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Background@#The Korean name for Angelica gigas Nakai (AGN) is Cham-dang-gui, which grows naturally or is cultivated, and its dried roots are used in traditional herbal medicines. The AGN root exert various pharmacological effects. Despite the various pharmacological effects of the AGN root, there are no reports on its anti-oral microbial effects. The purpose of this study was to reveal the anti-oral microbial effect and the microbial and biochemical changes in oral microorganisms according to the concentration of the ethanol extract of AGN (EAGN) root, and to confirm the possibility of using EAGN as a plant-derived functional substance for controlling oral infectious microorganisms. @*Methods@#Disk diffusion test, growth measurement, biofilm formation assay, and measurements of acid production and bufferingcapacity were performed to confirm the antibacterial effect of EAGN. @*Results@#EAGN showed anti-oral bacterial effects against Streptococcus mutans and Aggregatibacter actinomycetemcomitans at all concentrations, with S. mutans showing a more susceptible effect at concentrations above 5.0 mg/ml and A. actinomycetemcomitans at 3.75 mg/ml. EAGN treatment significantly reduced A. actinomycetemcomitans growth at all concentrations tested. Biofilm formation was significantly reduced at concentrations above 3.75 mg/ml for S. mutans and 2.5 mg/ml for A. actinomycetemcomitans. Acid production in S. mutans and A. actinomycetemcomitans was significantly increased by treatment with EAGN, and the buffering capacities of S. mutans and A. actinomycetemcomitans increased from an EAGN concentration of 3.75 mg/ml and above. @*Conclusion@#EAGN showed anti-oral bacterial effects against both S. mutans and A. actinomycetemcomitans at concentrations above 3.75 mg/ml, which were thought to be related to the inhibition of their growth and biofilm formation. Therefore, EAGN can be used as a safe functional substance derived from medicinal plants owing to its antibacterial effects against S. mutans and A. actinomycetemcomitans.
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Objective@#Face-to-face evaluation is the most important in psychiatric evaluation, but smart healthcare, including non-face-to-face evaluation, can be beneficial considering the situation in which face-to-face evaluation is limited or the preventive aspect of mental illness. In this paper, we aimed to check whether mental health screening tests have the same significance as paper-based tests even when collected through mobile applications. @*Methods@#A smart mental healthcare screening test was conducted on the 1,327 community subjects. We measured two indicators of depression (Patient Health Questionnaire 9-item scale, PHQ-9) and anxiety (Generalized Anxiety Disorder 7-item scale, GAD-7) to check mental health conditions. @*Results@#The average Cronbach’s alpha value of the PHQ-9 questionnaire was good at 0.870. As a result of PHQ-9’s principal component analysis, one component with an eigenvalue of 1 or more was identified, which is suitable to be described as a single factor. The average Cronbach’s alpha value of the GAD-7 was 0.919. The structural validity of the GAD-7 was confirmed through principal component analysis. @*Conclusion@#Our results show that PHQ-9 and GAD-7 scales performed through mobile applications can have the same meaning as paper-based tests. Surveys using a tablet PC, or smartphone application can monitor residents’ mental health and accumulate data. Based on these data, smart mental health management can check the mental health of residents and treat mental illness in connection with medical services.
