Therapeutic experience on multiple contractures in sclerodermoid chronic graft versus host disease

Introduction  A 25-year-old male underwent allogenic peripheral blood stem cell transplantation and developed sclerodermoid chronic graft versus host disease. He complained of limitation of motion of major joints and some difficulties with activities of daily living (ADL) performances. Discussion  He had been treated with physical and occupational therapies. After the rehabilitative managements, range of motion and ADL performances improved slightly. Conclusion  Active and continuous multimodal rehabilitative treatment would be helpful in managing contracture and functional impairment and preventing the progression of the disease.     

Sa-Ahm Five Element Acupuncture

This study aimed to review the clinical basis for Sa-Ahm Five Element acupuncture. This form of acupuncture uses the Five-Shu acupoints and the tonification-sedation treatments based on the creation and control cycles of the Five Elements. A total of 28 books and papers from the ancient “Nan-Ching” to the modern “Medical Acupuncture” were used to study clinical practices. Sa-Ahm Five Element acupuncture could be practiced in different ways depending upon differential diagnoses. These diagnoses include theories of excess and deficiency of Yin and Yang, seven emotions, ZangFu (organ, viscera), and comparing pulse diagnosis and meridian therapy to meridian palpation. Clinical trials and guidelines for the practice of Sa-Ahm acupuncture should be created to allow for a more evidence-based clinical approach to using this technique.     

Clinical significance of microsatellite instability for stage II or III colorectal cancer following adjuvant therapy with doxifluridine

Microsatellite instability (MSI) is a molecular marker that can provide valuable prognostic information for colorectal cancer (CRC). However, the predictive role of the MSI status remains less clear than its role in prognostication due to mixed results from previous studies. Therefore, this study investigated the usefulness of the MSI status as a predictive factor for stage II or III CRC patients who received adjuvant doxifluridine therapy. Among 3030 patients with CRC who underwent surgical resection between 1997 and 2006, 564 patients were diagnosed with stage II or III, and adjuvant doxifluridine therapy was administered to 394 patients (70.0%). The MSI status was assessed using the markers BAT25 and BAT26, and samples with instability at both markers were scored as exhibiting high-frequency MSI (MSI-H). Among the 564 patients, 290 patients (51.4%) had stage II, and MSI-H was found in 41 patients (7.3%). With a median follow-up duration of 35.1 months (range, 0.5–135.2), the 5-year overall survival (OS) rate and relapse-free survival (RFS) rate were 87.5 and 76.2%, respectively. MSI-H showed a favorable survival trend for OS (P = 0.098) and significant survival benefit for RFS (P = 0.037) in all patients. In a univariate analysis, the doxifluridine-treated patients with MSI-H showed improved RFS compared to those with low or stable MSI (MSI-L/S) (P = 0.036), while the MSI status was not significantly associated with OS (P = 0.107). In a multivariate analysis, MSI-H was not significantly associated with RFS (Hazard ratio = 2.467, P = 0.125). In conclusion, this study confirmed the positive prognostic role of MSI-H. However, MSI-H patients with stage II or III CRC did not seem to benefit from doxifluridine adjuvant therapy.

     

Pharmacokinetic comparison of two valproic acid formulations--a plain and a controlled release enteric-coated tablets.

We investigated the single- and multiple dose pharmacokinetics of a new controlled-release formulation (Orfil retard enteric coated tablet) of valproic acid in comparison with those of the plain tablet as a reference. Twelve healthy volunteers were given each formulation of 300 mg in the single-dose study. In the steady-state multiple-dose study, twelve epileptic patients received 1200 mg/day of the reference drug (300 mg 9 AM, 300 mg 3 PM, 600 mg 9 PM) and the test formulation (600 mg 9 AM, 600 mg 9 PM) with at least one week interval in cross-over manner. The AUC values of the test controlled release formulation were 91.7% (95% confidence interval: 78.4-100.4%) of the reference drug in the single-dose study and 98.2% (95% confidence interval: 86.2%-109.9%) in the steady-state study. The AUC''s of the two formulations were not significantly different by ANOVA test. The Cmax and Tmax values of the test formulation were significantly different from the values of the reference in single-(Tmax: 158.4%, Cmax: 52.5% of the reference) and multiple-dose study (Tmax: 153.5% of the reference). The MRT values of the test formulation were also significantly greater (129.4% of the reference) in the single-dose study. Regarding the controlled-release characteristics of the test formulation, fluctuation index and percentage fluctuation of the twice a day dosage regimen of the test formulation were comparable with those of the thrice a day dosage regimen of the conventional tablet. Area deviation was even smaller in the test regimen of the controlled release formulation.(ABSTRACT TRUNCATED AT 250 WORDS)     

