The purpose of this study was to make and ascertain a decision making process on the base of patient-oriented utilitarianism in the treatment of patients of chronic adult periodontitis. Fifty subjects were chosen in Yonsei Dental hospital and the other fifty were chosen in Severance dental hospital according to the selection criteria. Fifty four patients agreed in this study. NS group(N=32) was treated with scaling and root planing without any surgical intervention, the other S group(N=22) done with flap operation. During the active treatment and healing time, all patients of both groups were educated about the importance of oral hygiene and controlled every visit to the hospital. When periodontal treatment needed according to the diagnostic results, some patients were subjected to professional tooth cleaning and scaling once every 3 months according to an individually designed oral hygienic protocol. Probing depth was recorded on baseline and 18 months after treatments. A questionnaire composed of 6 kinds(hygienic easiness, hypersensitivity, post treatment comfort, complication, functional comfort, compliance) of questions was delivered to each patient to obtain the subjective evaluation regarding the results of therapy. The decision tree for the treatment of adult periodontal disease was made on the result of 2 kinds of periodontal treatment and patient's ubjective evaluation. The optimal path was calculated by using the success rate of the results as the probability and utility according to relative value and the economic value in the insurance system. The success rate to achieve the diagnostic goal of periodontal treatment as the remaining pocket depth less than 3mm and without BOP was 0.83+/-0.12 by non surgical treatment and 0.82+/-0.14 by surgical treatment without any statistically significant difference. The moderate success rate of more than 4mm probing pocket depth were 0.17 together. The utilities of non-surgical treatment results were 100 for a result with less than 3mm probing pocket depth, 80 for the other results with more than 4mm probing pocket depth, 0 for the extraction. Those of surgical treatment results were the same except 75 for the results with more than 4mm. The pooling results of subjective evaluation by using a questionnaire were 60% for satisfaction level and 40% for no satisfaction level in the patient group receiving non-surgical treatment and 33% and 67% in the other group receiving surgical treatment. The utilities for 4 satisfaction levels were 100, 75, 60, 50 on the base of that the patient would express the satisfaction level with normal distribution. The optimal path of periodontal treatment was rolled back by timing the utility on terminal node and the success rate, the distributed ratio of patient's satisfaction level. Both results of the calculation was non surgical treatment. Therefore, it can be said that non-surgical treatment may be the optimal path for this decision tree of treatment protocol if the goal of the periodontal treatment is to achieve the remaining probing pocket depth of less than 3mm for adult chronic periodontitis and if the utilitarian philosophy to maximise the expected utility for the patients is advocated.
Adult ; Male ; Female ; Humans

Background: This clinical case presented a novel method of segmental mandible reconstruction using 3D-printed titanium implant with pre-mounted dental implants that was planned to rehabilitate occlusion.Case presentationA 53-year-old male who suffered osteoradionecrosis due to the radiation after squamous cell carcinoma resection. The 3D-printed titanium implant with pre-mounted dental implant fixtures was simulated and fabricated with selective laser melting method. The implant was successfully inserted, and the discontinuous mandible defect was rehabilitated without postoperative infection or foreign body reaction during follow-ups, until a year. Conclusions The 3D-printed titanium implant would be the one of the suitable treatment modalities for mandible reconstruction considering all the aspect of mandibular functions.

Myxomas of the maxillary sinus are rare but well described mesenchymal neoplasms. They may be related to dental malformations or missing teeth, but may also occur without any such abnormalities. Although these tumors are well circumscribed, they are often more extensive than apparent because of their local aggressiveness and ability to erode bone. They tend to recur despite their benign nature, so it should be widely resected to prevent recurrence. A brief overview of the literature and a report of a case of myxoma of the maxillary sinus is presented.
Cytochrome P-450 CYP1A1 ; Maxillary Sinus* ; Myxoma* ; Recurrence ; Tooth

Background: This clinical case presented a novel method of segmental mandible reconstruction using 3D-printed titanium implant with pre-mounted dental implants that was planned to rehabilitate occlusion.Case presentationA 53-year-old male who suffered osteoradionecrosis due to the radiation after squamous cell carcinoma resection. The 3D-printed titanium implant with pre-mounted dental implant fixtures was simulated and fabricated with selective laser melting method. The implant was successfully inserted, and the discontinuous mandible defect was rehabilitated without postoperative infection or foreign body reaction during follow-ups, until a year. Conclusions The 3D-printed titanium implant would be the one of the suitable treatment modalities for mandible reconstruction considering all the aspect of mandibular functions.

