A case report of toxic hepatitis caused by chloroform in automotive parts manufacturer coating process.

Background: Several cases of chloroform-induced hepatotoxicity have been reported worldwide, but only 2 cases have been reported in Korea. We encountered a case of toxic hepatitis due to chloroform exposure in February 2022 and report the diagnosis process and clinical findings. Case presentation: A 38-year-old employee in charge of the coating after washing (degreasing) at an automotive parts manufacturer complained of jaundice and was diagnosed with acute toxic hepatitis. After the initial diagnosis, he continued to work, his symptoms worsened, and he was hospitalized for 8 days. Liver ultrasonography (elastography) revealed acute hepatitis. The washing agent contained chloroform, which was not listed on the materials safety data sheet, and the concentrations of chloroform in the workplace were up to 4.7 times the time-weighted average. Conclusions: This patient showed typical toxic hepatitis with chloroform; further follow-up studies are required. Both employers and workers should be aware of information on toxic substances and take precautions to avoid exposure.

Overall and disease-specific survival outcomes following primary surgery for oral squamous cell carcinoma: analysis of consecutive 67 patients.

OBJECTIVES: This study evaluated the predictive factors for survival of patients with oral squamous cell carcinoma (OSCC) and investigated the overall and disease-specific survival (DSS) outcomes. MATERIALS AND METHODS: A total of 67 consecutive patients who underwent surgery for OSCC from January 2006 to November 2014 were included in this study. Patients were classified according to age, sex, pTNM stages, primary sites, smoking and alcohol drinking habits, depth of invasion, perineural and lymphovascular invasion, cell differentiation and postoperative radiotherapy. Kaplan-Meier methods were used to estimate the survival categorized by patient groups. Cox regression methods were used to investigate the main independent predictors of survival. RESULTS: Nineteen patients died of OSCC during follow-up periods. Another five patients died of other diseases including lung adenocarcinoma (n=1), cerebral infarction (n=1), general weakness (n=2), and pneumonia (n=1). The tongue (n=16) was the most common site for primary origin, followed by buccal mucosa (n=15), mandibular gingiva (n=15), maxillary gingiva (n=9), floor of mouth (n=9), retromolar trigone (n=2), and palate (n=1). Eleven patients had pTNM stage I disease, followed by stage II (n=22) and stage IV (n=34). No patients had pTNM stage III disease in this study. The overall survival of all patients was 64.2% and the DSS was 71.6%. DSS of patients with stage I and II disease was 100%. Stepwise Cox regression showed the two predictors for DSS were pTNM stage (P<0.0001, odds ratio=19.633) and presence of metastatic lymph nodes (P=0.0004, odds ratio=0.1039). CONCLUSION: OSCC has been associated with poor prognosis; however, there were improved survival outcomes compared with past studies. Advanced-stage disease and presence of metastatic lymph nodes were associated with poorer survival compared with early-stage OSCC and absence of neck node metastasis. Stage I and II OSCC were associated with excellent survival results in this study.

Evaluation of mechanical strength and bone regeneration ability of 3D printed kagome-structure scaffold using rabbit calvarial defect model.

In clinical conditions, the reconstructions performed in the complex and three-dimensional bone defects in the craniomaxillofacial (CMF) area are often limited in facial esthetics and jaw function. Furthermore, to regenerate a bone defect in the CMF area, the used scaffold should have unique features such as different mechanical strength or physical property suitable for complex shape and function of the CMF bones. Therefore, a three-dimensional synthetic scaffold with a patient-customized structure and mechanical properties is more suitable for the regeneration. In this study, the customized kagome-structure scaffold with complex morphology was assessed in vivo. The customized 3D kagome-structure model for the defect region was designed according to data using 3D computed tomography. The kagome-structure scaffold and the conventional grid-structure scaffold (as a control group) were fabricated using a 3D printer with a precision extruding deposition head using poly(ε-caprolactone) (PCL). The two types of 3D printed scaffolds were implanted in the 8-shaped defect model on the rabbit calvarium. To evaluate the osteoconductivity of the implanted scaffolds, new bone formation, hematoxylin and eosin staining, immunohistochemistry, and Masson's trichrome staining were evaluated for 16 weeks after implantation of the scaffolds. To assess the mechanical robustness and stability of the kagome-structure scaffold, numerical analysis considering the 'elastic-perfectly plastic' material properties and deformation under self-contact condition was performed by finite element analysis. As a result, the kagome-structure scaffold fabricated using 3D printing technology showed excellent mechanical robustness and enhanced osteoconductivity than the control group. Therefore, the 3D printed kagome-structure scaffold can be a better option for bone regeneration in complex and large defects than the conventional grid-type 3D printed scaffold.

