Emerging and upcoming therapies in insomnia.

Insomnia, commonly treated with benzodiazepine (BZD) receptor agonists, presents challenges due to associated serious side effects such as abuse and dependence. To address these concerns, many researches have been conducted to develop and advance both pharmacological and non-pharmacological interventions. Dual orexin receptor antagonists (DORAs), which include suvorexant, daridorexant and lemborexant, have recently been approved by United States Food and Drug Administration (US FDA) as a novel pharmacotherapeutic alternative. Unlike BZD receptor agonists that act as positive allosteric modulators of the gamma-aminobutyric acid type A subunit alpha 1 receptor, DORAs function by binding to both orexin receptor types 1 and 2, and inhibiting the action of the wake-promoting orexin neuropeptide. These drugs induce normal sleep without sleep stage change, do not impair attention and memory performance, and facilitate easier awakening. However, more real-world safety information is needed. Selective orexin-2 receptor antagonists (2-SORAs) is under clinical developments. This review provides an overview of the mechanism of action in relation to insomnia, pharmacokinetics, efficacy and safety information of DORAs and SORA. According to insomnia management guidelines, the first-line treatment for chronic insomnia is cognitive behavioral therapy for insomnia (CBT-I). Although it has proven effective in improving sleep-related quality of life, it has several restrictions limitations due to a face-to-face format. Recently, prescription digital therapy such as Somryst® was approved by US FDA. Somryst®, a smartphone app-based CBT-I, demonstrated meaningful responses in patients. However, digital limitations may impact scalability. Overall, these developments offer promising alternatives for insomnia treatment, emphasizing safety, efficacy, and accessibility.

A Rare Atypical Case of Asymptomatic and Spontaneous Intraneural Hematoma of Sural Nerve: A Case Report and Literature Review.

Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose. A 60-year-old woman visited our clinic with the complaint of a palpable mass on the right calf. She reported no medical history or trauma to the right calf and laboratory findings showed normal coagulopathy. Ultrasonography was performed, which indicated hematoma near saphenous vein and sural nerve or neurogenic tumor. We performed surgical exploration and intraneural hematoma was confirmed on sural nerve. Meticulous paraneuriotomy and evacuation was performed without nerve injury. Histological examination revealed intraneural hematoma with a vascular wall. No neurologic symptoms were observed. In literature review, we acknowledge that understanding anatomy of nerve, using ultrasonography as a diagnostic tool and surgical decompression is key for intraneural hematoma. Our case report may help establish the implications of diagnosis and treatment. Also, we suggested surgical treatment is necessary even in cases that do not present symptoms because neurological symptoms and associated symptoms may occur later.

Effective wound healing on diabetic mice by adhesive antibacterial GNPs-lysine composited hydrogel.

Current trends in wound care research focus on creating dressings for diverse wound types, aiming to effectively control the wound healing process. We proposed a wound dressing composed of oxidized hyaluronic acid and amine gelatin with embedded lysine-modified gelatin nanoparticles (HGel-GNPs-lysine). This dressing improves mechanical properties and reduces degradation rates. The storage modulus for HGel-GNPs-lysine was 3,800 Pa, exceeding that of HGel (1,750 Pa). The positively charged surface of GNPs-lysine effectively eliminated Escherichia coli and Staphylococcus aureus. In a diabetic mice model (C57BL/6), HGel-GNPs-lysine immobilized with basic-fibroblast growth factor promoted granulation tissue thickness and collagen density. Gene expression analysis indicated that HGel-GNPs-lysine reduced inflammation and enhanced angiogenesis. This study highlights that HGel-GNPs-lysine could offer alternative treatment strategies for regulating the inflammatory response at the injury site in wound dressing applications.

Clean-In-Place (CIP) wastewater management using nanofiltration (NF)-forward osmosis (FO)-direct contact membrane distillation (DCMD): Effects of draw salt.