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Purpose@#This study aimed to review our experience with the explantation of infected endovascular aneurysm repair (EVAR) grafts. @*Methods@#This single-center, retrospective, observational study analyzed the data of 12 consecutive patients who underwent infected aortic stent graft explantation following EVAR between January 1, 2010 and December 31, 2019, of which 11 underwent in situ graft reconstruction following graft removal. The presentation symptoms, infection route, original pathology of abdominal aortic aneurysms (AAA), graft materials, and clinical outcomes were analyzed. @*Results@#Six patients underwent total explantation, whereas 5 underwent removal of only the fabric portions. For in situ reconstructions, prosthetic grafts and banked allografts were used in 8 and 3 patients, respectively. Four mechanisms of graft infection were noted in 11 patients: 4 had bacteremia from systemic infections, 3 had persistent infections following EVAR of primary infected AAA, 3 had ascending infections from adjacent abscesses, and 1 had an aneurysm sac erosion resulting in an aortoenteric fistula. No infection-related postoperative complications or reinfections occurred during the mean 65.27-month (standard deviation, ±52.51) follow-up period. One patient died postoperatively because of the rupture of the proximal aortic wall pseudoaneurysm that had occurred during forceful bare stent removal. @*Conclusion@#Regardless of graft material, in situ graft reconstruction is safe for interposition in treating an infected aortic stent graft following EVAR. In our experience, the residual bare stent is no longer a risk factor for reinfection. Therefore, it is important not to injure the proximal aortic wall when removing the bare stent by force.
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Purpose@#This is a study to confirm the mediating effect of positive psychological capital in the relationship between the self-determination and grit of nursing students. @*Methods@#The subjects of the study were 122 university nursing department students in their junior and senior years. The data were collected from December 1 to 23, 2022. The collected data were analyzed by descriptive statistics, an independent t-test, Mann–Whitney U-test, Pearson’s correlation, and a hierarchical multiple regression analysis using IBM SPSS statistics version 26.0. @*Results@#A statistically significant correlation was observed between self-determination, positive psychological capital and grit (p<.001). The positive psychological capital had full mediation effects on the relationship between self-determination and grit. In other words, the higher levels of positive psychological capital were associated with better levels of grit among nursing students. @*Conclusion@#The study showed that positive psychological capital and self-determination have important effects on grit. To enhance the grit of nursing students, it is essential to implement educational programs aimed at improving self-determination and positive psychological capital.
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We report a case of subacute psychotic symptoms in a patient with germ cell tumor (GCT). The 32-year-old male patient showed progressive psychotic symptoms with diagnosis of GCT. His psychotic symptoms included delusions of reference and persecution. Brain magnetic resonance imaging, electroencephalography, and laboratory examinations were performed to evaluate any other causes. The clinical, neuroimaging, and laboratory review in this case suggested that the progressively developed psychotic symptoms that led to chronic deterioration were caused by the GCT. This is the case report in which subacute atypical psychotic symptoms in his thirties could develop from a GCT based on previous basic research findings showing the correlations of psychotic symptoms with GCT although it has the limitation of so early speculation.
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Objectives@#Schizophrenia (SPR) is the most devastating mental illness that causes severe deterioration in social and occupational functioning, but, the aetiology remains unknown. The aim was to identify patterns of association and segregation for genetic variants and to identify the genes and signalling pathways that determine the risk of developing SPR, through a family-based Genome-wide association study. @*Methods@#We have recruited 27 probands(with SPR) with their parents and siblings whenever possible. DNA was extracted from blood sampling of 58 individuals in 27 families and analysed in an Illumina core exome single nucleotide polymorphism (SNP) array. A family-based association test was used to derive SNP association values across all chromosomes. @*Results@#Although none of the final 800,000 SNPs reached the genome-wide significant threshold of 5×10-8 , the most significant 3 SNPs were within the 10-5 -10-7 . @*Conclusions@#This confirms that SPR is not monogenic but results as a consequence of interactions between multiple host genes and possibly also environmental factors. The present approach provides novel insights into the mechanisms underlying SPR and raises the possibility of identifying individuals at risk of acquiring this condition. In this study, several possible susceptibility genes have been identified that are linked to a range of different pathways, which could reflect the mind-body interaction that is included in the psychiatric genomics consortium.
