1,016 species were detected. Bacteroidetes, Fusobacteria, Synergistetes, and Spirochaetes were the abundant phyla in periodontitis subjects, whereas Firmicutes and Proteobacteria were identified as the dominant phyla in the gingivitis and healthy subjects, respectively. Although high levels of Porphyromonas, Fusobacterium, Fretibacterium, Rothia, Filifactor, and Treponema genera were observed in the periodontitis subjects, Streptococcus, Capnocytophaga, Leptotrichia, and Haemophilus genera were found at high frequency in the gingivitis subjects. Species including Porphyromonas gingivalis, Fusobacterium nucleatum, and Fretibacterium fastidiosum were significantly increased in periodontitis subjects. On the other hand, Streptococcus pseudopneumoniae, Haemophilus parainfluenzae, and Leptotrichia hongkongensis were preferentially observed in the gingivitis subjects. Intriguingly, the halophile Halomonas hamiltonii was revealed as a predominant species in the healthy subjects. Based on Fast UniFrac analysis, distinctive bacterial clusters were classified for the healthy, gingivitis, and periodontitis state. The current findings might be useful for understanding the pathogenesis, diagnosis, and treatment of periodontal diseases.

Alpha-amylase is a human salivary protein with affinity to lipopolysaccharide of Aggregatibacter actinomycetemcomitans.

Aggregatibacter actinomycetemcomitans lipopolysaccharide (Aa.LPS) is a major virulence factor associated with aggressive periodontitis. Although the recognition of Aa.LPS is potentially initiated by salivary proteins in the oral cavity, Aa.LPS-binding proteins (Aa.LPS-BPs) in saliva are poorly characterized. The purpose of this study was to capture and identify Aa.LPS-BPs in human saliva using a LTQ-Orbitrap hybrid Fourier transform mass spectrometry. Aa.LPS conjugated onto N-hydroxysuccinimidyl-Sepharose(®) 4 Fast Flow beads (Aa.LPS-beads) activated Toll-like receptor 4 and produced nitric oxide and Interferon gamma-inducible protein-10, implying that the conjugation process did not alter the biological properties of Aa.LPS. Aa.LPS-BPs were subsequently isolated from the nine human saliva samples from healthy individuals with the Aa.LPS-beads followed by identification with the mass spectrometry. Aa.LPS-BPs include α-amylase, serum albumin, cystatin, lysozyme C, submaxillary gland androgen-regulated protein 3B, immunoglobulin subunits, polymeric immunoglobulin receptor, deleted in malignant brain tumors 1, prolactin-inducible protein, lipocalin-1, and basic salivary proline-rich protein 2. Specific binding was validated using a pull-down assay with α-amylase which was captured at the highest frequency. Alpha-amylase demonstrated to interfere with the adherence and biofilm formation of A. actinomycetemcomitans. Even heat-inactivated α-amylase showed the interference to the same extent. Conclusively, we identified unique Aa.LPS-BPs that provide useful information to understand bacterial pathogenesis and host innate immunity in the oral cavity.

The association of osteoprotegerin gene polymorphisms with periodontitis.

BACKGROUND: It has been demonstrated that genetic variation accounts for approximately half of the variance in periodontitis. The reported association of polymorphisms in the osteoprotegerin (OPG) gene with osteoporosis suggests that the OPG gene may also influence the genetic risk for periodontitis. SUBJECTS AND METHODS: We investigated the distribution of OPG gene polymorphisms in 49 patients with aggressive (n = 14) or chronic (n = 35) periodontitis and 49 control subjects without periodontitis, using polymerase chain reaction (PCR)-restriction fragment length polymorphism and PCR-single strand conformation polymorphism followed by direct sequencing. RESULTS: A total of seven known polymorphisms and one new mutation, G373A, were identified. The T950 and G1181 alleles were more common in patients with periodontitis (P = 0.028 and P = 0.047, respectively) than in control subjects. Especially, G1181 allele was associated with patients with aggressive periodontitis. CONCLUSION: The TG haplotype of T950C and G1181C polymorphisms in the OPG gene may be useful genetic markers for the prediction of periodontitis. Further studies in a larger population are required to determine whether these alleles directly contribute to periodontitis susceptibility.

Typical and atypical symptoms of myocardial infarction among African-Americans, whites, and Koreans.