A substantial amount of water is being used during Clean-in-Place (CIP) operation, and is transformed into wastewater that can cause eutrophication to the nearby ecosystem. The present study proposed the Nanofiltration (NF) - Forward Osmosis (FO) - Direct Contact Membrane Distillation (DCMD) to recover the cleaning agents and reclaim freshwater from the model CIP wastewater. NF steps were suggested as prefiltration steps to remove organic compounds from the CIP wastewater. NF steps reduced the lactose and protein contents by 100 % and 95.6 %, respectively. The permeates from NF steps were further managed by the integrated FO-DCMD system. Several draw salts such as NaCl, KCl, MgCl2, and CaCl2 were compared to investigate the influence on FO and DCMD performance. It was found that monovalent salts (NaCl and KCl) outperformed the divalent salts (MgCl2 and CaCl2) in terms of water flux for both FO and DCMD. This can be attributed to the lower viscosity and higher mass transfer coefficient. In addition, the replenishment costs of each salt were evaluated since salts loss occurred during FO and DCMD operation. The cost evaluation revealed that NaCl is most the cheapest salts per reclaimed water. All of this observation indicates that NaCl is preferred in terms of water flux and replenishment cost. The NF permeate kept concentrated using the integrated FO-DCMD or single FO with 2 M of NaCl. Compared to a single FO that showed a consistent decline in draw solution concentration, FO-DCMD could maintain the concentration of the draw solution. Despite the constant concentration, flux decline of FO was observed due to fouling formation caused by the high-temperature operation. However, the FO-DCMD could accomplish the recovery of pure water. Finally, the cleaning agents recovered by the NF-FO-DCMD showed the cleaning efficacy comparable to the fresh NaOH. These results suggest the potential of the proposed system to manage the CIP wastewater.

Current understanding of angiosarcoma: disease biology and evolving treatment.

Angiosarcoma is a very rare soft tissue sarcoma that originates from endothelial cells and typically has a poor prognosis. It is most commonly found in elderly white men and can occur anywhere in the body, particularly in the head, neck, and scalp. Patients who have undergone previous radiation treatment or who have chronic lymphedema also face an elevated risk of this condition. Various genetic changes are suspected to contribute to the development of angiosarcoma, and these changes have been identified as potential targets for treatment. For localized disease, wide surgical resection is often the prudent course of action. A multidisciplinary approach, which may include surgery, radiotherapy, systemic chemotherapy, or immunotherapy, is typically the most effective way to achieve favorable outcomes. In this review, we discuss the general understanding of angiosarcoma and its management, with a particular focus on the current evolving treatments for the disease.

Rare Case of Managing and Evaluating Viability after Replantation of a Serial Self-Amputated Bilateral Testis by a Patient with Schizophrenia: A Case Report.

Amputation of the testis is very rare in clinical situations; therefore, most surgeons have no experience with an amputated testis. In this case, a 31-year-old male with schizophrenia amputated both testes due to self-mutilation. We performed replantation surgery via microscopy. On postoperative day 1, he removed his right testis by using his hand, even though his hands were restrained. The second attack disrupted the viability of the right testis. However, after proper management, we checked the normal sex hormone level by preserving the replanted left testis. We evaluated the viability of the replanted testis by performing five examinations, namely, intraoperative indocyanine green injection, testicular scan with technetium pertechnetate, contrast-enhanced computerized tomography, Doppler ultrasonography, and serum testosterone level. In this report, we aimed to describe our rare experience about management with replantation of the amputated testes and evaluation of their viability.

Full-thickness skin rejuvenation by a novel dual-length microneedle radiofrequency device: A proof-of-concept study using human skin.

BACKGROUND: A novel dual-length microneedle radiofrequency (DLMR) device has been developed to achieve full-thickness skin rejuvenation by stimulating the papillary and reticular dermis simultaneously. This device's dual-level targeting concept need to be validated on human skin, although its clinical efficacy has been demonstrated in a previous study. OBJECTIVES: This study evaluated the dual-depth targeting capability and the ability to induce rejuvenation in each layer of vertical skin anatomy, that is, the epidermis, papillary dermis, and reticular dermis, using full-thickness human facial skin samples. METHODS: Human facial skin samples were obtained from 13 Asian patients who had facelift surgery. To validate the dual-depth targeting concept, DMLR-treated skin samples were analyzed using a digital microscope, thermal imaging, and hematoloxylin and eosin (H&E) staining immediately after DLMR application. On samples stained with H&E, Masson's tricrome, and Verhoeff-Van Gieson, histological observation and morphometric analysis were performed. Total collagen assay (TCA) and quantitative real-time polymerase chain reaction (qPCR) were used to assess changes in total collagen content and mRNA expression levels of collagen types I/III and vimentin, respectively. RESULTS: The DLMR device successfully induced thermal stimulation in the papillary and reticular dermis. The thickness, stacks, and dermal-epidermal junction convolution of the epidermis treated with DLMR were significantly increased. Collagen bundles in the dermis treated with DLMR exhibited a notable increase in thickness, density, and horizontal alignment. Dermal collagen levels were significantly higher in the morphometric and TCA data, as well as in the qPCR data for dermal matrix proteins. CONCLUSIONS: Our DLMR device independently and precisely targeted the papillary and reticular dermis, and it appears to be an effective modality for implementing full-thickness rejuvenation.