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Background@#Secretory leukocyte protease inhibitor (SLPI) protects tissues from proteases and promotes cell proliferation andhealing. SLPI also reduces periodontal inflammation and alveolar bone resorption by inhibiting proinflammatory cytokine expression in rat periodontal tissues and osteoblasts. However, little is known of the role of SLPI in the expression of osteoclast regulatory factors from osteoblasts, which are crucial for the interaction between osteoblasts and osteoclasts. Therefore, we aimed to determine the effects of SLPI on the regulation of osteoclasts and osteoblasts in LPS-treated alveolar bone and osteoblasts. @*Methods@#Periodontitis was induced in rats using LPS. After each LPS injection, SLPI was injected into the same area. Immu-nohistochemical analysis was performed with antibodies against SLPI, RANKL, OPG, and Runx2 in the periodontal tissue. RT-PCR and western blotting were performed to determine the expression levels of SLPI, RANKL, OPG, and Runx2 in LPS- and SLPI/LPS-treated MC3T3-E1 cells. SLPI/LPS-treated MC3T3-E1 cells were also stained with Alizarin Red S. @*Results@#Immunohistochemical analysis showed that the expression levels of SLPI, OPG, and Runx2 were higher while that of RANKLwas lower in the LPS/SLPI group relative to those in the LPS group. The mRNA and protein expression of SLPI, OPG, and Runx2 was higher in SLPI/LPS/MC3T3-E1 cells than in LPS/MC3T3-E1 cells, and RANKL expression was lower. During differentiation, OPG and Runx2 protein levels were higher whereas RANKL levels were lower in SLPI/LPS/MC3T3-E1 than in LPS/MC3T3-E1 cells on days 0, 4, 7, and 10. In addition, mineralization and matrix deposition were higher in SLPI/LPS/MC3T3-E1 than in LPS/MC3T3-E1 on days 7 and 10. SLPI decreased RANKL expression in LPS-treated alveolar bone and osteoblasts but increased the expression of OPG and Runx2. @*Conclusion@#SLPI can be considered as a regulatory molecule that indirectly regulates osteoclast activation via osteoblasts andpromotes osteoblast differentiation.
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Background@#The purpose of this study is to investigate the tooth whitening effect of Listerine Healthy White and provide effective management of extrinsic discoloration by comparing the whitening effects of existing whitening products. @*Methods@#The included study four groups: those using whitening gel, whitening toothpaste, and Listerine Healthy White and a control using artificial saliva. Each group received 40 bovine tooth specimens, which were stained with commonly consumed tooth-coloring-inducing foods; black tea, black coffee, and instant noodles for 72 hours. The specimens were treated with tooth whitening materials for 5 weeks, after which the lightness (L*) was measured weekly using a spectrophotometer. @*Results@#There was a significant difference in lightness among the groups between the 1st and 5th week of treatment for all tooth-coloring-inducing foods (p＜0.05). When comparing the changes in lightness values from before whitening to the 5th week of whitening for all tooth-coloring-inducing foods, the order of change was as follows: whitening gel, whitening toothpaste, Listerine Healthy White, and artificial saliva. Listerine Healthy White showed a significant whitening effect for all toothcoloring-inducing foods (p＜0.05). Particularly, changes in lightness values for specimens stained by black tea after 5 weeks of whitening were in the following order: whitening gel (21.72), whitening toothpaste (14.89), Listerine Healthy White (12.91), and artificial saliva (3.85). For specimens stained by black coffee, the changes in lightness values were in the following order: whitening gel (12.99), whitening toothpaste (9.66), Listerine Healthy White (7.91), and artificial saliva (3.12). Lastly, changes in lightness values for specimens stained by instant noodles were as follows: whitening gel (10.84), whitening toothpaste (9.85), Listerine Healthy White (7.71), and artificial saliva (2.61). @*Conclusion@#Listerine Healthy White exhibits continuous whitening effects over time, and for consumers seeking convenient ways to achieve tooth whitening effects at home, consistent use of Listerine Healthy White is recommended.