Most public education about the clinical symptoms of MI and the appropriate response to those symptoms has been designed to reach educated segments of the white population based on data gathered from white men. As a result, AAs and Korean-Americans may be less alert to chest pain, less likely to relate this symptom to heart attack, and less likely to seek treatment promptly. Our findings provide a race-specific database on CHD risk factors and types of MI symptoms, which should be of particular interest to the trauma and emergency care nurse as well as to the coronary care nurse. AAs and Koreans experienced chest pain as frequently as whites, but AAs experienced the atypical symptoms of dyspnea and fatigue more often, and Koreans experienced dyspnea, perspiration, and fatigue more often than whites. This information can be helpful in developing public education programs on MI that are sensitive to our increasingly diverse population. In the acute and critical care setting, these data assist the nurse to recognize that "classic" signs and symptoms of acute MI may not be classic for all racial and ethnic groups. This awareness can lead to more culturally sensitive assessment tools and educational interventions, earlier recognition of acute MI with more appropriate triage decisions, more aggressive treatment, and a reduction in morbidity and mortality of these high-risk groups.

Enzyme-catalyzed synthesis of sugar-containing monomers and linear polymers.

Commercially available proteases and lipases were screened for their ability to acylate regioselectively sucrose and trehalose with divinyladipic acid ester. Opticlean M375 (subtilisin from Bacillus licheniformis) was observed to form sucrose 1'-O-adipate and trehalose 6-O-adipate in anhydrous pyridine. Novozym-435 (lipase B from Candida antarctica) catalyzed the synthesis of sucrose 6, 6'-O-divinyladipate and trehalose 6, 6'-O-divinyladipate in acetone. These diesters were then employed as monomers in polycondensation reactions with various diols (aliphatic and aromatic) catalyzed by Novozym-435 in organic solvents to yield linear polyesters with M(w)'s up to 22,000 Da. Spectroscopic analysis confirmed that only the vinyl end groups of sugar esters reacted in the enzymatic polymerization with the diol, and not the internal sugar-adipate linkages. The two-step enzymatic strategy to yield sugar-based polyesters, which is the first report of its kind, results in higher molecular weights and faster reaction times than one-step enzymatic polyester synthesis.

Effects of recombinant monokines on hepatic pyruvate dehydrogenase, pyruvate dehydrogenase kinase, lipogenesis de novo and plasma triacylglycerols. Abolition by prior fasting.

1. The effects of recombinant human tumour necrosis factor alpha (TNF) and murine interleukin-1 alpha (IL-1) on the activation state of the hepatic pyruvate dehydrogenase complex (PDHa), the activity of mitochondrial PDH kinase, hepatic lipogenesis de novo and plasma triacylglycerol (TG) concentrations were studied. 2. Monokine effects depended upon prior nutritional state. In rats fasted for 20 h or 45 h before monokine administration and refeeding (orally or with intravenous glucose), PDHa, TG and hepatic lipogenesis were not increased. In rats fed ad libitum, treatment with TNF plus IL-1 increased the contribution of hepatic lipogenesis to circulating TG to 550% of control values (P = 0.03) and plasma TG concentrations to 159% (P = 0.02), whereas PDHa increased slightly to 120% (P = 0.02) and liver glycogen content fell to 45.8% (P = 0.05) of control values. 3. Intrinsic hepatic PDH kinase activity was not changed by monokine treatment in rats fed ad libitum. 4. The increased lipogenesis de novo showed no correlation (r2 = 0.05, not significant) with hepatic PDHa in individual animals fed ad libitum. 5. In conclusion, these results suggest that monokines increase pyruvate flux through hepatic PDH in vivo in rats fed ad libitum primarily by mechanisms other than covalent modification of PDH. Prior nutritional status exerts a permissive effect for monokine stimulation of PDHa and lipogenesis, consistent with a substrate-mediated action, but the mechanism of this permissive effect remains uncertain.

Mechanisms of fructose-induced hypertriglyceridaemia in the rat. Activation of hepatic pyruvate dehydrogenase through inhibition of pyruvate dehydrogenase kinase.

