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Context: Data from Asian populations about gender-related differences in Crohn's disease are few. Objectives This study was to analyze the clinical characteristics between women and men affected by Crohn's disease., Methods: This was a retrospective cohort study to analyze consecutive Crohn's disease patients from Jan 2000 to Dec 2012. Clinical and phenotypic characteristics and treatment outcomes were evaluated., Results: 79 patients (55 male and two of them with positive family history) were diagnosed with Crohn's disease. Ileocolonic disease and inflammatory lesion was the most dominant site of involvement and disease behavior respectively in both men and women. Apart from higher frequency of nausea (45.83 vs 23.64%, P 0.024) and lower body mass index (19.44 vs 22.03 kg/m2, P 0.003) reported in women, no significant gender-related differences in clinical characteristics were observed. Women were more associated with delay use of immunosuppressive therapy (12 vs 36 months, P = 0.028), particularly for those aged less than 40 years old (85 vs 62.6%, P = 0.023). Cox proportional hazard regression analysis revealed that active smoking (HR, 4.679; 95% CI, 1.03-21.18) and delayed use of immunosuppressive therapy (HR, 4.13; 95% CI, 1.01-16.88) were only independent risk factors associated with increased risk of complications., Conclusions: There were no significant gender-specific differences in clinical and phenotypic characteristics between male and female Crohn's disease patients. Smoking history and delay use of immunosuppressive therapy were associated with higher risk of complications.

Background: Protocols for antibiotic treatment of pyogenic liver abscess (PLA) are usually based on clinicians' own experience without any validation. Our study was to evaluate the clinical implication of C-reactive protein (CRP) in predicting treatment outcome and adequacy of antibiotic therapy of PLA., Patients and Methods: Patients with PLA in whom white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and CRP were checked regularly during the clinical course were included. The prolife of CRP during the clinical course was compared with that of ESR and WBC. The usefulness of CRP in predicting the chance of recovery and adequacy of antibiotic therapy was examined., Results: From 2000 to 2011, 109 patients with PLA underwent regular monitoring of WBC, ESR, and CRP. Except for ESR, both WBC and CRP showed an initial rapid reduction in first 3 weeks, followed by a relatively slow decrease. From week 3 to week 6, the CRP ratio (relative to CRP at week 1) of patients with and without adverse events (i.e. including mortality) was compared; a significant difference was found at week 3 (P=0.001), week 4 (P=0.004), week 5 (P=0.011), and week 6 (P=0.018), whereas no statistically significant difference was found in the WBC ratio over the same period. By week 3, a CRP ratio of 0.423 or less was a marker of good outcome (sensitivity 0.846; specificity 0.667) and was also a marker of adequacy of antibiotic therapy of 5 weeks or less (sensitivity 0.786; specificity 0.714) if the ratio was 0.278 or less., Conclusion: Weekly CRP measurement was useful in the identification of patients with PLA with good outcome and adequacy of antibiotic therapy of 5 weeks or less.

Betel quid (BQ) is a psychostimulant, an addictive substance, and a group 1 carcinogen that exhibits the potential to induce adverse health effects. Approximately, 600 million users chew a variety of BQ. Areca nut (AN) is a necessary ingredient in BQ products. Arecoline is the primary alkaloid in the AN and can be metabolized through the cytochrome P450 (CYP) superfamily by inducing reactive oxygen species (ROS) production. Full-length CYP26B1 is related to the development of oral pharyngeal cancers. We investigated whether a splice variant of CYP26B1 is associated with the occurrence of ROS related oral and pharyngeal cancer. Cytotoxicity assays were used to measure the effects of arecoline on cell viability in a dose-dependent manner. In vitro and in vivo studies were conducted to evaluate the expression of the CYP26B1 splice variant. The CYP26B1 splice variant exhibited lower expression than did full-length CYP26B1 in the human gingival fibroblast-1 and Ca9-22 cell models. Increased expression of the CYP26B1 splice variant was observed in human oral cancer tissue compared with adjacent normal tissue, and increased expression was observed in patients at a late tumor stage. Our results suggested that the CYP26B1 splice variant is associated with the occurrence of BQ-related oral cancer.

An 80 year old man presented subacutely with drowsiness and confusion. Subsequent MRI brain imaging demonstrated multiple posterior circulation infarcts. Extracranial vasculitis was suspected when his ESR was found to be high and vascular imaging showed multifocal irregular narrowing of both vertebral arteries. This was confirmed by targeted temporal artery biopsy, which showed chronic granulomatous inflammation typical of giant cell arteritis (GCA). The patient made a significant recovery following treatment with prednisolone.

The aim of this study was to compare the clinical characteristics and treatment outcomes of patients with young and adult onset Crohns disease. Among 79 consecutive Crohns disease patients (11 (13.92%) with onset =16 years old), young onset Crohns disease was significantly associated with fever (36.36 vs. 14.71%, P 0.041), weight loss (72.7 vs. 29.4%, P 0.003), isolated abdominal pain (45.45 vs. 16.18%, P 0.013), lower body mass index ( 17.32 vs. 21.29 kgm2, P 0.019), and extraintestinal manifestation, particularly oral (45.5% vs. 22.1%, P 0.049) and perianal lesion (63.6% vs. 36.8%, P 0.046). In both groups, ileocolonic disease and inflammatory lesion were the most prevalent site of involvement and dominant disease behavior respectively. Their complication and bowel resection rate were similar but the former took a longer period of time to develop in the young onset group (84 vs. 24 month, P 0.018). Cox proportional hazard regression analysis revealed that active smoking and delayed use of immunosuppressive therapy were the only independent risk factors associated with increased risk of complications.

This study focused on the application of novel finite-element analysis software for constructing a finite-element model from the computed tomography data of a human dentulous mandible. The finite-element model is necessary for evaluating the mechanical response of the alveolar part of the mandible, resulting from occlusal force applied to the teeth during biting. Commercially available patient-specific general computed tomography-based finite-element analysis software was solely applied to the finite-element analysis for the extraction of computed tomography data. The mandibular bone with teeth was extracted from the original images. Both the enamel and the dentin were extracted after image processing, and the periodontal ligament was created from the segmented dentin. The constructed finite-element model was reasonably accurate using a total of 234,644 nodes and 1,268,784 tetrahedral and 40,665 shell elements. The elastic moduli of the heterogeneous mandibular bone were determined from the bone density data of the computed tomography images. The results suggested that the software applied in this study is both useful and powerful for creating a more accurate three-dimensional finite-element model of a dentulous mandible from the computed tomography data without the need for any other software.

Background: Drug eluting balloon (DEB) is a new therapeutic option for treatment of obstructive coronary lesions in percutaneous coronary intervention (PCI). There is limited data on the safety and efficacy of DEB in Asian patients in contemporary clinical registries. We evaluated the clinical efficacy and safety of SeQuent Please paclitaxel-eluting balloon in our cohort of South-East Asian patients in real world clinical practice., Methods: Between January 2010 to November 2012, 320 patients (76% male, mean age 61.3 ± 11.2 years) with a total of 337 coronary lesions were treated with SeQuent Please drug-eluting balloon (DEB). The primary endpoint was major adverse cardiac events (MACE) ie a composite of cardiovascular death, target vessel related myocardial infarction (MI) and target lesion revascularization (TLR) at 9 months follow-up., Results: The majority of patients presented with acute coronary syndrome (76%).The most common indication for the use of DEB was small vessel disease (54%) followed by instent restenosis (21%), bifurcation lesions (6%) and others (19%). An average of 1.23 ± 0.5 DEB were used per patient, with mean DEB diameter of 2.6 ± 0.6 mm and average total length of 24.0 ± 11.1 mm.At 9 months follow-up, 5.3% of patients developed MACE. MACE was mainly driven by TLR(4%) followed by target vessel related myocardial infarction (2.6%) and cardiovascular death (1%)., Conclusion: SeQuent Please DEB was a safe and effective treatment modality in our cohort of South-East Asian patients with a low incidence of MACE observed at 9 months follow-up.