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Background@#Some studies confirm the reduction of the number of Streptococcus mutans in saliva and dental plaque by Lactobacillus, however, these effects are not always confirmed in in vitro and clinical studies, and only the risk of dental caries has been reported. Our in vitro study aimed to reveal microbial and biochemical changes in the single cultures of S. mutans, Lactobacillus casei and Aggregatibactor actinomycetemcomitans and co-cultures of S. mutans and L. casei or A. actinomycetemcomitans according to sucrose concentration. We also aimed to confirm the anti-oral bacterial and anti-biofilm activities of L. casei and A. actinomycetemcomitans against S. mutans according to sucrose concentration. @*Methods@#S. mutans (KCCM 40105), L. casei (KCCM 12452), and A. actinomycetemcomitans (KCTC 2581) diluted to 5×106 CFU/ml were single cultured, and L. casei or A. actinomycetemcomitans applied at concentrations of 10%, 20%, 30% and 40% to S. mutans were co-cultured with selective medium containing 0%, 1% and 5% sucrose at 36.5°C for 24 hours. Measurements of bacterial growth value and acid production, disk diffusion and biofilm formation assays were performed. @*Results@#In the medium containing sucrose, the bacterial growth and biofilm formation by S. mutans, L. casei, and A. actinomycetemcomitans were increased. In contrast, 30% and 40% of L. casei in the medium containing 0% sucrose showed both anti-oral bacterial and anti-biofilm activities. This implies that L. casei can be used as probiotic therapy to reduceS. mutans in a 0% sucrose environment. @*Conclusion@#The concentration of sucrose in the oral environment is important for the control of pathogenic bacteria that cause dental caries and periodontitis. To apply probiotic therapy using L. casei for S. mutans reduction, the concentration of sucrose must be considered.
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Background@#The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to healthcare systems, consequently endangering tuberculosis (TB) control. We investigated delays in TB treatment among notified patients during the first wave of the COVID-19 pandemic in Korea. @*Methods@#We systemically collected and analyzed data from the Korea TB cohort database from January to May 2020. Groups were categorized as ‘before-pandemic’ and ‘during-pandemic’ based on TB notification period. Presentation delay was defined as the period between initial onset of symptoms and the first hospital visit, and healthcare delay as the period between the first hospital visit and anti-TB treatment initiation. A multivariate logistic regression analysis was performed to evaluate factors associated with delays in TB treatment. @*Results@#Proportion of presentation delay > 14 days was not significantly different between two groups (48.3% vs. 43.7%, P = 0.067); however, proportion of healthcare delay > 5 days was significantly higher in the during-pandemic group (48.6% vs. 42.3%, P = 0.012). In multivariate analysis, the during-pandemic group was significantly associated with healthcare delay > 5 days (adjusted odds ratio = 0.884, 95% confidence interval = 0.715–1.094). @*Conclusion@#The COVID-19 pandemic was associated with healthcare delay of > 5 days in Korea. Public health interventions are necessary to minimize the pandemic’s impact on the national TB control project.
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Objective@#This study examined the volume of choroid plexus across AD without delusion (AD-D), AD with paranoid delusion (AD+PD), and AD with misidentification delusion (AD+MD). @*Methods@#This is a hospital based cross-sectional study of patients with AD. The main outcome measure is the volume of choroid plexus that were measured as regions of interest with magnetic resonance imaging and the FreeSurfer analysis at baseline. Analysis of covariance (ANCOVA) was conducted to compare the differences on the volume of choroid plexus across AD-D, AD+PD, and AD+MD after controlling demographics. @*Results@#There was no volume difference in the both choroid plexus between AD-D and AD+D. However, the volumes of both cho-roid plexus were significantly reduced in AD+MD compared to AD+PD. @*Conclusion@#Our study demonstrates that AD+MD has significantly reduced volumes of choroid plexus compared to AD+PD. These findings suggest that AD+MD and AD+PD may have different pathophysiological mechanisms related to neuroimmune re-sponses in the choroid plexus.
