No potential conflict of interest relevant to this letter was reported. The authors reply: Campochiaro and Caruso are correct that mention of cardiovascular associations with ankylosing spondylitis and axial spondyloarthritis, including specific conductionsystem lesions and aortic-root lesions, was largely absent from our review of spondyloarthritis. These specific lesions are uncommon and tend to occur late in the disease course, as does the other more common but less specific cardiovascular illness mentioned in their letter. The focus of our article was on early diagnosis and clinical management of the axial disease, and this priority, along with space and citation limitations, precluded our describing specific cardiovascular manifestations. Rudwaleit M, van derRudwaleit and colleagues make the important point that diagnosis in clinical practice cannot be based solely on fulfillment of classification criteria. We tried to make this point in the article, but perhaps our wording conveyed some unintended ambiguity. In order to introduce the new concept of axial spondyloarthritis, we described the classification criteria for this entity proposed by the ASAS in 2009. In discussing this concept, including the critical role of MRI, we referred to this entity as a diagnosis, in the sense of its being a defined medical condition. We did not intend by this to imply that one can rely strictly on these criteria to establish a diagnosis in clinical practice. In fact, we stated explicitly, "These classification criteria have limited use outside the arena of clinical research," to introduce the algorithm (in Fig. 2 of our article) for use in clinical practice.The algorithm itself is a modification of one published by the correspondents and their colleagues, 1 but it was modified specifically to further emphasize the importance of weighing clinical data and post-test probabilities 2 and of applying clinical judgment to the diagnostic process. Moreover, the discussion of MRI findings includes mention of lesions that are not part of the classification criteria but that can be helpful in supporting a diagnosis in clinical practice. Finally, the Summary section in our article reemphasizes the potential difficulty in accurately establishing or ruling out a diagnosis of axial spondyloarthritis, with no mention of criteria. Viral Load Kinetics of MERS Coronavirus InfectionTo the Editor: The outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) infection in South Korea involved 186 patients and resulted in 38 deaths, with four large hospital outbreaks accounting for 82% of the total cases. 1,2 Here, we report changes in viral load over time in patients with MERS.We included all patients who were admitted to three Seoul National University-affiliated hospitals; the institutional review boards of these hospitals approved this study and waived the need for written informed consent on public health grounds. The patients were categorized into a group with severe disease (severe group) or a group with mild disease (mild grou...

Novel coronavirus (SARS-CoV-2) is found to cause a large outbreak started from Wuhan since December 2019 in China and SARS-CoV-2 infections have been reported with epidemiological linkage to China in 25 countries until now. We isolated SARS-CoV-2 from the oropharyngeal sample obtained from the patient with the first laboratory-confirmed SARS-CoV-2 infection in Korea. Cytopathic effects of SARS-CoV-2 in the Vero cell cultures were confluent 3 days after the first blind passage of the sample. Coronavirus was confirmed with spherical particle having a fringe reminiscent of crown on transmission electron microscopy. Phylogenetic analyses of whole genome sequences showed that it clustered with other SARS-CoV-2 reported from Wuhan.Coronaviruses (CoVs), within the order Nidovirales, are enveloped, single-strand, positivesense RNA viruses with a large genome of approximately 30 kbp in length. CoV was cultured for the first time in human embryonic tracheal organ cultures by Tyrrell and Bynoe in 1965, 1 and it was named as 'corona' due to crown-like appearance of the surface projections on electron microscopy. All CoVs develop only in the cytoplasm of infected cells, bud into cytoplasmic vesicles, and then extrude in virus particles of 70-80 nm in diameter by exocytic secretory pathway.Among four genera of CoVs, beta-CoV includes five subgenus-embevovirus, sarbecovirus including severe acute respiratory syndrome (SARS)-CoV, merbecovirus including Middle East respiratory syndrome (MERS)-CoV, nobecovirus, and hibecovirus. Because CoVs can infect a variety of animals, SARS-CoV and MERS-CoV crossed the species barriers.Since December 2019, 2019 novel CoV (SARS-CoV-2) has been making a large outbreak involving 49,053 laboratory-confirmed patients and 1,383 mortality in 25 countries including J Korean Med Sci. 2020 Feb 24;35(7):e84 https://doi.