I-MIBG myocardial scintigraphy as a noninvasive screen for the diagnosis of coronary artery spasm

Background. It has been suggested that the sympathetic nervous system might play an important role in the development of coronary artery spasm. However, no cardiac imaging modality has been able to demonstrate abnormal sympathetic innervation in patients with coronary artery spasm. The purpose of this study was to assess the presence and location of abnormal sympathetic innervation using iodine 123-metaiodobenzylguanidine (¹²³I-MIBG) single photon emission computed tomography (SPECT) and to evaluate the clinical efficacy of ¹²³I-MIBG SPECT as a noninvasive screening test in patients with coronary artery spasm.Methods and Results. Coronary arteriography and a provocative test with intravenous administration of ergonovine maleate were performed in 26 patients (20 men, 6 women, mean age 48.2 ± 12.0 years, range 20 to 67 years) who were suspected of having a coronary artery spasm. The subjects were divided into 2 groups: group 1 (n = 18) comprised subjects with a positive provocative test result, and group 2 (n = 8) comprised subjects with negative provocative test results. Ten healthy subjects served as controls. No abnormal MIBG uptake was observed in the control subjects. Abnormal sympathetic nervous innervation using ¹²³I-MIBG SPECT was observed either as a reduced uptake or a defective pattern in the perfused areas in 13 of the 18 regions supplied by vessels of ergonovine-induced vasospasm. Normal sympathetic innervation, as evidenced by normal ¹²³I-MIBG uptake, was noted in all of the 60 segments of normal vessel territories. Reduced uptake of ¹²³I-MIBG was not detected in the perfused areas of 5 vasospasm-induced vessels (perfusion territory of left anterior descending coronary artery [LAD] and the right coronary artery [RCA] in 2 and 3 patients, respectively). The sensitivity and specificity of ¹²³I-MIBG for detection of coronary artery spasm were 72.2% (95% confidence interval [CI] 55 % to 89 %) and 100 %, respectively. The positive predictive and negative predictive values were 100% and 92.3% (95% CI 91% to 93%), respectively.Conclusion. ¹²³I-MIBG SPECT is a feasible method to evaluate noninvasively and localize the territories of coronary arteries with spasm. Invasive diagnostic coronary arteriography with ergonovine provocation test may be unnecessary for diagnosis of coronary artery spasm in patients with typical resting pain, negative exercise test or normal thallium perfusion scan results, but showing abnormalities in ¹²³I-MIBG SPECT.     

Asthma attack associated with oxidative stress by exposure to ETS and PAH.

Asthma is primarily an airways inflammatory disease, and the bronchial airways have been shown to be particularly susceptible to oxidant-induced tissue damage. OBJECTIVE: The purpose of this study was to investigate whether pulmonary inflammation in asthma is associated with exposure to environmental oxidants such as polycyclic aromatic hydrocarbon (PAH) and environmental tobacco smoke (ETS). METHOD: We assessed the exposure level of PAH and ETS by using urinary 1-hydroxypyrene glucuronide (1-OHPG) and cotinine. We estimated oxidative damage and inflammatory cytokine levels from 16 asthma patients and 16 patients in stable conditions 1 to 2 months later. RESULTS: Our study showed that the levels of oxidative damage, as measured by malondialdehyde (MDA), were significantly increased (p = 0.006) during the asthma attacks. Proinflammatory and anti-inflammatory cytokines were both increased during the asthma attacks compared to the stable conditions at follow-up. Interleukin (IL-6) and IL-10 were especially increased significantly (p = 0.015 and p < 0.001, respectively). Correlations were observed between inflammatory cytokines such as IL-6 and IL-1beta (p = 0.034). CONCLUSION: This study supports the results of in vitro studies that oxidative stress, specifically lipid peroxidation, contributes to the pathophysiology of asthma. Therefore, environmental interventions based on this better understanding are needed to significantly reduce oxidant stress and prevent or minimize the development of asthmatic symptoms.     