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Objective@#Although previous studies have shown association between anterior corpus callosum (ACC) and various psychotic disorder, the effect of ACC on development on psychotic symptoms in Alzheimer’s disease (AD) is still unclear. The purpose of this study is to investigate the association of ACC with the development of psychosis in patients with AD. @*Methods@#This is a hospital based cross-sectional study of 241 AD patients. The main outcome measure is the volume of ACC that were measured as regions of interest with magnetic resonance imaging and the FreeSurfer analysis at baseline. Analysis of covariance and Logistic regression analysis conducted to assess the association between the volume of ACC and the presence of psychosis in AD, adjusting for age, education, Clinical Dementia Rating-Sum of Boxes, and total intracranial volume. @*Results@#We found that the volume of ACC is significantly reduced in AD with psychosis (AD+P) compared to AD without psychosis (AD-P) (774.27±142.96 vs. 833.09±142.04, p=0.005). The volume of ACC associated with the presence of psychosis in AD (odds ratio=0.995; 95% confidence interval=0.993-0.997; p=0.006). @*Conclusion@#We have found that reduced volume of ACC in AD+P, suggesting that ACC might play an important role in the underlying pathogenesis of development of psychotic symptoms in AD.
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Background@#Estrogen deficiency affects the structure and function of the salivary glands in women, leading to a decrease in salivary secretion and a change in the composition of saliva. Previous studies on changes in the salivary glands that cause estrogen deficiency have reported only partial results for the parotid and submandibular glands, and there are few comparative morphological studies of histological changes between the parotid and submandibular glands in ovariectomized rats (OVX) leading to estrogen deficiency. This study aimed to analyze the histopathological and histochemical changes in the parotid and submandibular salivary glands causing estrogen deficiency by using OVX, and to discuss the mechanism on these changes. @*Methods@#The parotid and submandibular glands from sacrificed control and OVX groups were fixed with cold 4% paraformaldehyde in phosphate buffer (pH 7.2). The tissues were dehydrated using a series of graded ethyl alcohol and embedded in paraffin. For histopathological analysis, sections cut to a thickness of 6 to 7 μm were stained with hematoxylin and eosin (H&E). For histochemical analysis, Periodic acid-Schiff (PAS), Alcian blue (AB, pH 2.5), and PAS+AB (pH 2.5 and pH 1) staining was performed. @*Results@#Histopathological analysis of OVX tissue showed that the parotid and submandibular salivary glands were broadly and clearly separated and divided into lobes. In OVX, acinar and ductal cells with condensed polymorphic or pyknotic nucleus, which are presumed to be characteristic of apoptotic cells, and degenerated cells with lipid deposition in cytoplasmic granules and ruptured membranes were increased. Histochemical analysis of OVX, confirmed an increase in the number and acidification of acinar secretory granules. @*Conclusion@#Histopathological and histochemical changes and the effects of estrogen deficiency are more evident in the submandibular salivary gland than in the parotid gland.
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A 16-year-old, 7.4 kg, castrated male Cocker Spaniel presenting anorexia and weight loss was referred due to a splenic mass, and total splenectomy was performed to resolve clinical signs. Following surgery, the dog developed mild hyperkalemia (6.27 mmol/L) without any clinical symptoms. Further investigations were conducted to determine the cause of hyperkalemia. The serum-plasma potassium difference was measured (1.05 mmol/L), and pseudohyperkalemia was diagnosed. The cause of pseudohyperkalemia was considered as thrombocytosis after splenectomy. The dog did not receive any specific treatment to lower blood potassium. To our knowledge, we report the first case of post-splenectomy pseudohyperkalemia in a dog.