Adefovir dipivoxil (ADV) is one of the commonly used antiviral agents in the treatment of chronic hepatitis B infection. Nephrotoxicity is dose related and occurred at a daily dosage of >30 mg. However, it is now increasingly recognized that nephrotoxicity can occur at a daily dose of 10 mg. We present a case of acquired Fanconi syndrome in a patient with chronic hepatitis B who had been treated with ADV for 4 years. She presented with progressive muscle weakness and generalized bone pain. The laboratory results showed the feature of proximal renal tubule dysfunction, particularly severe hypophosphatemia. Diagnostic approach to hypophosphatemia and proximal renal tubular dysfunction is discussed. After switching over from ADV to entecavir, her symptoms and laboratory findings returned to normal. Acquired Fanconi syndrome can be associated with ADV at a conventional dosage, and therefore, patients treated with long-term ADV should have regular monitoring of renal function and calcium and phosphate levels.

Objectives: Contemporary experience with mitral valve (MV) repair in the rheumatic population is limited. We aimed to examine the long-term outcomes of rheumatic MV repair, to identify the predictors of durability and to compare the repair for rheumatic and degenerative MVs., Methods: MV repairs for both rheumatic and degenerative lesions were analysed prospectively from our valve-repair registry. The primary outcomes investigated were mortality, survival, freedom from reoperation and freedom from valve failure. Logistic and Cox regression analyses were performed to define the predictors of reoperation and valve failure., Results: Between 1997 and 2010, 627 consecutive rheumatic MV repairs were performed (46.7% of all mitral repair procedures). The mean age of our study group was 32 ± 19 (range 3-75 years). In-hospital mortality was 2.4% and late mortality was 0.3%. Freedoms from reoperation for rheumatics at 5 and 10 years were 91.8 ± 4.8 and 87.3 ± 3.9%, respectively, comparable with that for degenerative valves at 92.0 ± 1.7 and 91.8 ± 4.8%, respectively (P = 0.79). Freedoms from valve failure for rheumatics at 5 and 10 years were 85.6 ± 2.3 and 72.8 ± 4.6%, respectively, whereas those for degenerative repairs were 88.7 ± 5.1 and 82.4 ± 7.7%, respectively (P = 0.45). Independent predictors for reoperation and valve failure in rheumatic patients were residual mitral regurgitation >2+ and performance of commissurotomy., Conclusions: The durability of MV repair for rheumatic disease in the current era has improved and is comparable with the outstanding durability of repairs for degenerative disease. Modifications of standard repair techniques, adherence to the importance of good leaflet coaptation and strict quality control with stringent use of intraoperative transoesophageal echocardiography have all contributed to the improved long-term results.

Objectives: Type IIIa mitral regurgitation (MR) due to rheumatic leaflet restriction often renders valve repair challenging and may predict a less successful repair. However, the utilization of leaflet mobilization and extension with the pericardium to increase the surface of coaptation may achieve satisfactory results. We reviewed our experience with leaflet extension in rheumatic mitral repair with emphasis on the technique and mid-term results., Methods: Between 2003 and 2010, 62 of 446 rheumatic patients had leaflet extension with glutaraldehyde-treated autologous pericardium as part of their mitral repair procedure. Their clinical and echocardiographic data were prospectively analysed., Results: The mean age of the rheumatic patients was 20.2 ± 11.7 years; range 3-60 years. Fourty-eight (77.4%) patients had predominant MR, while 22.6% had mixed mitral stenosis and mitral regurgitation (MS/MR). Leaflet extension was performed in the posterior, anterior and both leaflets in 77, 13 and 10% of patients, respectively. Additional repair procedures included neo-chordal replacement, chordal transfer/shortening/fenestration/resection, commissurotomy and papillary muscle splitting. All repairs were stabilized with annuloplasty rings. The follow-up was complete in all patients with a mean follow-up of 36.5 ± 25.6 months. There was no mortality in this series. At the latest follow-up, the MR grade was none/trivial in 64.5 of patients, mild in 22.6, moderate in 6.5, moderately severe in 4.8 and severe in 1.6%. Two patients had redo mitral surgery. At 5 years postoperatively, the estimated rates of freedom from reoperation and valve failure were 96.8 and 91.6%, respectively., Conclusions: Repair with leaflet extension in rheumatic disease resulted in good early and mid-term outcomes. A wider utilization of this technique may increase the feasibility and durability of repair in complex rheumatic mitral valve disease.

Objective: The study aimed to compare the clinical characteristics of abdominopelvic (AP) abscess in patients with and without newly diagnosed Crohn's disease (CD)., Methods: We investigated 91 consecutive patients with AP abscess (14 newly diagnosed with CD) from January 2001 to December 2010. The clinical, radiological, microbiological and pathological features and patients' outcomes were evaluated., Results: Patients with newly diagnosed CD were younger (42.5 vs. 57.9 years, P = 0.004), more associated with fever (50.0% vs. 13.0%, P = 0.004) and weight loss (21.4% vs. 3.9%, P = 0.045), and normoglycemic (5.2 mmol/L vs. 6.7 mmol/L, P = 0.001). Their abscesses, located predominantly at the paracolic gutter region (P = 0.002) were associated with fistulae (P = 0.001) and caused by transmural bowel wall inflammation. More patients in the CD group required temporarily parenteral nutritional support (P = 0.000) and had a longer hospital stay (P = 0.045) and a higher local recurrent rate (P = 0.000)., Conclusion: AP abscesses associated with newly diagnosed CD display distinct clinical behavior with a high risk of local recurrence., (© 2013 The Authors. Journal of Digestive Diseases © 2013 Wiley Publishing Asia Pty Ltd and Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine.)

Background: Previous studies have focused on the role of age as a prognostic factor in pyogenic liver abscess (PLA) and results have been controversial. The aim of this study was to compare the clinical characteristics of PLA in elderly (age ≥65 years) and non-elderly patients in order to identify any differences so that an early diagnosis can be made and appropriate therapeutic measures can be instituted promptly., Methods: We performed a retrospective analysis of patients with PLA. The demographic and clinical features, laboratory and imaging findings, management, and clinical outcomes of elderly and non-elderly patients were studied., Results: Between January 2000 and December 2010 inclusive, 319 patients had PLA; 168 (52.7%) were aged ≥65 years. Elderly patients were more likely to have acute onset of symptoms (4.2 vs. 5.3 days, p < 0.04), co-morbidities, and respiratory symptoms (25.6% vs. 14.6%, p < 0.01). They also had lower serum bilirubin (28.1 vs. 37.1 μmol/l, p < 0.04), alanine aminotransferase (71.6 vs. 94.3 U/l, p < 0.02), and glycosylated hemoglobin (8.1% vs. 10%, p < 0.01), and more often had septal lobulation (64.3% vs. 54.3%, p < 0.04) and pneumobilia (10.1% vs. 4.0%, p < 0.02). Moreover, they required a longer duration of oral antibiotics (2.63 vs. 2.05 weeks, p < 0.01) and had a higher incidence of acute coronary syndrome during the illness (7.7% vs. 2.0%, p < 0.01). Gram-negative organisms were the dominant isolates in both groups, but the elderly had a lower incidence of Gram-positive infections (5.4% vs. 13.2%, p < 0.01). Lastly, old age was associated with local recurrence of PLA (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.0-9.7, p < 0.04) and mortality (OR 3.17, 95% CI 1.25-8.04, p = 0.015)., Conclusions: Elderly patients tend to have a more atypical presentation in PLA, for which clinicians should be on high alert. We found older age to be associated with a higher recurrence of PLA and a higher mortality rate., (Copyright © 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Atopic dermatitis (AD) is a relatively common disease in patients in the Asia-Pacific region. It presents a particular clinical challenge and requires careful clinical management. The chronic nature of AD characterized by flares, exacerbations and periods of quiescence requires a multipronged approach aimed at reducing itch, inflammation and the appearance of secondary lesions. In addition, varying levels of maintenance therapy may be required to avoid exacerbations. Survey data from the region indicate that there is significant variation across the Asia-Pacific with regard to current treatment practices. The management of AD may also be influenced by differing health-care systems, variable climate, access to medical care and cultural diversity. The current consensus guidelines have been developed to provide up-to-date and concise evidence- and experience-based recommendations directed towards general practitioners and general dermatologists in the Asia-Pacific region on the management of pediatric and adult AD., (© 2013 Japanese Dermatological Association.)