Rabbit Calvarial Defect Model for Customized 3D-Printed Bone Grafts.

Bone graft materials are commonly used to regenerate various bone defects, but their application is often limited because of the complex defect shape in various clinical conditions. Hence, customized bone grafts using three-dimensional (3D) printing techniques have been developed. However, conventional simple bone defect models are limited for evaluating the benefits and manufacturing accuracy of 3D-printed customized bone grafts. Thus, the aim of the present study was to develop a complex-shaped bone defect model. We designed an 8-shaped bony defect that consists of two simple circles attached to the rabbit calvarium. To determine the critical-sized defect (CSD) of the 8-shaped defects, 5.6- and 7-mm-diameter trephine burs were tested, and the 7-mm-diameter bur could successfully create a CSD, which was easily reproducible on the rabbit calvarium. The rate of new bone formation was 28.65% ± 8.63% at 16 weeks following creation of the defect. To confirm its efficacy for clinical use, the 8-shaped defect was created on a rabbit calvarium and 3D computed tomography (CT) was performed. A stereolithography file was produced using the CT data, and a 3D-printed polycaprolactone graft was fabricated. Using our 8-shaped defect model, we were able to modify the tolerances of the bone graft and calvarial defect to fabricate a more precise bone graft. Customized characteristics of the bone graft were then used to improve the accuracy of the bone graft. In addition, we confirmed the fitting ability of the 3D-printed graft during implantation of the graft. Our 8-shaped defect model on the rabbit calvarium using a 7.0-mm trephine bur may be a useful CSD model for evaluating 3D-printed graft materials.

Fibular flap for mandible reconstruction in osteoradionecrosis of the jaw: selection criteria of fibula flap.

BACKGROUND: Osteoradionecrosis is the most dreadful complication after head and neck irradiation. Orocutaneous fistula makes patients difficult to eat food. Fibular free flap is the choice of the flap for mandibular reconstruction. Osteocutaneous flap can reconstruct both hard and soft tissues simultaneously. This study was to investigate the success rate and results of the free fibular flap for osteoradionecrosis of the mandible and which side of the flap should be harvested for better reconstruction. METHODS: A total of eight consecutive patients who underwent fibula reconstruction due to jaw necrosis from March 2008 to December 2015 were included in this study. Patients were classified according to stages, primary sites, radiation dose, survival, and quality of life. RESULTS: Five male and three female patients underwent operation. The mean age of the patients was 60.1 years old. Two male patients died of recurred disease of oral squamous cell carcinoma. The mean dose of radiation was 70.5 Gy. All fibular free flaps were survived. Five patients could eat normal diet after operation; however, three patients could eat only soft diet due to loss of teeth. Five patients reported no change of speech after operation, two reported worse speech ability, and one patient reported improved speech after operation. The ipsilateral side of the fibular flap was used when intraoral soft tissue defect with proximal side of the vascular pedicle is required. The contralateral side of the fibular flap was used when extraoral skin defect with proximal side of the vascular pedicle is required. CONCLUSIONS: Osteonecrosis of the jaw is hard to treat because of poor healing process and lack of vascularity. Free fibular flap is the choice of the surgery for jaw bone reconstruction and soft tissue fistula repair. The design and selection of the right or left fibular is dependent on the available vascular pedicle and soft tissue defect sites.

Influence of anatomic position and intraoperative exposure of the inferior alveolar nerve on neurosensory disturbance after sagittal split ramus osteotomy: a three-dimensional computed tomography study.

OBJECTIVE: To evaluate the influence of the anatomic position and intraoperative exposure of the inferior alveolar nerve on neurosensory disturbance (NSD) in sagittal split ramus osteotomy. STUDY DESIGN: The anatomic factors of the nerve were measured on preoperative three-dimensional computed tomography in 98 patients. The intraoperative nerve exposure was assessed. NSD was evaluated for 1 year after surgery. The correlations between NSD and the factors were analyzed. RESULTS: The NSD decreased as the lateral marrow space from the nerve increased (P < .01). The complete nerve exposure increased NSD by 7.6 times (P = .01). The nerve exposure increased as the buccal plate thickness increased (P = .01) and decreased as the vertical marrow space from the nerve increased (P = .01). CONCLUSIONS: The nerve exposure and the lateral marrow space from the nerve affected NSD. The buccal plate thickness and the vertical marrow space indirectly affected NSD through nerve exposure.