PURPOSE: Questionnaire-based diagnostic criteria for atopic dermatitis (AD) have been proposed to detect the major group of AD with flexural dermatitis. We aimed to develop novel, questionnaire-based diagnostic criteria for childhood AD, which can detect more comprehensive AD including non-flexural type. METHODS: The draft version of questionnaire to detect childhood AD was prepared to be used for preliminary hospital- (n=1,756) and community-based (n=1,320) surveys. From analysis, the Reliable Estimation of Atopic dermatitis of ChildHood (REACH) was derived and verified in derivation (n=1,129) and validation (n=1,191) sets by community-based surveys. RESULTS: The REACH consists of 11 questions including 2 major and 9 minor criteria. AD is diagnosed as the major group of 'eczema on the antecubital or popliteal fossa' to fulfill the 2 major criteria (2M), and the minor group of 'eczema on the non-antecubital or popliteal fossa' to fulfill the 1 major plus 4 or more minor criteria (1M+4m). In the validation set, the overall 1-year AD prevalence by the REACH was estimated as 12.3% (95% CI, 10.5%-14.2%), and the REACH showed a sensitivity of 75.2%, a specificity of 96.1%, and an error rate of 6.4%. The REACH demonstrated better diagnostic performance than the ISAAC in terms of the number of misclassification (10.0%). CONCLUSIONS: We propose the REACH as new full, questionnaire-based diagnostic criteria for childhood AD in epidemiological surveys. Further studies are warranted to validate the REACH in different populations or countries in the context of large-scale, epidemiological surveys.
Dermatitis ; Dermatitis, Atopic* ; Prevalence ; Sensitivity and Specificity

PURPOSE: Lipopolysaccharide-binding protein (LBP) is a 65-kDa acute phase protein, derived from the liver, which is present in high concentrations in plasma. Data regarding the association between circulating plasma LBP levels and obesity-related biomarkers in the pediatric population are scarce. We aimed to determine whether there was a difference in plasma LBP levels between overweight/obese and normal-weight adolescents and to assess the correlation of circulating LBP levels with anthropometric measures and obesity-related biomarkers, including insulin resistance, liver enzyme levels, and lipid profiles. METHODS: The study included 87 adolescents aged 12-13 years; 44 were overweight/obese and 43 were of normal-weight. We assessed anthropometric and laboratory measures, including body mass index (BMI), blood pressure, insulin resistance, liver enzyme levels, and lipid profiles. Plasma LBP levels were measured using an enzyme-linked immunosorbent assay. RESULTS: The mean age of the participants was 12.9±0.3 years. Circulating plasma LBP levels were significantly increased in overweight/obese participants compared with those in normal-weight participants (7.8±1.9 µg/mL vs. 6.0±1.6 µg/mL, P<0.001). LBP levels were significantly and positively associated with BMI, systolic blood pressure, aspartate aminotransferase, alanine aminotransferase, total cholesterol, low density lipoprotein-cholesterol, fasting glucose and insulin, and insulin resistance as indicated by the homeostatic model assessment of insulin resistance (HOMA-IR) (all P<0.05). In multivariate linear regression analysis, BMI and HOMA-IR were independently and positively associated with plasma LBP levels. CONCLUSION: LBP is an inflammatory biomarker associated with BMI and obesity-related insulin resistance in adolescents. The positive correlation between these parameters suggests a potentially relevant pathophysiological mechanism linking LBP to obesity-related insulin resistance in adolescents.
Acute-Phase Proteins ; Adolescent* ; Alanine Transaminase ; Aspartate Aminotransferases ; Biomarkers ; Blood Pressure ; Body Mass Index ; Cholesterol ; Enzyme-Linked Immunosorbent Assay ; Fasting ; Glucose ; Humans ; Insulin Resistance* ; Insulin* ; Linear Models ; Liver ; Obesity ; Plasma*

A 55-year-old female presented with extensive yellowish eruptive plaques over both elbows and the buttocks that she had first noticed 2 years earlier. Yellowish orange discoloration of her palmar creases was noted. Her serum cholesterol and triglyceride were markedly elevated. Lipoprotein electrophoresis showed a broad beta band. On apolipoprotein E genotyping, the arginine at position 158 had been replaced by cysteine in both alleles (E2/E2). Under a diagnosis of type III hyperlipoproteinemia, combined atorvastatin and fenofibrate therapy for 2 months normalized the serum cholesterol and triglyceride levels.
Alleles ; Apolipoproteins ; Arginine ; Buttocks ; Cholesterol ; Citrus sinensis ; Cysteine ; Elbow ; Electrophoresis ; Female ; Fenofibrate ; Heptanoic Acids ; Humans ; Hyperlipoproteinemia Type III ; Hyperlipoproteinemias ; Lipoproteins ; Middle Aged ; Pyrroles ; Xanthomatosis ; Atorvastatin Calcium