Our objective was to compare patients with concurrent and sequentially presented systemic lupus erythematosus (SLE)-related protein-losing enteropathy (PLE). Patients with history of SLE admitted for PLE were selected and their clinical, laboratory, endoscopic and imaging characteristics, treatment and outcome were analyzed. From 2001 to 2010, 21 and 27 patients had concurrent and sequentially presented SLE-related PLE, respectively, and their clinical characteristics were comparable except the following: the concurrent group had more pleural effusion (P < 0.01), cutaneous (P < 0.03), neurological (P = 0.02) manifestations, higher creatine phosphokinase (127.6 IU/L vs. 105.7 IU/L, P < 0.05) and lactate dehydrogenase (504.0 IU/L vs. 422.2 IU/L, P < 0.05); whereas the sequential group had higher anti-double strand DNA titer (179.8 vs. 100.4, P < 0.05), 24-h urine protein excretion (1.1 g/d vs. 0.6 g/d, P < 0.05) and increased proteinuria after onset of PLE (0.21 g/d vs. 1.1 g/d, P < 0.04). The endoscopic, histological and radiological features were comparable between the two groups. More patients from the sequential group required more potent immunosuppressive therapy for induction (55.6% vs. 14.3%, P = 0.002) and maintenance (48.2% vs. 9.5%, P < 0.01).The concurrent group associated with better treatment outcomes, with requiring shorter mean time (4.5 months vs. 7.9 months, P = 0.03) for normalbuminemia and more individuals (90.5% vs. 63%, P < 0.02) achieving normalbuminemia in first year. The complications were infrequent: two drug-related adverse events from each group, one patient each from the concurrent group developed shingle and SLE nephropathy. PLE associated with concurrent and sequentially presented of SLE are comparable in clinical behavior; and the immunosuppressive therapy is generally well-responded and tolerated. However, the concurrent group is associated with better disease activity control.

Background: Stent delivery failure occurs in 4% of all percutaneous coronary interventions (PCIs) and >90% of these failures are due to vessel tortuosity and/or calcification. Stent performance of the newly launched Integrity coronary stent has markedly improved due to its novel manufacturing process utilizing continuous sinusoid technology. We sought to evaluate the deliverability of Integrity coronary stents in severely tortuous coronary lesions in real-world clinical practice., Methods: From January to August 2011, a total of 35 patients (25 males; mean age, 60.7 ± 11.4 years) with obstructive coronary artery disease involving severely tortuous coronary vessels underwent PCI with Integrity coronary stents., Results: The most common target vessel for PCI was left circumflex artery (54.3%) followed by right coronary artery (42.8%) and left anterior descending (2.9%), with 37.1% of lesions located distally. Mean stent diameter was 3.04 ± 0.51 mm and mean stent length was 20.5 ± 6.6 mm. Acute procedural success was achieved in 33 patients (94%) using conventional PCI techniques. Predilatation was performed in 31 patients (89%) and buddy wires were used in 12 patients (34.3%). For the 2 cases (6%) in which stent delivery failed, Heartrail catheters were used as a bailout to facilitate stent delivery. There were no peri- or postprocedural adverse events., Conclusion: This early experience with Integrity coronary stent in severely tortuous coronary arteries yielded a promising result in terms of stent deliverability. It could potentially shorten PCI procedural time in this technically challenging subgroup of patients.

The purpose of this animal study was to investigate the influence of maternal lead exposure during pregnancy and lactation on molar development in the offspring. Scanning electron microscopy revealed no significant differences in the molar morphology among the groups. However, in all the experimental groups, deep, wide cracks were found in the occlusal enamel. Further, the experimental groups had smaller molar diameters than the control group, lead exposure during lactation had a greater influence on the molar size in the offspring, and the groups with the higher dose of lead exposure during pregnancy and lactation had significantly smaller molar sizes than the groups that received the lower dose. The mesiodistal and buccolingual diameters of molars were measured as 3.10 ± 0.07 and 1.95 ± 0.04 mm for control group, 2.97 ± 0.08 and 1.94 ± 0.01 mm for lactation group of low dose, 2.96 ± 0.05 and 1.84 ± 0.02 mm for lactation group of high dose, 3.09 ± 0.06 and 1.94 ± 0.04 mm for pregnancy group of low dose, and 3.02 ± 0.06 and 1.85 ± 0.06 mm for pregnancy group of high dose, respectively.

Aim: To investigate the clinical features and in-hospital outcomes of young adults with acute myocardial infarction (AMI) in Singapore., Methods: Between January 2005 to September 2010, 333 consecutive patients aged ≤ 45 years old were diagnosed to have AMI at our institution. As Singapore is a multi-ethnic society, we also analysed whether ethnic differences exist between the three dominant ethnic groups, Malay, Chinese and Indian with regards to the clinical features. Clinical data was collected retrospectively on demographic characteristics, presenting signs and symptoms, blood investigation, angiographic findings and in-hospital clinical outcomes., Results: The mean age at presentation was 40.2 ± 4.0 years with male predominance (94%). The majority of patients were Chinese (51%) followed by Indians (31%) and Malays (18%). The most common risk factor was smoking (74%) followed by hypertension (28.5%) and hyperlipidemia (20.0%). 37% of patients were obese. The majority of patients had single vessel disease (46%) on coronary angiography. The mean total cholesterol, low-density lipoprotein and high-density lipoprotein levels were 5.6 ± 1.2 mmol/L, 3.8 ± 1.1 mmol/L and 0.93 ± 0.25 mmol/L respectively. The mean left ventricular function was 44% ± 10% with the incidence of heart failure 3% and cardiogenic shock 4.5%. Overall in-hospital mortality was low with 4 deaths (1.2%). For ethnic subgroup analysis, Indians have a 3-fold risk of developing premature AMI when compared to other ethnic groups., Conclusion: Young AMI patients in Singapore are characterized by male predominance, high incidence of smoking and obesity. Overall in-hospital clinical outcomes are favourable. Among the 3 ethnic groups, Indians have the highest risk of developing premature AMI.