Development of supplemental nutrition care program for women, infants and children in Korea: NutriPlus+

Onto the world-fastest ageing of society, the world-lowest fertility rate prompted a development of various policies and programs for a betterment of the population in Korea. Since the vulnerability of young children of low socio-economic class to malnutrition was clearly shown at the in-depth analysis of the 2001 Korea National Health and Nutrition Examination Survey data, an effort to devise supplemental nutrition care program for pregnant/breastfeeding women, infants and preschool children was initiated. The program was designed to offer nutrition education tailored to fit the needs of the participants and special supplementary foods, using USDA WIC program as a benchmark. Based on the dietary intake of those age groups, target nutrients were selected and their major food sources were searched through nutrient content of foods and dietary pattern analysis. As a result, we developed 6 kinds of food packages using combinations of 11 different food items. The amount of each item in a food package was determined to supplement the intake deficit in target nutrients. Nutrition education in NutriPlus⁺ aims to improve the nutrition knowledge, attitude, and dietary behaviors of the participants, and is provided through group lessons, individual counseling sessions and home visits. Breastfeeding is promoted with top priority in education for the health of both mother and baby. The eligibility guidelines were set for residency, household income, age, pregnancy/breastfeeding and nutritional risk such as anemia, stunting, underweight, and/or inadequate nutrient intake. Income eligibility was defined as household income less than 200 percent of the Korean poverty guidelines. A pilot study to examine the feasibility of program implementation was run in 3 public health centers in 2005 and expanded to 15 and 20 in the following 2 years. The result of 3-year pilot study will be reported separately along with the ultimate nationwide implementation of the NutriPlus⁺ in 2008.     

Effect of curing method and curing time on the microhardness and wear of pit and fissure sealants.

OBJECTIVE: To evaluate the effects of a light source, polymerization time and storage time on the microhardness and wear of pit and fissure sealants. METHODS: Five commercial pit and fissure sealants (Fissurit F [FF], Teethmate F1 [TF], Apollo Seal [AS], Concise [CC], and Ultraseal XT Plus [US]) were used. Specimens were cured with a conventional visible light curing unit (Curing Light XL 3000) for 10, 20, 30, 40s or with a plasma arc light curing unit (Apollo 95E) for 3, 6, 9, 12s. The specimens were kept dry in light-shielded bottles at 37 degrees C for 1 week, then half of them were thermocycled. The rest of them were stored in distilled water in light-shielded bottles for another 30 days, which were kept in an incubator at 37 degrees C, followed by thermocycling. Microhardness and wear of the specimens were measured. RESULTS: Similar degree of microhardness was achieved with the shorter curing time with the plasma arc light curing unit as with the conventional visible light-curing unit. With conventional visible light curing, the microhardness of the top surface was higher than that of the bottom surface (P<0.05). With plasma arc light curing, the microhardness of the top surface was higher than that of the bottom surface for AS and CC, but for FF, TF and US, the microhardness of the top surface was lower than that of the bottom surface, except in the 3-s curing of US. For FF, AS, CC and US, wear in the 6s curing with plasma arc light was similar to or less than that of the 30s curing with conventional visible light, but for TF, wear of the 9s curing with plasma arc light was similar to that of the 20s curing with conventional visible light. After storage in distilled water for 30 days followed by thermocycling, there was a tendency towards a decrease in microhardness and an increase in wear. There was a significant negative correlation between microhardness and wear (P<0.01). SIGNIFICANCE: The tested curing methods differed significantly in their curing capacity. This study suggested that a plasma arc light curing unit needs shorter curing time than a visible light curing unit to achieve similar mechanical properties of the pit and fissure sealants tested.