This study presents a comparative risk pattern for cancer of the oral cavity, pharynx and larynx, in relation to cigarette smoking and alcohol consumption based on data from case-control studies conducted in Korea Cancer Center Hospital, Seoul, Korea. The risk of cancer of the oral cavity, pharynx and larynx rose for current smokers and declined for ex-smokers. In males the odds ratios (ORs) for these sites rose with duration of smoking and number of cigarettes smoked per day. The relationship is strongest for laryngeal cancer. The risk for all sites was elevated linearly as amount and frequency of alcohol intake increased. Heavy drinkers, i.e. males who drank 90 g ethanol daily had an approximately 15-fold risk of cancer of the oral cavity, an 11-fold risk of pharyngeal cancer and an 11-fold risk of laryngeal cancer compared with non-drinkers. Alcohol drinking was a much stronger risk factor for cancer of the oral cavity than cancer of the pharynx and larynx. Alcohol was a much weaker risk factor for laryngeal cancer than cigarette smoking. Cancer of the oral cavity, pharynx and larynx also showed an interaction between smoking and alcohol, suggesting a synergistic effect.

Gallic acid [3,4,5-trihydroxybenzoic acid (GA)], a natural phytochemical, is known to have a variety of cellular functions including beneficial effects on metabolic syndromes. However, the molecular mechanism by which GA exerts its beneficial effects is not known. Here we report that GA plays its role through the activation of AMP-activated protein kinase (AMPK) and by regulating mitochondrial function via the activation of peroxisome proliferator-activated receptor-γ coactivator1α (PGC1α). Sirtuin 1 (Sirt1) knockdown significantly blunted GA's effect on PGC1α activation and downstream genes, suggesting a critical role of the AMPK/Sirt1/PGC1α pathway in GA's action. Moreover, diet-induced obese mice treated with GA showed significantly improved glucose and insulin homeostasis. In addition, the administration of GA protected diet-induced body weight gain without a change in food intake. Biochemical analyses revealed a marked activation of AMPK in the liver, muscle, and interscapular brown adipose tissue of the GA-treated mice. Moreover, uncoupling protein 1 together with other genes related to energy expenditure was significantly elevated in the interscapular brown adipose tissue. Taken together, these results indicate that GA plays its beneficial metabolic roles by activating the AMPK/Sirt1/PGC1α pathway and by changing the interscapular brown adipose tissue genes related to thermogenesis. Our study points out that targeting the activation of the AMPK/Sirt1/PGC1α pathway by GA or its derivatives might be a potential therapeutic intervention for insulin resistance in metabolic diseases.

Five pentacyclic triterpenoids isolated from Campsis grandiflora were tested for insulin-mimetic and insulin-sensitizing activity. The compounds enhanced the activity of insulin on tyrosine phosphorylation of the IR (insulin receptor) beta-subunit in CHO/IR (Chinese-hamster ovary cells expressing human IR). Among the compounds tested, CG7 (ursolic acid) showed the greatest enhancement and CG11 (myrianthic acid) the least. We characterized the effect of CG7 further, and showed that it acted as an effective insulin-mimetic agent at doses above 50 mug/ml and as an insulin-sensitizer at doses as low as 1 mug/ml. Additional experiments showed that CG7 increased the number of IRs that were activated by insulin. This indicates that a major mechanism by which CG7 enhances total IR auto-phosphorylation is by promoting the tyrosine phosphorylation of additional IRs. CG7 not only potentiated insulin-mediated signalling (tyrosine phosphorylation of the IR beta-subunit, phosphorylation of Akt and glycogen synthase kinase-3beta), but also enhanced the effect of insulin on translocation of glucose transporter 4 in a classical insulin-sensitive cell line, 3T3-L1 adipocytes. The results of the present study demonstrate that a specific pentacyclic triterpenoid, CG7, exerts an insulin-sensitizing effect as an IR activator in CHO/IR cells and adipocytes. The enhancement of insulin activity by CG7 may be useful for developing a new class of specific IR activators for treatment of Type 1 and Type 2 diabetes.