Background: A retrospective analysis of all women undergoing hysterectomy at Sydney West Advanced Pelvic Surgery Unit (SWAPS) was performed in the nine-year period from 2001 to 2009., Aims: To evaluate the incidence, timing and presenting symptoms of vaginal vault dehiscence after hysterectomy, especially via the laparoscopic approach to gain further understanding of patient risk factors and surgical factors that may predispose to this complication., Methods: Women who presented with vaginal vault dehiscence were identified and possible pre-operative, intra-operative and post-operative risk factors were assessed. A comprehensive literature search was performed to assess the current understanding and incidence of vault dehiscence after laparoscopic hysterectomy., Results: A total of 1224 hysterectomies were performed between 2001 and 2009. 989 (80.80%) were performed laparoscopically of which five women (0.42%) presented with vault dehiscence post-operatively. All had undergone total laparoscopic hysterectomy resulting in a vault dehiscence rate of 1.59% after total laparoscopic hysterectomy specifically. Baseline characteristics included a mean age of 42.8 years (37-51 years), mean BMI of 26.8 kg/m(2) (23.8-32.3 kg/m(2)) and a mean parity of two deliveries (1-3 deliveries). The main presenting symptom of vaginal vault dehiscence was vaginal bleeding. Women with confirmed vaginal vault dehiscence readmitted to hospital at a mean of 18 days (11-28 days) post-operatively., Conclusion: Vaginal vault dehiscence is a rare complication after hysterectomy, but more common after a laparoscopic approach. A delayed presentation with vaginal bleeding was the main presenting symptom in this study - a literature review has shown common presenting symptoms to include abdominal pain, vaginal evisceration and vaginal bleeding. Techniques specific to total laparoscopic hysterectomy seem especially important in the increased risk of vaginal vault dehiscence seen after laparoscopic hysterectomy., (© 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

During surgical correction of facial deformities, accurate prediction of the resulting facial profile is important for the patient and the surgeon. The purpose of the present study was to investigate profile changes after surgical treatment of mandibular prognathism. Thirty patients (20 females and 10 males; ages 17-28 years) with mandibular prognathism underwent vertical ramus osteotomy. Preoperative and postoperative cephalograms were analyzed; landmarks were identified and compared. The mean horizontal setback of the pogonion (Pog) was 11.7 mm. The setback ratios of labrale inferius (Li)/incision inferius (Ii), labiomental sulcus (Si)/point B, and soft tissue pogonion (PogS)/pogonion (Pog) were 0.98, 0.99, and 0.95, respectively. There were no sex-related changes in soft tissue. These findings indicate that changes in soft tissue closely correlate with the amount of mandibular setback in the horizontal direction. Such information might facilitate more accurate prediction of the outcome of orthognathic surgery., (Copyright © 2012. Published by Elsevier B.V.)

Aim: To compare the clinical characteristics of pyogenic liver abscess (PLA) in patients with and without hepatic neoplasm (HN)., Methods: Authors performed a retrospective analysis involving patients with PLA. The demographic, clinical features, laboratory and imaging findings, management and outcome of patients with and without HN were studied., Results: From January 2000 to December 2009 inclusive, 318 patients (35 with HN) had PLA, and mean age and comorbidity were comparable between the two groups. More patients with HN experienced right upper quadrant pain (68.6% vs. 52.7%, P < 0.04), developed jaundice (14.3% vs. 5.7%, P < 0.03) and hepatomegaly (17.1% vs. 3.9%, P < 0.01), and had higher serum total bilirubin level (43.3 μmol/L vs. 30.0 μmol/L, P = 0.05). Most patients in both groups had PLAs in the right hepatic lobe, and biliary tract disorder was the most common underlying cause (71.4% and 61.8%). However, more PLAs in the HN group were associated with thicker abscess wall (37.1% vs. 19.4%, P < 0.01), septal lobulation (77.1% vs. 58%, P < 0.02), gaseous cavitation (17% vs. 7.8%, P = 0.03), portal thrombophlebitis (11.4% vs. 1.8%, P < 0.01) and aerobilia (25.9% vs. 5.5%, P < 0.01). Mixed bacterial growth (40% vs. 15.2%, P < 0.01) and Gram-negative bacilli (22.8% vs. 60.4%, P < 0.01) were dominant isolates in PLAs with and without HN, respectively. Although incidence of the complications was comparable between the two groups, patients with HN had a higher mortality rate than those without (71.4% vs. 8.8%, P < 0.01). Multivariate logistic regression analysis revealed underlying active malignancy [odds ratio (OR): 40.45, 95% CI: 14.76-111.65], hypoalbuminemia (OR: 1.22, 95% CI: 1.14-1.38), disseminated intravascular coagulation (OR: 3.32, 95% CI: 1.19-9.69) and acute coronary syndrome (OR: 4.48, 95% CI: 1.08-17.8) were independent risk factors associated with mortality. However, several HN cases, presented concurrently with PLAs, were found to have curative resectable tumors and had good prognosis after surgery., Conclusion: PLA associated with HN tends to form a distinct clinical syndrome with a different extent of clinical manifestations, radiological and microbiological features and complications.

Objective: The aim of our study was to compare protein-losing enteropathy (PLE) associated with or without systemic autoimmune (SA) diseases., Methods: Patients diagnosed with PLE were selected, and their clinical characteristics, laboratory, endoscopic and imaging characteristics, treatment, and outcome were analyzed., Results: From 2001 to 2010, 74 patients (60 patients with SA disease) with a female predominance were diagnosed with PLE. The SA group tended to be younger, presented early (4.3 vs. 7 weeks, P=0.08), and had significantly more mucocutaneous-articular involvement (16.7 vs. 0%, P<0.05; 50 vs. 0%, P<0.02; 43.3 vs. 0%, P<0.01), compared with the other group, which showed more weight loss (64.3 vs. 25%, P<0.01), malaise and fatigue (57.1 vs. 28.3%, P<0.02), and tended to have more gastrointestinal (GI) symptoms. The SA group was associated with lymphopenia (0.8 vs. 2.7 × 10⁹/l, P<0.01), hyperglobulinemia (43 vs. 31.2 IU/l, P<0.04), lactate dehydrogenase (511.1 vs. 393.5 IU/l, P<0.05), hematuria (48.3 vs. 7.1%, P<0.01), and pyuria (23.3 vs. 0%, P<0.03), whereas the non-SA group had a higher platelet count (402 vs. 262.5 × 10⁹/l, P<0.01) and alkaline phosphatase (111 vs. 78.2 IU/l, P<0.03) on admission. A subgroup analysis of patients with SA disease showed that more lupus patients had pericardial effusion (14.6 vs. 0%, P=0.08), polyarthritis (50 vs. 16.7%, P=0.02), lower C3 level (0.5 vs. 0.85 mg/l, P<0.01), antinuclear factors (89.6 vs. 58.3%, P<0.01), and antiextractable nuclear antigen antibody (73.3 vs. 37.5%, P<0.03), whereas nonlupus patients had higher C-reactive protein (87.9 vs. 40 mg/l, P<0.01) and more antineutrophil cytoplasmic antibody (ANCA) (60 vs. 3%, P=0.00). Thirty-seven (71%) patients with SA disease had diffuse nonerosive erythematous GI mucosa with chronic inflammatory cells in the lamina propria layer, and 12 (85.7%) patients without SA disease had focal lesions. The treatment response was comparable between the two groups. However, the time required to normalize the serum albumin level (6.3 vs. 12.3 months, P=0.02) of patients with SA disease was much shorter than that of the non-SA group and those of inflammatory markers, specifically, C-reactive protein and complement C3, of its own group (6.3 vs. 11.6 vs. 12.1 months, P<0.04). More patients without SA disease had infective episodes during the management period (14.3 vs. 1.7%, P<0.01)., Conclusion: Patients with PLE associated with SA disease tend to have a distinct clinical syndrome with regard to the extent of clinical manifestations and laboratory, endoscopic, and histological features compared with those without. Patients without SA disease are more prone to develop complications and mortality. However, both can be effectively treated with comparable treatment response.