STI571 is an effective agent for the patients with chronic myeloid leukemia (CML). But, complete molecular response with STI571 is rarely reported in accelerated phase CML. Here we report a patient with accelerated phase CML who achieved complete molecular response with STI571. A 60-year old female patient visited emergency room with syncope. Her white blood cell count was 30,800/microliter (basophil 23%), hemoglobin 8.9g/dL, and platelet counts 2,748,000/microliter. Bone marrow was hypercellular with increase in megakaryocyte and basophils (15%). She was diagnosed as an accelerated phase CML. Seven days after stopping hydroxyurea, we used STI571 in a daily oral dose of 600mg. Generalized edema and skin rash were observed 15 days after treatment (all grade 1) and were controlled well with conservative management. Complete hematologic and cytogenetic responses were achieved after 1 month and 3 months of therapy with STI571 respectively. Complete molecular response was simultaneously proven by conventional reverse transcriptase PCR and real-time PCR analysis. The patient still remained in complete hematologic, cytogenetic, and molecular responses for 24 months. Treatment with STI571 was well tolerated and rapid hematologic improvement was observed. This case shows STI571 can induce complete molecular response as well as cytogenetic response in accelerated phase CML.
Basophils ; Bone Marrow ; Cytogenetics ; Edema ; Emergency Service, Hospital ; Exanthema ; Female ; Humans ; Hydroxyurea ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukocyte Count ; Megakaryocytes ; Middle Aged ; Platelet Count ; Real-Time Polymerase Chain Reaction ; Reverse Transcriptase Polymerase Chain Reaction ; Syncope ; Imatinib Mesylate

The effect of forskolin on corticostriatal synaptic transmission was examined by recording excitatory postsynaptic currents (EPSCs) in rat brain slices using the whole-cell voltage-clamp technique. Forskolin produced a dose-dependent increase of corticostriatal EPSCs (1, 3, 10, and 30micrometer) immediately after its treatment, and the increase at 10 and 30micrometer was maintained even after its washout. When the brain slices were pre-treated with (DL)-2-amino-5-phosphonovaleric acid (AP-V, 100micrometer), an NMDA receptor antagonist, the acute effect of forskolin (10micrometer) was blocked. However, after washout of forskolin, an increase of corticostriatal EPSCs was still observed even in the presence of AP-V. When KT 5720 (5micrometer), a protein kinase A (PKA) inhibitor, was applied through the patch pipette, forskolin (10micrometer) increased corticostriatal EPSCs, but this increase was not maintained. When forskolin was applied together with AP-V and KT 5720, both the increase and maintenance of the corticostriatal EPSCs were blocked. These results suggest that forskolin activates both NMDA receptors and PKA, however, in a different manner.
Animals ; Brain ; Carbazoles ; Cyclic AMP-Dependent Protein Kinases ; Excitatory Postsynaptic Potentials ; Forskolin ; N-Methylaspartate ; Patch-Clamp Techniques ; Pyrroles ; Rats ; Receptors, N-Methyl-D-Aspartate ; Synaptic Transmission

The striatum receives glutamatergic afferents from the cortex and thalamus, and these synaptic transmissions are mediated by alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) and N-methyl-D-aspartate (NMDA) receptors. The purpose of this study was to characterize glutamate receptors by analyzing NMDA/AMPA ratio and rectification of AMPA and NMDA excitatory postsynaptic currents (EPSCs) using a whole-cell voltage-clamp method in the dorsal striatum. Receptor antagonists were used to isolate receptor or subunit specific EPSC, such as (DL)-2-amino-5-phosphonovaleric acid (APV), an NMDA receptor antagonist, ifenprodil, an NR2B antagonist, CNQX, an AMPA receptor antagonist and IEM-1460, a GluR2-lacking AMPA receptor blocker. AMPA and NMDA EPSCs were recorded at -70 and +40 mV, respectively. Rectification index was calculated by current ratio of EPSCs between +50 and -50 mV. NMDA/AMPA ratio was 0.20+/-0.05, AMPA receptor ratio of GluR2-lacking/GluR2-containing subunit was 0.26+/-0.05 and NMDA receptor ratio of NR2B/NR2A subunit was 0.32+/-0.03. The rectification index (control 2.39+/-0.27) was decreased in the presence of both APV and combination of APV and IEM-1460 (1.02+/-0.11 and 0.93+/-0.09, respectively). These results suggest that the major components of the striatal glutamate receptors are GluR2-containing AMPA receptors and NR2A-containing NMDA receptors. Our results may provide useful information for corticostriatal synaptic transmission and plasticity studies.
6-Cyano-7-nitroquinoxaline-2,3-dione ; Adamantane ; alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid ; Animals ; Excitatory Postsynaptic Potentials ; N-Methylaspartate ; Piperidines ; Plastics ; Rats ; Receptors, AMPA ; Receptors, Glutamate ; Receptors, N-Methyl-D-Aspartate ; Synaptic Transmission ; Thalamus