Recovery of cleaning agents from Clean-In-Place (CIP) wastewater using nanofiltration (NF) and direct contact membrane distillation (DCMD).

Increasing concerns about freshwater sources necessitate the management of wastewater, such as the wastewater generated from Clean-in-Place (CIP) operations. In this investigation, a membrane system composed of nanofiltration (NF) and direct contact membrane distillation (DCMD) was proposed to manage model dairy CIP wastewater that contained NaOH as an alkaline cleaning agent. During the NF step, prefiltration by a 4 kDa membrane or a 4 kDa membrane followed by a 200 Da membrane (4 kDa/200 Da) was used to remove the whey protein and lactose. With these two membranes in series of NF, the protein concentration was reduced by 92.4% and the lactose content was reduced to a non-detectable level when compared to the model CIP wastewater. Before concentrating the permeates from NF steps, three DCMD membranes (FR, Solupor, and ST) with different characteristics were evaluated to manage the NF permeates from 4 kDa or 200 Da NF. An increase in the feed temperature from 40 °C to 60 °C resulted in an increase in the water flux during DCMD operation, except for FR. In addition, it was found that ST generated the highest water flux when compared to the other membranes. Using ST and a feed temperature of 60 °C, the permeates from 4 kDa or 4 kDa/200 Da were continuously concentrated for 7 h with DCMD. During this concentration, there was no significant decline in flux. The cleaning effectiveness of the cleaning agent (NaOH) recovered by NF and DCMD was compared with a fresh cleaning solution using quartz crystal microbalance with dissipation (QCM-D). It was found that the cleaning agents recovered by 4 kDa/200 Da NF presented a statistically identical cleaning rate compared to fresh NaOH. This research highlights the potential of NF and DCMD to regenerate alkaline cleaning agents, while reclaiming water from dairy CIP wastewater.

Synergistic effects of 915 MHz microwave heating and essential oils on inactivation of foodborne pathogen in hot-chili sauce.

Essential oil is a food additive with antimicrobial properties but with limitations due to strong organoleptic properties. However, thermal treatments can be applied to reduce essential oil content while ensuring antimicrobial activities in food matrices. In this study, the inactivation efficiency of essential oils on E. coli O157:H7, Salmonella Typhimurium and Listeria monocytogenes in buffered peptone water (BPW) and hot-chili sauce was evaluated when coupled with 915 MHz microwave heating. Essential oils used in this study did not affect the dielectric properties and further heating rate of BPW and hot-chili sauce. The dielectric constant of BPW was 76.3 and dielectric loss factor was 30.9. In addition, it took 85 s to reach 100 °C for all samples. Among essential oils, synergistic microbial inactivation with microwave heating was observed from carvacrol (CL) and citral (CI), but not from eugenol (EU) and Carvone (CN). Specifically, CL and microwave heating (M) for 45 s showed the most effective inactivation (ca. 6 log reduction) for the pathogens in BPW. Similar trends were shown in hot-chili sauce. However, M + CI inactivation did not show synergistic effects in hot-chili sauce. Microwave heating time for hot-chilis sauce was 40 s. In propidium iodide uptake study, M + CL was found to cause most severe damage to cell membrane (758.5 of PI value for E. coli O157:H7) while M + CU and M + CN had little impact. In DiBAC4(3) test, CL resulted in the largest value (2.09 for E. coli O157:H7). These observations highlight that CL induces synergistic effects as it caused severe membrane damage along with destruction of membrane potential. The combined treatment did not show any significant difference in quality change compared to untreated hot-chili sauce (p > 0.05). The result indicates the potential application of CL and M combination for hot-chili sauce processes to ensure microbiological safety with acceptable quality.