Intracoronary bolus of eptifibatide during percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) has been shown to result in higher local platelet glycoprotein IIb/IIIa receptor occupancy with improved microvascular perfusion. It is unclear whether intracoronary administration of eptifibatide in a larger patient population results in favourable clinical outcomes. We evaluated the safety and efficacy of two regimens of intracoronary eptifibatide (bolus only versus bolus followed by intravenous infusion) in patients undergoing primary PCI for ST-elevation MI. They were divided into two groups: Group A (n=67) who received fixed-dose intracoronary eptifibatide bolus only and Group B (n=88) who received intracoronary bolus and continuous intravenous infusion of eptifibatide for 18 h. The preliminary findings from our registry showed that both regimens were associated with good angiographic outcomes, few bleeding events and low in-hospital major adverse cardiac events. A large prospective randomized, multi-centre trial is needed to confirm our observation.

Background: Long-term sequential expression of receptor activator of NF-κB ligand (RANKL) and osteoprotegrin (OPG) in lipopolysaccharide (LPS)-induced rat periapical lesions has not been studied., Materials:   Seventy-two 4-week-old Wistar rats were divided into eight experimental groups and one control group (eight animals in each)., Methods: Lipopolysaccharide-induced periapical lesions were produced in rats by occlusal exposure of the pulp of their lower first molars in all experimental groups but not the control group. The extent of periapical destruction was measured by radiographic imaging. RANKL and OPG mRNA were measured in all tissue sections containing the periapical lesions as well as the control group every week from week 1 to week 8 by real-time quantitative reverse transcription polymerase chain reaction. RANKL and OPG protein were determined by immunohistochemistry. Osteoclasts were identified by enzyme histochemistry., Results: The sequential changes in the mRNA and protein expression of RANKL and OPG were largely compatible with the occurrence of osteoclasts histologically and enzymes histochemically, as well as the mean areas of the periapical lesions radiographically during long-term observation of the LPS-induced rat periapical lesions., Conclusion: This study may be the first to demonstrate the long-term RANKL and OPG expression every week from week 1 to week 8 using LPS to produce periapical infection in a Wistar rat model. The long-term findings of high expressions of RANKL and OPG further extend the potential application of the Wistar rat model for future experimental trials using RANKL inhibitor to evaluate the treatment outcome for LPS-induced rat periapical lesions., (© 2011 John Wiley & Sons A/S.)

Protein kinase C (PKC) has been implicated in carcinogenesis and displays variable expression profiles during cancer progression. Studies of dietary phytochemicals on cancer signalling pathway regulation have been conducted to search for potent signalling regulatory agents. The present study was designed to evaluate any suppressive effect of maslinic acid on PKC expression in human B-lymphoblastoid cells (Raji cells), and to identify the PKC isoforms expressed. Effects of maslinic acid on PKC activity were determined using a PepTag assay for non-radioactive detection of PKC. The highest expression in Raji cells was obtained at 20 nM PMA induced for 6 hours. Suppressive effects of maslinic acid were compared with those of four PKC inhibitors (H- 7, rottlerin, sphingosine, staurosporine) and two triterpenes (oleanolic acid and ursolic acid). The IC₅₀ values achieved for maslinic acid, staurosporine, H-7, sphingosine, rottlerin, ursolic acid and oleanolic acid were 11.52, 0.011, 0.767, 2.45, 5.46, 27.93 and 39.29 μM, respectively. Four PKC isoforms, PKC βI, βII, δ, and ζ, were identified in Raji cells via western blotting. Maslinic acid suppressed the expression of PKC βI, δ, and ζ in a concentration-dependent manner. These preliminary results suggest promising suppressive effects of maslinic acid on PKC activity in Raji cells. Maslinic acid could be a potent cancer chemopreventive agent that may be involved in regulating many downstream signalling pathways that are activated through PKC receptors.

Background: Recurrent pyogenic cholangitis (RPC) is recognized as an important cause of pyogenic liver abscesses (PLA). Although it is endemic to Southeast Asia, it is seen increasing in the west mainly owing to immigration. The aim of this study is to compare the clinical characteristics of PLA in patients with RPC and without RPC., Methods: We performed a retrospective analysis involving patients with PLA. The demographic, clinical features, laboratory and imaging findings, management strategy, and outcome of patients with and without RPC were studied., Results: From January 2000 to December 2009 inclusive, 319 patients (27 with RPC and 292 without RPC) had PLA. Patients with RPC had higher mean age (71.7 vs. 64.9 years; P=0.03) and tended to have more acute onset of presentation than it did in those without RPC. The common clinical features of the two groups were fever, chill, and right upper quadrant pain. Patients without RPC tended to have more respiratory symptoms and signs. The laboratory abnormalities of both groups shared common features such as anemia, leukocytosis, high erythrocyte sedimentation rate and C-reactive protein, hypoalbuminemia, elevated total bilirubin, and alanine aminotransferase. Left lobe was predominantly involved in patients with RPC (51.9% vs. 23.6%; P<0.01) whereas those without RPC usually had PLA at right lobe (67.5 vs. 40.7%; P<0.01). Both groups also shared common radiological features such as hypoechoic in ultrasonograpphy, rim enhancement and septal lobulation in computed tomography. However, aerobila was found more in patients with RPC than those without RPC (25.9 vs. 5.5%; P<0.01) and the latter tended to have more abscess ruptures. The biliary tract disorder was the most common cause of the disease in the two groups. The microorganisms involved had distinct patterns between these two groups. Patients with RPC tended to have fewer complications than patients without RPC as there were fewer occurrences in metastatic infections, disseminated intravascular coagulation, and acute renal and respiratory failure. PLA in patients with RPC had higher recurrence rate than those without RPC (37 vs. 2.4%; P<0.01). The odds ratio of local recurrence between RPC and non-RPC group was 23.95 (95% confidence interval, 8.11-70.72). However, both were effectively managed by the combination of antibiotic and image-guided aspiration with/without drainage, and their mortality rates are comparable with each other., Conclusion: PLA associated with RPC tends to have distinct clinical syndrome in regards to different extent of clinical manifestations, radiological and microbiological features, and complications. Its recurrent rate is higher than that of non-RPC type. However, both can be effectively treated with a combination of antibiotic and image-guided aspiration with/without drainage.

We describe 2 cases of complex coronary lesions in which the conventional 0.014-inch balloon catheters failed to cross a chronic subtotal occlusion and also failed to adequately predilate a calcified coronary lesion. The novel use of a 0.010-inch guidewire and compatible balloon catheters in both cases allowed us to perform the percutaneous coronary intervention (PCI) successfully, and we highlight the usefulness of these new devices as important adjunctive tools in PCI. (J Interven Cardiol 2011;24:315-319)., (©2011, Wiley Periodicals, Inc.)