1. The effects of purified diets containing 70% glucose or 70% fructose on the activation state of hepatic pyruvate dehydrogenase (PDHa), activity of mitochondrial PDH kinase, plasma triacylglycerols (TG) and hepatic lipogenesis de novo in rats were measured. 2. Plasma TG were significantly increased in the fructose-fed compared with the glucose-fed group (125 +/- 45 mg/dl versus 57 +/- 19 mg/dl; P less than 0.002) after 3-5 weeks on the diet despite less daily food intake. 3. Hepatic PDHa in fructose-fed rats was 144% of the value in glucose-fed rats (15.4 +/- 1.2% versus 10.7 +/- 0.5%; P less than 0.002), whereas cardiac muscle PDHa was not different (45.5 +/- 6.6% versus 41.0 +/- 7.8%). 4. Intrinsic hepatic PDH kinase activity was decreased to 34% of glucose-fed values by fructose feeding (-k = 3.56 +/- 0.39 versus 10.41 +/- 1.85 min-1; P less than 0.005). 5. The fractional contribution to very-low-density-lipoprotein palmitate from hepatic lipogenesis de novo, measured by a stable-isotope mass-spectrometric method, was 10.49 +/- 2.42% (n = 8) in fructose-fed rats versus 5.55 +/- 1.38% (n = 9) in glucose-fed rats (P less than 0.05), and 2.66 +/- 2.39% (n = 3) in chow-fed rats (P less than 0.05 versus fructose-fed group). The absolute contribution to circulating TG from lipogenesis de novo was also significantly higher in the fructose-fed than in the glucose-fed group (14.9 +/- 5.1 mg/dl versus 2.9 +/- 0.6 mg/dl; P less than 0.05) 6. Portal insulin concentrations were significantly higher in the fructose-fed rats (206 +/- 49 mu-units/ml versus 81 +/- 15 mu-units/ml; P less than 0.05). 7. In conclusion, dietary fructose appears to have a specific activating effect on hepatic PDH, mediated at least in part by inhibition of PDH kinase. These results are consistent with increased flux through hepatic PDH and synthesis of new fat, not just increased re-esterification of non-esterified fatty acids.

Urban nutritional problems of Korea.

Rapid economic development resulted in urbanization of Korea, since 1960s. Seoul is the center of politics, finance, education and culture of Korea. Mostly young people have migrated to large cities, such as Seoul and Pusan. For instance, the population in Seoul city was 2.5 million in 1960 but increased to 10 million in 1990. Presently, total population of Seoul and Pusan, second largest city, composed of approximately 50% of whole national population. The economic distribution among urban people became extremely uneven creating a large gap between low and high income group. As a consequence, both under and over nutritional problems coexist. According to the national nutrition survey data, animal food, such as meat, fish and dairy products have been consumed about 6 times more, and cereal consumption was far less in higher income group. In terms of nutrients intake, 28% of total caloric intake comes from lipids and 15-17% of total caloric intake from protein. This was found in higher income group, while low income group consumed more than 80% of total caloric intake from carbohydrate. The trends of major causes of death in Korea have changed. The degenerative diseases, cerebral disorder, high blood pressure became leading cause of death in recent years. Malignant neoplasm and diabetes followed second leading cause of death in Korea. Undernutrition and nutritional insufficiencies, anemia and low growth rate continue to exist among low income group. According to the annual death rate by age group, the age between 34-54 was the highest in the world.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of individual patient teaching through home visiting on compliance with sick role behavior in diabetic patients and duration of the effect of the teaching].

In order to determine the effect of individual patient teaching through home visiting on compliance with sick role behavior and the blood sugar level in diabetic patients, to determine if the effectiveness of the education was still present four years later and to inquire as to the effective time for a repeat education program this study was done through two quasi-experimental researches. The subjects consisted of 52 diabetic patients. The results of the study may be summarized as follows: 1. Hypothesis I, in which the compliance with sick role behavior, the knowledge on diabetes and the health belief of the experimental group who received a diabetic education program will be higher than those of the control group who didn't receive the diabetic education, was supported by both studies in 1984 and 1988, confirming the effect on diabetic patients of the individualized education through home visiting: In the 1984 study: Compliance(t = -11.7, p less than .001) Knowledge(t = -5.41, p less than .001) Health belief(t = -4.74, p less than .001) In the 1988 study: Compliance(t = -4.85, p less than .001) Knowledge(t = -2.85, p less than .01) Health Belief(t = -2.99, p less than .005) 2. The Hypothesis II, the blood sugar level of the experimental group will be lower than that of the control, was rejected in both studies, 1984 and 1988. 3. The Hypothesis III, the compliance, knowledge and health belief of the experimental group who received the education program in 1984 will not last till 1988, was supported in part, in compliance and health belief, but not in knowledge. In conclusion those who received the education program twice with an interval of 2 weeks, 4 years ago still had knowledge of diabetes but compliance and health belief had disappeared.