Effect of temperature, wall shear stress, and NaOH concentration on cleaning effectiveness.

The objective of this research was to evaluate the effect of various operational parameters and their interaction on cleaning rate of NaOH. The parameters include wall shear stress, temperatures, and NaOH concentrations of cleaning fluid. The higher cleaning effectiveness for proteinaceous deposits was achieved at higher wall shear stress. The wall shear stress of 2.42 Pa removed over 90% of foulant after 10 min of operation, which was significantly higher than the removal of lower wall shear stress (0.84 and 0.39 Pa). Similarly, the cleaning rate increased with increase in temperature and concentration of cleaning solution. The use of cleaning solution (0.05% NaOH) at 65°C provided significantly higher cleaning rate than 25°C. A cleaning solution concentration of 0.5% NaOH provided significantly higher removal of foulant than 0% or 0.05% concentrations. However, analysis on the interaction between temperature and the wall shear stress suggested that the temperature above 45°C and wall shear stress above 0.65 Pa did not provide significant improvement in cleaning efficacy. When a cleaning solution temperature was maintained at 45°C, higher wall shear stress provided more rapid removal of the foulant when the cleaning agent concentration was 0.05% or 0.5%. In water rinse conducted without chemical agents, no much improvements in foulant removal were observed with increase in wall shear stress. The change of activation energy (Ea ) indicates that water rinse was sensitive to temperature change at higher wall shear stress. However, cleaning with cleaning agents was less sensitive to temperature variation compared to the water rinse. PRACTICAL APPLICATION: Considering the intense use of water and chemical compounds during cleaning operation, finding operating condition to ensure acceptable cleanness with minimized input is desired. Temperature, cleaning agent concentration, and wall shear stress are the major components to influence the cleaning efficacy. The result of the study demonstrates the potential for optimization of in-place cleaning by appropriate adjustments of the CIP operating parameters.

Penoscrotal defect reconstruction using loco-regional flaps in treatment of extramammary Paget's disease: Experience and suggestion of a simplified algorithm.

BACKGROUND: Reconstruction of penoscrotal defects resulted from margin-controlled excision of extramammary Paget's disease (EMPD) remains challenging, due to its unpredictably varying extents. The present study aimed to investigate outcomes of reconstruction of penoscrotal defects following radical excision of EMPD and to introduce a simplified algorithm for selecting reconstruction strategies. METHODS: Patients with penoscrotal EMPD who were treated with wide excision and subsequent reconstruction from 2009 to 2020 were reviewed. Their demographics, operation-related characteristics, and postoperative outcomes were evaluated. RESULTS: In total, 46 patients with a mean age of 64.9 years (range, 44-85 years) were analyzed. An average size of defects was 129.6 cm2 (range, 8-900 cm2 ). The most frequently involving anatomical subunit was scrotum, followed by suprapubic area and penile shaft. Twenty-six patients had defects spanning multiple subunits. The most commonly used reconstruction methods for each anatomical subunit were internal pudendal artery perforator (IPAP) flaps and/or scrotal flaps for scrotal defects, superficial external pudendal artery perforator (SEPAP) flaps for suprapubic defects, and skin grafts for penile defects. In all but four cases, successful reconstruction was achieved with combination of those reconstruction options. No major complications developed except for one case of marginal flap necrosis. All patients were satisfied with their aesthetic and functional results. CONCLUSIONS: Diverse penoscrotal defects following excision of EMPD could be solidly reconstructed with combination of several loco-regional options. A simplified algorithm using in combination of IPAP flap, SEPAP flap, scrotal flap, and skin graft may enable efficient and reliable reconstruction of penoscrotal EMPD defects.

Scalp metastasis from an adenocarcinoma of the lung mimicking a cystic mass: case report and literature review.

A 67-year-old man visited our plastic surgery clinic complaining of a palpable protruding mass (2.0 × 2.5 cm) in the right occipital region. To establish an appropriate treatment plan for the cystic mass, brain magnetic resonance imaging was performed. A 2.2 cm nodular lesion with peripheral enhancement in the right occipital region of the scalp was confirmed. In addition, two rim-enhancing nodular lesions up to 9 mm with marked perilesional edema in the right frontal lobe were confirmed. The findings suggested metastasis from cancer. After further evaluations, a mass in the right lower lung field was identified as adenocarcinoma of the lung. Histological examination characterized the excised lesion as a cutaneous metastasis from lung adenocarcinoma. This case report shows that a cystic mass, which commonly occurs in the scalp, may indicate lung cancer. In particular, if a cystic mass of the scalp is identified in a person at high risk for lung cancer, appropriate evaluation and urgent treatment should be performed.