Objectives: Our objective was to determine the feasibility and early to medium-term outcome of stenting the patent ductus arteriosus at the time of radiofrequency valvotomy in the subgroup of patients with pulmonary atresia with intact ventricular septum and intermediate right ventricle., Background: Stenting of the patent ductus arteriosus and radiofrequency valvotomy have been proposed as the initial intervention for patients with intermediate right ventricle inasmuch as the sustainability for biventricular circulation or 1½-ventricle repair is unclear in the early period., Methods: Between January 2001 and April 2009, of 143 patients with pulmonary atresia and intact ventricular septum, 37 who had bipartite right ventricle underwent radiofrequency valvotomy and stenting of the patent ductus arteriosus as the initial procedure. The mean tricuspid valve z-score was -3.8 ± 2.2 and the mean tricuspid valve/mitral valve ratio was 0.62 ± 0.16., Results: Median age was 10 days (3-65 days) and median weight 3.1 kg (2.4-4.9 kg). There was no procedural mortality. Acute stent thrombosis developed in 1 patient and necessitated emergency systemic-pulmonary shunt. There were 2 early in-hospital deaths owing to low cardiac output syndrome. One late death occurred owing to right ventricular failure after the operation. Survival after the initial procedure was 94% at 6 months and 91% at 5 years. At a median follow-up of 4 years (6 months to 8 years), 17 (48%) attained biventricular circulation with or without other interventions and 9 (26%) achieved 1½-ventricle repair. The freedom from reintervention was 80%, 68%, 58%, and 40% at 1, 2, 3, and 4 years, respectively., Conclusions: Concomitant stenting of the patent ductus arteriosus at the time of radiofrequency valvotomy in patients with pulmonary atresia with intact ventricular septum and intermediate right ventricle is feasible and safe with encouraging medium-term outcome., (Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)

Objective: In the present study, we examined whether 2, 2-bis [4-(2-hydroxy-3-methacryloxypropoxy) phenyl] propane (Bis-GMA) has effects on LSC2 cells, human dental pulp cell line., Material and Methods: The viability, cell cycle, and morphology of LSC2 cells were analyzed after exposure to several different concentrations of Bis-GMA. The recovery of viability of Bis-GMA exposed cells was also analyzed in the condition without Bis-GMA. Further, penetration of Bis-GMA to dentin disc was examined using isocratic high-performance liquid chromatography., Results: There was a concentration-dependent decrease in cell proliferation and an increase in cell number in the sub-G1 population after exposure to Bis-GMA. Furthermore, the cells showed typical characteristics of apoptotic cells after the exposure to high concentration of Bis-GMA. In contrast, cells exposed to lower concentrations of Bis-GMA recovered their viability after being cultured without Bis-GMA. We also found that Bis-GMA is capable of penetrating 1-mm-thick dentin discs, though the penetrated concentration was lower than that showing cytotoxicity., Conclusion: These results suggest that Bis-GMA has cytotoxic effects, though dental pulp exposed to lower concentrations is able to recover their viability when Bis-GMA is removed.

Background: Existing surveillance systems for sexually transmitted diseases (STD) and reproductive tract infections (RTI) are important but often ineffective, as they tend to omit cases diagnosed by private-practice doctors, Methods: During a 15-day study period, 277 private-practice doctors and all public-practice doctors of all the eight local Social Hygiene Clinics (SHC) in Hong Kong filled out daily a standard log-form, recording the number of patients diagnosed with particular types of STD/RTI. Projections for all local private-practice and public-practice doctors were made by the stratification method., Results: Data showed that 0.75% of private patients and 40.92% of public patients presented the listed STD/RTI syndromes. It is projected that 12,504 adults were diagnosed with such syndromes by all local private-practice (10,204) or public-practice doctors (2,300); 0.22% (male: 0.26%; female: 0.18%) of the local adult population would fall into this category. The ratio of STD/RTI cases, diagnosed by private-practice versus public-practice doctors, was 4:1. Of the participating private-practice doctors, 96% found the process easy to administer and 75% believed that it was feasible for such a STD/RTI surveillance system to be implemented annually., Conclusions: Surveillance of STD/RTI based only on data obtained from the public health system is inadequate. Data obtained from public-practice and private-practice doctors are very different and the majority of the patients presented their STD/RTI syndromes to private-practice doctors. The proposed, improved surveillance system is feasible and has the strengths of involving both private-practice and public-practice medical practitioners and being well accepted by private-practice doctors.

Chronic inflammation is one of the predisposing factors for neoplastic transformation. Targeting inflammation through suppression of the pro-inflammatory pathway by dietary phytochemicals provides an important strategy for cancer prevention. Maslinic acid is a novel natural triterpenoid known to inhibit proliferation and induce apoptosis in some tumor cell lines. Although maslinic acid has cytotoxic and pro-apoptotic effects on cancer cells, the underlying mechanisms of its effects on the inflammatory pathway have yet to be elucidated. It has been reported that abnormal expression of pro-inflammatory enzyme cyclooxygenase-2 (COX-2) causes promotion of cellular proliferation, suppression of apoptosis, enhancement of angiogenesis and invasiveness. In the present study, the suppressive effect of maslinic acid on COX-2 expression and the binding activity of upstream transcription factors NF- κB and AP-1, which are known to regulate COX-2 transcriptional activation, were assessed using Raji cells. The anti-inflammatory action of maslinic acid was benchmarked against oleanolic acid and other standard drugs. Western blot analysis and electrophoretic mobility shift assay (EMSA) were employed to analyze COX-2 expression as well as NF- κB and AP-1 binding activity. Our results showed that maslinic acid suppresses COX-2 expression in a concentration-dependent manner. Likewise, the constitutive nuclear NF- κB (p65) activity as well as phorbol 12-myristate 13-acetate (PMA)- and sodium N-butyrate (SnB)-induced AP-1 binding activity in Raji cells were significantly reduced following treatment with maslinic acid. Since maslinic acid suppresses COX-2 expression in Raji cells at concentrations that also lowered the NF- κB (p65) and AP-1 binding activity, it is possible that the suppression of COX-2 by this natural triterpenoid might be achieved, at least in part, via the NF- κB and AP-1 signaling pathways., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective. Photodynamic therapy has been expanded for use in endodontic treatment. The aim of this study was to investigate the antimicrobial effects of diode laser irradiation on endodontic pathogens in periapical lesions using an in vitro apical lesion model. Study Design. Enterococcus faecalis in 0.5% semisolid agar with a photosensitizer was injected into apical lesion area of in vitro apical lesion model. The direct effects of irradiation with a diode laser as well as heat produced by irradiation on the viability of microorganisms in the lesions were analyzed. Results. The viability of E. faecalis was significantly reduced by the combination of a photosensitizer and laser irradiation. The temperature caused by irradiation rose, however, there were no cytotoxic effects of heat on the viability of E. faecalis. Conclusion. Our results suggest that utilization of a diode laser in combination with a photosensitizer may be useful for clinical treatment of periapical lesions.

Background: The objective of this study is to estimate the incidence of genital warts in Hong Kong and explore a way to establish a surveillance system for genital warts among the Hong Kong general population., Methods: A total of 170 private doctors and all doctors working in the 5 local Social Hygiene Clinics (SHC) participated in this study. During the 14-day data collection period (January 5 through 18, 2009), the participating doctors filled out a log-form on a daily basis to record the number of patients with genital warts. The total number of new cases of genital warts presented to private and public doctors in Hong Kong was projected using the stratification sampling method., Results: A total of 721 (0.94%) adults presented with genital warts to the participating doctors during the two-week study period, amongst them 73 (10.1%) were new cases. The projected number of new cases of genital warts among Hong Kong adults was 442 (297 male and 144 female) during the study period. The incidence of genital warts in Hong Kong was estimated to be 203.7 per 100,000 person-years (respectively 292.2 and 124.9 per 100,000 person-years for males and females)., Conclusions: The incidence of genital warts is high among adults in Hong Kong. The study demonstrates the importance of collecting surveillance data from both private and public sectors.