The effect of ginseng consumption on the risk of cancer was investigated by interviewing 905 pairs of cases and controls matched by age, sex, and date of admission to the Korea Cancer Center Hospital, Seoul, Korea. Of the 905 cases 562 (62%) had a history of ginseng intake compared to 674 of the 905 controls (75%) a statistically significant difference (p less than 0.01). The odds ratio (OR) of cancer in relation to ginseng intake was 0.56 (95% confidence interval (CI), 0.45-0.69). Ginseng extract and powder were shown to be more effective than fresh sliced ginseng, the juice, or tea in reducing the OR. Odds ratios for decreasing levels of ginseng intake were 1.00, 0.58, 0.43 and 0.25 for males and 1.00, 0.81, 0.56 and 0.52 for females. A trend test showed a significant decrease in proportion of cancer cases with increasing frequency of intake for males (p less than 10(-5)) as well as for females (p less than 0.05). Chi-square homogeneity tests also confirmed significant differences between cases and controls for both sexes (p less than 10(-3)). The reliability of recall for ginseng use was assessed by interviewing 180 randomly-selected subjects twice using the same questionnaire. The overall agreement in reported ginseng use between the two interviews was 0.85, and the Kappa value was 0.71 (p less than 0.01). These results strongly support the hypothesis of preventive effects of ginseng on cancer suggested by earlier animal studies.

Given the mode of transmission of Middle East respiratory syndrome (MERS), healthcare workers (HCWs) in contact with MERS patients are expected to be at risk of MERS infections. We evaluated the prevalence of MERS coronavirus (CoV) immunoglobulin (Ig) G in HCWs exposed to MERS patients and calculated the incidence of MERS-affected cases in HCWs. We enrolled HCWs from hospitals where confirmed MERS patients had visited. Serum was collected 4 to 6 weeks after the last contact with a confirmed MERS patient. We performed an enzyme-linked immunosorbent assay (ELISA) to screen for the presence of MERS-CoV IgG and an indirect immunofluorescence test (IIFT) to confirm MERS-CoV IgG. We used a questionnaire to collect information regarding the exposure. We calculated the incidence of MERS-affected cases by dividing the sum of PCR-confirmed and serology-confirmed cases by the number of exposed HCWs in participating hospitals. In total, 1169 HCWs in 31 hospitals had contact with 114 MERS patients, and among the HCWs, 15 were PCR-confirmed MERS cases in study hospitals. Serologic analysis was performed for 737 participants. ELISA was positive in five participants and borderline for seven. IIFT was positive for two (0.3%) of these 12 participants. Among the participants who did not use appropriate personal protective equipment (PPE), seropositivity was 0.7% (2/294) compared to 0% (0/443) in cases with appropriate PPE use. The incidence of MERS infection in HCWs was 1.5% (17/1169). The seroprevalence of MERS-CoV IgG among HCWs was higher among participants who did not use appropriate PPE.

Background/Aims As the coronavirus disease-2019 global pandemic progresses, screening of antiviral agents effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is urgently needed. In addition, considering the viral load kinetics of SARS-CoV-2, which peaks early in the illness, and the massive burden of the disease, which may increase in the near future, identifying well-tolerated oral antivirals becomes increasingly important. We examined the in vitro activity of lopinavir/ritonavir and hydroxychloroquine on SARS-CoV-2, at concentrations which can be used to treat coronavirus-19 patients with little concern of toxicity. Methods Lopinavir/ritonavir (7/1.75 μg/mL), hydroxychloroquine base (1 or 2 μg/mL), or a combination thereof were administered 1 hour after the inoculation of SARS-CoV-2 to Vero cells at a multiplicity of infection of 0.05. We examined cytopathic effects of virus 48 hours after administration of the respective treatments and measured viral loads at three time points (0, 24, and 48 hours post-treatment) by quantitative real-time reverse-transcription polymerase chain reaction, and compared the results obtained from the different antiviral regimens tested. Results The severity of cytopathic effects was lower in lopinavir/ritonavir-treated cells, and viral load was significantly reduced in this group compared with the control group ( p < 0.001). However, hydroxychloroquine did not show significant inhibitory effects on anti-SARS-CoV-2-mediated cytotoxicity or on viral load at either concentration. Conclusions Lopinavir/ritonavir showed significant inhibitory effects on SARS-CoV-2 in vitro at its usual plasma concentration. However, the in vitro antiviral activity of hydroxychloroquine at concentrations commonly used in humans was minimal, whether used alone or in combination with lopinavir/ritonavir.