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Objectives@#：This study was aimed to investigate whether 1) sexual dimorphism in subcortical gray matter volumes (GMV) and the length ratio between the second and fourth digits (2D:4D) would be found and 2) 2D:4D would have associated with subcortical GMV in healthy elderly people. @*Methods@#：Sixty-two females aged 70.3±6.3 (mean±SD) years and 23 males aged 70.4±4.9 years were recruited from the Dementia Clinic in the Pusan National University Hospital. The subjects with the clinical dementia rating scale-sum of boxes (CDR-SB) total score greater than 2.0, any psychiatric or neurological disease, or any pathologic lesion on brain MRI other than micro-angiopathy were excluded. The 2D:4D of the left and right hands were measured 3 times each. Volumetric segmentation of T1-weighted MRI scans was done by Freesurfer software (v7.1.1.1). @*Results@#：2D:4Ds of males were smaller than those of females significantly on repeated measures ANOVA. The males’ thalamus, putamen, hippocampus in both hemispheres and the right amygdala were larger than females’. These differences were not significant after controlling for age, education and total intracranial volume (ICV). In the females, the left 2D:4D was negatively correlated with the left hippocampal volume. In the males, 2D:4D was positively correlated with the volumes of ipsilateral or contralateral thalamus, hippocampus, amygdala and accumbens. These correlations were not significant after Bonferroni’s correction, except for the right accumbens. @*Conclusions@#：Sexual dimorphism of 2D:4D is preserved in healthy elderly people. There is a significant correlation between the right 2D:4D and GMV of the accumbens in males.
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The present study examined cortical cerebral microinfarcts (CMIs) on a 3T magnetic resonance imaging and investigated the impact of CMIs on the comprehensive functional outcomes during the post-stroke rehabilitation period. Patients with acute phase of firstever ischemic stroke were retrospectively recruited (n = 62) and divided into 2 groups with and without CMIs. Clinical parameters including age, sex, stroke lesion laterality, location, the National Institutes of Health Stroke Scale score, as well as history of hypertension, dyslipidemia, diabetes mellitus, and smoking were obtained. Functional outcomes were assessed twice at baseline and one month later with the Korean version of the MiniMental State Examination, the Berg balance scale (BBS), and the functional independence measure. Partial correlation and multiple linear regression analyses were used to examine the relationship between the presence of CMIs and the change in functional outcomes. At least one CMI was reported in 27 patients, who were older (p = 0.043). The presence of CMIs was significantly associated with functional impairment in all 3 functional outcomes, after controlling for confounding factors (p < 0.05). CMIs might contribute to poor functional outcomes during the post-stroke rehabilitation period. These results suggest that CMIs should be considered when establishing rehabilitation treatment strategies or making a prognosis.
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Dystonia is a movement disorder characterized by involuntary contraction of muscles resulting in repetitive or twisting movements. Dystonia is generally caused by basal ganglia dysfunction.Recent studies have reported an association between dystonia and brainstem disorders. However, the pathological mechanism is uncertain, and detailed management strategies are limited. Here, we report a case of hemidystonia with abnormal posture and impaired proprioception after pontine hemorrhage that was effectively treated with pharmacotherapy combined with early intensive comprehensive rehabilitation. A 45-year-old man presented with abnormal posture and dystonic movement in the right hand and foot after a pontine hemorrhagic stroke. Pharmacotherapy with clonazepam and benztropine was administered, and comprehensive rehabilitation programs were implemented intensively from the early stages of symptom onset. After 3 months, the patient was able to walk independently, go up and down a few stairs without the use of a handrail, and was able to perform activities of daily living with minimal assistance.
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Objectives@#：A recent study of a European sample implied that the 14 genes previously known to be related with schizophrenia may play little roles. But much work remains before dismissing these genes from their connection to schizophrenia. This is a pilot study for family based association test (FBAT) analysis of estrogen metabolism gene in a Korean population with schizophrenia. @*Methods@#：27 probands with schizophrenia were recruited with their parents and siblings. The subjects were interviewed using Korean versions of diagnostic interview for genetic studies and family interview for genetic studies. We analyzed 2 single nucleotide polymorphism (SNP) of ESR1, COMT gene. We performed FBAT and linkage disequilibrium analyses for each individual SNP. @*Results@#：We found a significant SNP of ESR1 gene in chromosome 6 for the qualitative phenotype of schizophrenia. That result was replicated for the quantitative phenotype of apparent onset, apparent onset of psychosis, and first treatment age. We also found a significant SNP of ESR1 gene in chromosome 6 for the quantitative phenotype of any delusions. @*Conclusions@#：Our results show that quantitative traits such as age of onset, any delusions, and any hallucinations could be continuous with qualitative trait in schizophrenia. But we should be very cautious because there are clear limitations in some nominal number of SNPs and the small incomplete pedigrees. In the future, FBAT analyses in families with subtyped schizophrenic probands according to personality, working memory, cognition will facilitate fine mapping analyses for searching candidate genes of schizophrenia.