The effects of sandblasting media and steam cleaning treatment after sandblast were examined on tensile bond strength of porcelain to titanium. The use of the commercially available silica-coated alumina particles for sandblast was significantly effective for increasing bond strength than the conventional alumina. It might be due to the increased surface roughness and existence of remaining silica on titanium surface. Additional application of the steam cleaning on titanium surface after sandblasting could make the surface configuration clear in SEM by removing some sandblasted particles loosely embedded in titanium as well as the debris and oily contaminants. The resultant bond strength was significantly improved to reach almost the maximum strength of this porcelain-titanium system regardless of the kind of sandblasting media used, which was confirmed by the observation of the failure mode showing that most of the fracture surface was occupied by cohesive failure in porcelain.

Choledochal varices are a rare cause of hemobilia associated with chronic portal vein thrombosis. We present a case of chronic portal vein thrombosis complicated with bleeding from choledochal varices. The presentation, clinical manifestations and management are described.

We numerically study the ground state phase diagram of the two-dimensional hard-core Bose-Hubbard model with nearest-(V(1)) and next-nearest-neighbour (V(2)) repulsions. In particular, we focus on the quarter-filled phases where one supersolid and two solid phases are observed. Using both canonical and grand canonical quantum Monte Carlo (QMC) methods and a mean-field calculation, we provide evidence for the existence of a commensurate supersolid. Despite the two possible diagonal long-range orderings for the solid phase, only one kind of supersolid phase is found to be energetically stable. The competition between the two solid phases manifests itself as a first-order phase transition around 2V(2) ∼ V(1). The change of order parameters as a function of the chemical potential is also presented.

It is important to develop a suitable three-dimensional scaffold for the regeneration therapy of dental pulp. In the present study, the effects of hyaluronic acid (HA) sponge on responses of the odontoblastic cell line (KN-3 cells) in vitro, as well as responses of amputated dental pulp of rat molar in vivo, were examined. In vitro, KN-3 cells adhered to the stable structure of HA sponge and that of collagen sponge. In vivo, dental pulp proliferation and vessel invasion were observed in both sponges implanted at dentin defect area above amputated dental pulp, and the cell-rich reorganizing tissue was observed in the dentin defect when HA sponge was implanted as compared with collagen sponge. Expression levels of IL-6 and TNF-alpha in KN-3 cells seeded in HA sponge were nearly the same with those in the cells seeded in collagen sponge, while the numbers (0.67 x 10(3) at 1 week and 0.7 x 10(3) at 3 weeks) of granulated leukocytes that invaded into HA sponge from amputated dental pulp was significantly lower than those (1.22 x 10(3) at 1 week and 1.1 x 10(3) at 3 weeks) of collagen sponge (p < 0.01 at 1 week and p < 0.05 at 3 weeks). These results suggest that HA sponge has an appropriate structure, biocompatibility, and biodegradation for use as a scaffold for dental pulp regeneration., ((c) 2009 Wiley Periodicals, Inc.)

Introduction: Pulp regeneration therapy is important to overcome the limitations of conventional therapy to induce reparative dentinogenesis. In the present study, we examined the effects of controlled release of different dosages of fibroblast growth factor-2 (FGF-2) from gelatin hydrogels to regenerate the dentin-pulp complex., Methods: After the amputation of dental pulp of rat molars, gelatin hydrogels incorporating various dosages of FGF-2 were individually implanted into dentin defects above the sites of the amputated pulps. Histologic changes as well as the expression of dentin matrix protein-1 (DMP-1) and nestin in the dentin defect area above the amputated pulp were analyzed., Results: We found that controlled release of high doses of FGF-2 from gelatin hydrogels induced DMP-1-positive calcified particles in the proliferating pulp, whereas a moderate dose of FGF-2 induced DMP-1-positive dentinal bridge on the surface of the proliferating pulp. These findings indicate that the dosage of released FGF-2 has an influence on the structure of calcified tissue regenerated in dentin defects. In addition, pulp cells near calcified tissues regenerated in dentin defects were nestin-negative, suggesting that the calcified tissues might be osteodentin., Conclusions: Our results showed that the dentin regeneration on amputated pulp, not reparative dentin formation toward amputated pulp, can be regulated by adjusting the dosage of FGF-2 incorporated in biodegradable gelatin hydrogels.

Introduction: It is important to develop an antimicrobial agent without any damage on dental pulp. In the present study, we examined whether pretreatment of bacterial lipopolysaccharides (LPS) with ozonated water (O(3)aq) improves LPS-induced responses of rat odontoblastic cell line, KN-3., Methods: After the pretreatment of LPS with O(3)aq, effects of LPS and O(3)aq-treated LPS on cell viability; calcification ability; expression of cyclooxygenase 2 (COX-2), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-alpha); and activation of p38 of KN-3 cells were examined., Results: The formation of mineralized nodules by KN-3 cells was suppressed by LPS, whereas that suppression was inhibited by the pretreatment of LPS with ozonated water. We also found that LPS-induced expression of COX-2, IL-6, and TNF-alpha and p38 activation were markedly suppressed when LPS was pretreated with ozonated water. Furthermore, expression of COX-2, IL-6, and TNF-alpha by LPS were mainly induced through p38 activation., Conclusion: These results suggest that odontoblastic cells exhibit inflammatory responses against LPS and that ozonated water has the ability to improve LPS-induced inflammatory responses and suppression of odontoblastic properties of KN-3 cells through direct inhibition of LPS.

The aim of this study was to develop a three-dimensional (3D) finite element (FE) model of a sound extracted human second premolar from micro-CT data using commercially available software tools. A detailed 3D FE model of the tooth could be constructed and was experimentally validated by comparing strains calculated in the FE model with strain gauge measurement of the tooth under loading. The regression coefficient and its standard error in the regression analysis between strains calculated by the FE model and measured with strain gauge measurement were 0.82 and 0.06, respectively, and the correlation coefficient was found to be highly significant. These results suggested that an FE model reconstructed from micro-CT data could be used as a valid model to estimate the actual strains with acceptable accuracy.

Background: A wide spectrum of human papillomavirus (HPV) types can infect the male genitalia. An HPV vaccine covering HPV6 and 11 is now available. Detailed data on the distribution of these two types in anogenital warts is needed to assess the potential benefits of the vaccine., Study Design: Anogenital wart specimens collected from 130 Chinese men were examined for HPV-type distribution by a method that covers a broad spectrum of high- and low-risk HPVs, and able to reveal multiple types from a single specimen., Results: Forty-four (33.8%) of the 130 specimens had a coinfection with multiple HPV types. In 63.1% of cases, only HPV6 and/or HPV11 were/was found. In 26.2% of cases, HPV6 and/or HPV11 were/was found together with one or more other HPV types. In 10.8% of specimens, only non-6/11 HPV types were found. HPV16 and/or 18 were/was found in 12 (9.2%) specimens, with majority (8/12, 66.7%) of which existed as coinfections with HPV6/11. Other HPV types found included HPV39, 51, 52, 55, 59, 61, 62, 68, 58, 72, 81, 83, 84 and CP6108., Conclusions: A substantial proportion of HPV6/11-positive male anogenital warts are coinfected with other HPV types. The efficacy of HPV6/11 vaccine for preventing these lesions needs to be defined before the benefits of vaccinating men can be precisely assessed.