Is Elective Nighttime Operation Associated With Adverse Outcomes? Analysis in Immediate Tissue Expander-Based Breast Reconstruction.

BACKGROUND: Despite the long-standing presumption that nighttime surgery could affect adverse outcomes, its association independent of patient's general condition and disease severity remains unclear. We hypothesized that conducting elective surgery for subjects with good physical status at nighttime was not associated with increased risks of postoperative complications and aimed to examine it in tissue-expander-insertion (TEI) operation for breast reconstruction. METHOD: Patients who underwent immediate unilateral TEI-based breast reconstruction between 2014 and 2019 were enrolled. They were categorized into 3 groups based on the starting time of the TEI operation: 8 am to 6 pm (group 1), 6 pm to 8 pm (group 2), and after 8 pm (group 3). The postoperative complication rates were compared among the groups. The independent associations of each variable, including the operation starting time and adverse outcomes, were analyzed. RESULTS: In total, 1458 patients were analyzed, including 970 in group 1, 358 in group 2, and 130 in group 3. The groups showed similar baseline characteristics regarding comorbidities and the American Society of Anesthesiologists classification. Compared with group 1, group 3 was associated with significantly increased rates of overall complications including infection, reoperation, and premature removal of the tissue expander. These differences retained influences in the multivariable analyses. Group 3 showed a significantly longer hospitalization period than the other 2 groups. The complication rates did not differ between groups 1 and 2. CONCLUSIONS: Conducting TEI operation at nighttime seems to be associated with increased risks of adverse postoperative outcomes compared with conducting it during regular working hours.

An innovative method of reconstructed penis reduction: a case report.

Background: Surgery to reduce the size of the reconstructed penis is uncommon. Patients who have undergone total penis reconstruction may want to reduce the size of their reconstructed penis due to convenience issues. To reduce reconstructed penis size, surgical treatment is essential. However, no research has thus far reported on this methodology. Case Description: A 50-year-old Asian man experienced a nearly total loss of his penis due to trauma 30 years ago. He underwent nearly total penis reconstruction using a tubed abdominal flap. The patient's reconstructed penis showed hypospadias, which caused discomfort during urination. The length of the penis was 17 cm. The patient felt that the reconstructed penis was too large, and a reduction surgery was planned for corrective action. Y-shape incision lines were applied on both lateral sides of the reconstructed penis to reduce the circumference, and curved incision lines were applied on the front and back of the penis to construct the neomeatus and glans of the penis. The incision was made, and the remnant tissue was dissected, with attention paid to avoid damage to the neourethra. After the tissue resection, the neourethra was isolated and resected to fit the height of the penis to construct the neomeatus and correct the hypospadias. An approximation was performed after the reconstructed penis reduction. Conclusions: Two years after the surgery, there were no complications, such as urethral stricture or fistula, and the patient was satisfied with the shape and size of the reduced penis (9 cm). The surgical reconstructed penis reduction procedure introduced in this case report achieved satisfactory aesthetic and functional results.

Current concepts of Kimura disease: pathophysiology and evolution of treatment.

Kimura disease (KD) is a chronic inflammatory disorder that frequently involves the subcutaneous tissue of the head and neck regions. It often manifests as regional lymphadenopathy or salivary gland enlargement in the affected area. The histologic architecture of the lymph nodes in KD patients is preserved, while the affected tissues show follicular hyperplasia and eosinophilic infiltration. No single modality has been adopted as an optimal treatment for KD. This article concentrates on the fundamental features of KD and reviews current approaches to its treatment.

Evolution of Morphological and Chemical Properties at p-n Junction of Cu(In,Ga)Se2 Solar Cells with Zn(O,S) Buffer Layer as a Function of KF Postdeposition Treatment Time.