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Background@#Personality might be one of the important factors related to stress-coping in mood disorders. This study aimed to investigate the relationship between personality and stress-coping strategies in patients with bipolar and depressive disorders. @*Methods@#A total of 195 patients diagnosed with bipolar and depressive disorders according to the criteria mentioned in Diagnostic and Statistical Manual of Mental disorders’ 5th edition were included. Pearson’s correlation and multiple regression analyses were used to analyze the relationship between personality, measured by Temperament and Character Inventory and NEO-Five Factor Inventory, and coping strategies, measured by Coping Inventory for Stressful Situations. @*Results@#Self-directedness was reported to be positively associated with task-oriented coping in bipolar disorders, and harm avoidance was negatively associated with task-oriented coping in depressive disorders. Beck Depression Inventory score, neuroticism, and extroversion were found to be positively associated with emotion-oriented coping in bipolar disorders, and neuroticism was positively associated with emotion-oriented coping in depressive disorders. Extroversion was reported to be positively associated with avoidance-oriented coping in bipolar disorders, and extroversion, novelty seeking, and reward dependence were positively associated with avoidance-oriented coping in depressive disorders. @*Conclusion@#This study concluded that the relationship between personality and stress-coping strategies may vary based on the type of mood disorder that is diagnosed. The interaction between personality and stress-coping might be considered for the modification of coping strategies in mood disorders.
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Background@#We aimed to investigate the effect of Citrous limon extract (CLE) on oxidative stress-induced cytotoxicity and nitric oxide (NO) generation and the tooth bleaching effect of CLE as a substitute for hydrogen peroxide (H2O2) and determine the feasibility and application of CLE as a safe and effective natural tooth bleaching agent. @*Methods@#The protective effect of CLE on H2O2-induced cytotoxicity in Raw264.7 macrophages was investigated by the MTT assay. The inhibitory effect of CLE on the generation of H2O2-induced NO was confirmed by the NO assay, and the changes in inducible nitric oxide synthase (iNOS) protein expression were confirmed by western blotting. Stained bovine teeth were treated with/without 15% and/or 35% CLE and H2O2, 15% sodium bicarbonate (NaHCO3) for 3 hours, and were irradiated with/without bleaching light (BL) for 15 minutes. The color change of the treated bovine tooth surface was measured using a colorimeter. @*Results@#The viability of Raw264.7 cells treated with each concentration of CLE and 500 µM H2O2 significantly increased as CLE increased, and NO generation and iNOS protein expression were significantly reduced in cells treated with 300 µg CLE+/500 µM H2O2+ and 300 µg CLE+/500 µM H2O2+/150 µg NaHCO3+. The bleaching effect of 35% CLE+ was higher than that of 15% CLE+ and 15% NaHCO3+, and the effect was similar to that of 15% H2O2+. The 35% CLE+/15% NaHCO3+ showed the greatest bleaching effect and was higher than that of the groups irradiated with the BL. The greatest bleaching effect was observed with 35% CLE+/15% NaHCO3+, followed by 35% H2O2+/BL+. @*Conclusion@#CLE inhibited oxidative stress-induced cytotoxicity and NO generation in Raw264.7 cells and, could replace H2O2, which causes side effects and risks in teeth breaching treatment. It showed greatest teeth bleaching effect when combined with NaHCO3. CLE is an effective and safe natural tooth bleaching substitute.