Frequency of bone graft in implant surgery.

BACKGROUND: Implant surgery has become popular with the advance of surgical techniques such as sinus lifting, guided bone regeneration, and block bone graft. However, there were no data about the frequency of bone graft during implant surgery. The purpose of this study was to report the frequency and types of bone graft depending on dental implant patients' profile to complement the database regarding implant surgery. METHODS: The implant operations had been performed from January 2006 to October 2014. The upper and lower jaws were divided into six sextants. A total of 792 sextants were included in this study. Patient information including sex, age, sites, bone graft, and types of bone were investigated. RESULTS: A total of 1512 implants had been placed. Male and female sextants were 421 and 371, respectively (M:F = 1:0.88). Average age was 54.3 (ranging from 20 to 88 years old). Implants were placed in the posterior maxilla (322 sextants, 40.7 %), posterior mandible (286 sextants, 36.1 %), anterior maxilla (127 sextants, 16.1 %), and anterior mandible (57 sextants, 7.2 %). Bone graft was performed in 50.3 % of the sextants. Among the bone grafted sites, sinus lifting with lateral approach (22.1 %) and guided bone regeneration (22.7 %) were performed most frequently. CONCLUSIONS: Bone graft in implant surgery was necessary to augment defects. More than half of the sextants needed bone graft for implant installation.

Immunostimulation activity of a polysaccharide from fermented ginseng with Hericium erinaceum mycelia in solid-state culture.

Korean fresh ginseng was cultured with Hericium erinaceum mycelia (HE) in solid-state culture (SSC) to enhance the immunomodulation activity. Hot-water extracts (FG-HE-HW) of H. erinaceum-fermented ginseng (FG-HE) fractionated into a crude polysaccharide (FG-HE-CP) showed higher mitogenic, macrophage stimulation, and intestinal immune system modulation activities (1.52, 1.63, and 1.35x relative to a saline control at 100 µg/mL, respectively) than the crude polysaccharide from non-fermented ginseng (NG-CP; 1.35, 1.50, and 1.18x) and H. erinaceum mycelia alone (HE-CP; 1.26, 1.46, and 1.27x). After FG-HE-CP was further fractionated on a DEAE-Sepharose CL-6B column, the polysaccharide fraction (FG-HE-CP-III) exhibited larger activity increases than any subfraction from NG-CP or HE-CP. FG-HE-CP-III mainly consisted of Ara, Gal, Glc, and GalA (molar ratios of 0.45:1.00: 0.51:0.73). NaIO4 oxidation decreased the activities of FG-HE-CP-III (51.0-76.9%). The polysaccharide from H. erinaceum-fermented ginseng using SSC plays an important role for enhancement of immunomodulation activities of fresh ginseng.

A quantitative analysis of gait patterns in vestibular neuritis patients using gyroscope sensor and a continuous walking protocol.

BACKGROUND: Locomotion involves an integration of vision, proprioception, and vestibular information. The parieto-insular vestibular cortex is known to affect the supra-spinal rhythm generators, and the vestibular system regulates anti-gravity muscle tone of the lower leg in the same side to maintain an upright posture through the extra-pyramidal track. To demonstrate the relationship between locomotion and vestibular function, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and normal subjects using a gyroscope sensor and long-way walking protocol. METHODS: Gyroscope sensors were attached to both shanks of healthy controls (n=10) and age-matched VN patients (n = 10). We then asked the participants to walk 88.8 m along a corridor. Through the summation of gait cycle data, we measured gait frequency (Hz), normalized angular velocity (NAV) of each axis for legs, maximum and minimum NAV, up-slope and down-slope of NAV in swing phase, stride-swing-stance time (s), and stance to stride ratio (%). RESULTS: The most dominant walking frequency in the VN group was not different compared to normal control. The NAVs of z-axis (pitch motion) were significantly larger than the others (x-, y-axis) and the values in VN patients tended to decrease in both legs and the difference of NAV between both group was significant in the ipsi-lesion side in the VN group only (p=0.03). Additionally, the gait velocity of these individuals was decreased relatively to controls (1.11 ± 0.120 and 0.84 ± 0.061 m/s in control and VN group respectively, p<0.01), which seems to be related to the significantly increased stance and stride time of the ipsi-lesion side. Moreover, in the VN group, the maximum NAV of the lesion side was less, and the minimum one was higher than control group. Furthermore, the down-slope and up-slope of NAV decreased on the impaired side. CONCLUSION: The walking pattern of VN patients was highly phase-dependent, and NAV of pitch motion was significantly decreased in the ipsi-lesion side. The change of gait rhythm, stance and stride time, and maximum/minimum NAV of the ipsi-lesion side were characteristics of individuals with VN.