Background and Purpose: Pyogenic liver abscess (PLA) is a major hepatobiliary infection with a significant mortality rate of 10% to 25%. Over the past 2 decades, there have been significant developments in the management of this disease. This study describes the demographic, clinical, and microbiological features, management, and poor prognostic factors of PLA in Hong Kong., Methods: All patients with PLA admitted to the Tuen Mun Hospital, Hong Kong, from July 1998 to June 2004 were included. The medical records of eligible patients were reviewed to obtain demographic, clinical, laboratory, microbiological, and radiological data. Management strategies and factors associated with mortality were studied., Results: 111 patients were included. Fever, chills, and right upper quadrant pain were the most common presenting symptoms. Low albumin level, elevated alkaline phosphatase, and leukocytosis were the most common laboratory features. Klebsiella spp. was the most common etiological agent detected in cultures of blood and abscess aspirates. Fifty two percent of these isolates were Klebsiella pneumoniae. Fifty three percent of PLA cases were cryptogenic in origin and 22.5% had underlying biliary pathology. The mortality rate was 11.7%. By multiple logistic regression analysis, hepato-pancreatico-biliary malignancy (p=0.001), requirement for open surgery (p=0.01), and significant delay in diagnosis (p=0.019) were independent risk factors associated with in-hospital mortality., Conclusion: Although advances in imaging and therapeutic modalities have lead to substantial improvement of outcomes, patients with underlying malignancy and those requiring open surgery in particular are at significant risk of mortality. Delay in diagnosis can result in a fatal outcome. A high index of suspicion with prompt institution of treatment is the cornerstone of successful treatment for patients with PLA.

Celiac disease (CD) is an autoimmune disease characterized by mucosal inflammation and villous atrophy of the small bowel upon exposure to ingested gluten. Although common in developed countries, it is extremely rare in the Chinese population. Refractory celiac disease (RCD) is a rare complication of CD with poor prognosis. Patients may die of severe malabsorption or development of enteropathy-associated T-cell lymphoma. We report a case of RCD in a Chinese woman who required steroid therapy in addition to a gluten-free diet to induce disease remission. The possibility of CD in Chinese patients should not be overlooked.

Objective: Serum biomarkers are commonly used for diagnosing and monitoring the disease activity of ulcerative colitis (UC) patients. However, their role in predicting active mucosal inflammation on Chinese patients is unknown. Our aim was to determine the sensitivity and correlation of these biomarkers with clinical severity and mucosal inflammation., Methods: Patients who had been newly diagnosed or who had developed a clinical relapse were identified. Active mucosal inflammation was confirmed by colonoscopy and histology. Those patients who had routine serum biomarkers (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR], white cell count, hemoglobin, platelet count and albumin) checked within 14 days of the index colonoscopy were recruited for a retrospective analysis. The disease severity was graded clinically and the positive rate of each marker was determined. The correlation of these markers with the clinical severity and extent of colitis were assessed by the Mann-Whitney U-test or the Kruskal-Wallis test. For the categorical variable, chi(2) or the Fisher's exact test were adopted., Results: From January 2001 to December 2006, 49 Chinese UC patients fulfilled the inclusion criteria. There were 78 acute mucosal inflammatory episodes (24 at diagnosis and 54 clinical relapses). Abnormal CRP, ESR, white cell count, hemoglobin, platelet count and albumin occurred in 42.3%, 55.1%, 23.1%, 21.8%, 32.1% and 25.6% of these mucosal inflammatory episodes, respectively. For the severity of the clinical disease, all serum biomarkers demonstrated a good correlation with the severity grading. On the other hand, the serum biomarkers correlated well with endoscopic extensive colitis but not with proctitis or left-sided colitis., Conclusion: Routine serum biomarkers are not sensitive in predicting mucosal inflammation. However, they are helpful in identifying patients with extensive colitis or clinically severe disease.

Background and Aim: Rising incidence and prevalence of ulcerative colitis (UC) had been observed in Asian countries. We conducted a study in an Asian center, aiming to describe the epidemiology and clinical characteristics of UC in local Chinese population., Methods: This is a retrospective analysis of patients with diagnosis of UC in our hospital from June 1990 to December 2006. The diagnosis of UC has to satisfy the internationally accepted criteria. All patients were Chinese residents in a well-defined catchment area. Clinical and epidemiological data were obtained from medical records and patient interviews., Results: Seventy-three Chinese UC patients had been managed in our hospital. The hospital-based prevalence had risen by three times over a 10-year period, but no definite rising incidence can be demonstrated. The mean age at diagnosis was 40.6 years and the median duration of disease is 72 months. In our patient cohort, 38.4% had ulcerative proctitis and 26% had left-sided UC, whereas 35.6% had extensive UC at presentation. The majority presented with mild (39.7%) or moderate (30.2%) disease activity, but 27.4% presented with severe disease. Two patients (2.7%) present with fulminant disease with one of them developed toxic megacolon. Extra-gastrointestinal manifestations occurred in 13.7%. During the follow-up period, most patients (86.3%) were in disease remission. Four patients (5.5%) underwent colectomy, four patients (5.5%) died, and two patients (2.7%) were lost to follow up., Conclusion: The prevalence but not the incidence of UC is rising in Chinese population. It usually affects young patients and a substantial proportion of patients presented with severe and fulminant disease. The disease activity of most Chinese patients can be controlled with medical treatment, though a small proportion of patients need surgery or have fatal outcome.

A newly developed electropolishing system, equipped with an original agitation function for an electrolyte and using a safe electrolyte composed of an alcoholic solution, was applied for wrought and cast CP titanium and its alloys. Surface roughness and morphology of the polished surfaces were then examined. Under an electrolytic condition of 70-75 V, 2.0 kA/m2, and 30 degrees C, wrought CP Ti and Ti-6Al-4V alloy achieved an apparent mirror-like finishing with an average surface roughness (Ra) of 0.03 and 0.12 microm respectively. Under the same condition, on the other hand, cast CP Ti and Ti-6Al-7Nb alloy produced rougher polished surfaces with average Ra values of 0.67-0.80 microm, and the finishing was apparently shiny, but not mirror-like. SEM observation of the polished surfaces showed that wrought CP Ti was even and completely featureless, while wrought Ti-6Al-4V alloy was pitted. For cast CP Ti, a needle-like phase containing traces of iron was observed on the polished surface.

Background/purpose: This study was undertaken to describe the sonographic features of meniscal subluxation in the weight-bearing position and to determine any association between meniscal subluxation and radiographic osteoarthritis., Methods: In total, 238 knees with symptoms were examined successfully with weight-bearing anteroposterior and lateral radiographs and high resolution ultrasonography. The radiographs were examined to determine whether participants had radiographic osteoarthritis, graded using the Kellgren-Lawrence Scale. The degree of subluxation of the medial meniscus in each knee was measured using high resolution ultrasound with a 10-MHz linear transducer, at the level of the medial collateral ligament in weight-bearing condition. The degree of subluxation was compared in knees with the presence or absence of radiographic osteoarthritis using Students t test. Additional analysis between knees with early and advanced radiographic osteoarthritis was also performed., Results: Meniscal subluxation for knees with (n = 141) and without (n = 97) radiographic signs of osteoarthritis were 4.3 1.9 mm and 0.7 0.6 mm, respectively. The difference was highly significant (p < 0.001). After age adjustment, the medial meniscal subluxation of age-matched subjects were 4.8 1.7 mm for knees with radiographic osteoarthritis (n = 43) and 1.0 0.8 mm for knees without such changes (n = 43). The difference between the two groups was still significant (p < 0.001). The greatest meniscal subluxation was seen in knees with advanced radiographic signs of osteoarthritis; no knee with osteoarthritic changes on radiographs had an undisplaced meniscus., Conclusion: Meniscal subluxation is a prominent feature on weight-bearing sonographic imaging in patients with radiographic osteoarthritis and could be considered as a risk factor for the development of knee osteoarthritis. By using musculoskeletal ultrasonography, one can detect this occult meniscal derangement early before the appearance of radiographic signs of osteoarthritis.