Immunological activity of ginseng is enhanced by solid-state culture with Ganoderma lucidum mycelium.

Fresh ginseng was fermented with Ganoderma lucidum mycelium (GL) in solid-state culture to enhance its immunomodulatory activity. When crude polysaccharide (FG-GL-CP) was fractionated from lyophilized fermented ginseng (FG-GL), FG-GL-CP showed significantly higher mitogenic, macrophage stimulating, and intestinal immune system modulating activity (1.52-, 1.52- and 1.46-fold, respectively) than those of crude polysaccharide from nonfermented ginseng (NG-CP, 1.36-, 1.37- and 1.32-fold) and G. lucidum mycelium alone (GL-CP, 1.48-, 1.40- and 1.31-fold). After FG-GL-CP was further fractionated into two active carbohydrate-rich fractions (FG-GL-CP-II and III) on DEAE-Sepharose CL-6B (Cl⁻ form), the most active polysaccharide (FG-GL-CP-III-1) was purified as a single peak with a molecular weight of 71 kDa. FG-GL-CP-III-1 mainly consists of Ara, Man, Gal, and Glc (molar ratio: 0.85:1.00:0.81:0.76) in addition to a small amount of uronic acid. Methylation analysis indicates that FG-GL-CP-III-1 is composed mainly of terminal/4- or 5-linked Ara(f), terminal/4-linked Man, terminal/3,6-branched Gal, and terminal/4-linked Glc. NaIO4 oxidation of FG-GL-CP-III significantly decreased its activity (64.0-79.2%). These results suggest that solid-state culture of ginseng with G. lucidum may enhance the immunomodulatory activity and that neutral polysaccharides containing Ara, Man, Gal, and Glc may be important for the activity of fermented ginseng.

Ambulatory balance monitoring using a wireless attachable three-axis accelerometer.

BACKGROUND AND OBJECTIVES: The ability of conventional diagnostic equipment to monitor feelings of dizziness experienced during daily activities is limited. Our goal is to develop an ambulatory multipurpose device for monitoring balance to prevent falling in daily life. MATERIALS AND METHODS: A three-axis accelerometers and gyroscope sensors were attached to the head, pelvis, and legs of vestibular neuritis (VN) patients or age-, height-, and body weight-matched healthy volunteers. The sum of the deviations for the scalar value of acceleration [signal vector magnitude, SVM (g)] and angular velocity (°/s) was measured using the modified Romberg test. RESULTS: The repeated measure ANOVA model with acceleration showed a greater group difference (p < 0.001) than that with angular velocity (p < 0.01). There was no significant interaction effect within-subjects factor between replication and groups (p < 0.178). SVM within the VN group significantly increased for all sensor locations compared to the control group (p < 0.01). Strong correlations between measurements taken at head and pelvis as sensor location were observed for both groups (VN/control, r=0.68/r=072). CONCLUS ION: The SVM appears to accurately assess balance while standing, even repetitive measurement or any location in body.

Peyer's patch-mediated intestinal immune system modulating activity of pectic-type polysaccharide from peel of Citrus unshiu.

An intestinal immune system modulating polysaccharide (CUI-3IIb-3-2, 18kDa) was purified from Citrus unshiu peel. CUI-3IIb-3-2 mainly comprised GalA, GlcA, Ara, Gal and Rha, and it consisted of 4-linked GalA, terminal Araf, 4- or 5-linked/3,4- or 3,5-branched Ara, terminal Gal, and 2-linked/2,4-branched Rha. After CUI-3IIb-3-2 digestion by endo-α-d-(1→4)-polygalacturonase, its hydrolysate was fractionated into PG-1 and PG-2. Methylation analyses of PG-1 and PG-2 using base-catalysed ß-elimination suggested that CUI-3IIb-3-2 be assumed as pectic-type polysaccharide. Since the activities of PG-1 and PG-2 were potently decreased, the whole polysaccharide structure of CUI-3IIb-3-2 would be essential to maintain the activity. Meanwhile, when CUI-3IIb was orally administered in mice, bone marrow cell proliferation and GM-CSF/IL-6 production from Peyer's patch cell were significantly higher (1.76- and 2.03/2.51-fold, respectively) than a saline. Therefore, a pectic-type polysaccharide from citrus peel could stimulate Peyer's patches and produce hematopoietic growth factors resulted in bone marrow cell proliferation.