We carried out KF postdeposition treatment (PDT) on a Cu(In,Ga)Se2 (CIGS) layer with a process time varying from 50 to 200 s. The highest CIGS solar-cell efficiency was achieved at a KF PDT process time of 50 s; in this condition, we observed the highest level of K element at the near-surface of the CIGS layer and the perfectly passivated pinholes on the CIGS surface. At process times above 150 s, the oversupplied KF agglomerated into large islands and was subsequently eliminated during the deposition of the chemical bath deposition (CBD)-Zn(O,S) buffer layer owing to the islands' water-soluble characteristics. As a result, the growth mechanism of the CBD-Zn(O,S) layer varied as a function of KF PDT process time. X-ray photoemission spectroscopy (XPS) measurements were used to examine the dependency of the chemical state on the KF PDT process time, and from the results, we formulated a chemical reaction model based on the shift in the elemental binding energy following deposition of the CBD-Zn(O,S) buffer layer. The chemical states of the K-In-Se phase, which have a beneficial effect on the solar-cell performance owing to the formation of durable and improved p-n junctions, are formed only at a KF PDT process time of 50 s. We derived band alignments from the XPS depth profiles by extracting the conduction- and valence-band offsets, and we used optical-pump-THz-probe spectroscopy to measure the ultrafast photocarrier lifetimes related to the defect states following KF PDT. Our key findings can be summarized as follows: (i) photocarrier transport is beneficial at a low barrier height, and (ii) the photocarrier lifetime increases when the K-In-Se phases are formed on the CIGS surface, which allows K+ ions to be effectively substituted into Cu vacancies.

Comparison of flow characteristics in a bench-scale system with commercial-scale pipelines: Use of computational fluid dynamics (CFD).

The challenges for scale-up are often encountered in cleaning operations during the interpretation of data from clean-in-place (CIP) research. The objective of this investigation was to design and characterize flow characteristics in a bench-scale system in a manner that evaluates scale-up to a commercial-scale CIP operation. A bench-scale temperature-controlled vessel was designed for evaluation of in-place cleaning, and for development of scale-up parameters. The wall shear stress was selected as the parameter for the comparison, as it is the significant parameter associated with deposit removal. Using the traditional prediction models, the wall shear stress of bench-scale ranged 0.015 to 4.99 Pa with impeller speeds from 50 to 900 rpm. For the commercial-scale with 0.022 m of inside diameter, prediction ranged from 1.43 to 7.90 Pa with the mean fluid velocity from 0.72 to 1.67 m/s. Computational fluid dynamics (CFD) was used to predict wall shear stress on the surfaces within the bench-scale and commercial-scale systems. The predicted wall shear stress values ranged from 0.016 to 2.42 Pa for surfaces within the bench-scale system, and from 1.33 to 7.20 Pa for the commercial-scale system. The differences between two calculation methods are attributed to the averaging the magnitude over the whole area and the overestimation of friction coefficients employed in the traditional prediction. The results confirm that CFD provided more reliable wall shear stress estimates for surfaces of interest. The wall shear stress estimates for a bench-scale compare favorably to estimates for a commercial-scale pie section in a CIP system. PRACTICAL APPLICATION: The current investigation demonstrates that the computational fluid dynamics (CFD) simulation provides accurate estimates for the scale-up parameters. Both academic and industrial researchers will benefit from the proposed methodologies to compare the flow properties of the bench-scale and commercial-scale CIP operation that facilitate the practical implementation of the systems.

Thermal and non-thermal treatment effects on Staphylococcus aureus biofilms formed at different temperatures and maturation periods.

The objective of this study was to investigate the effect of temperature and maturation period on the resistance of Staphylococcus aureus biofilms to thermal and non-thermal treatments. First, biofilm development was compared at three different temperatures (15, 25, and 37°C) for 5 days. The cell population at 15 and 25°C remained relatively consistent approximately at 6.3 log CFU/cm2, whereas 37°C resulted in the highest cell population on day 1 (7.6 log CFU/cm2) followed by a continual decline. Then, biofilm resistance to steam and sodium hypochlorite (NaOCl) treatments was evaluated. Obtained results highlighted that biofilms had different resistance to both treatments depending on development conditions. Specifically, steam treatment of 10 s eliminated 4.1 log CFU/cm2 of the biofilm formed at 25°C for 5 days. The same treatment inactivated over 5 log population of biofilms developed in other temperature and maturation period conditions. Treatment with NaOCl reduced approximately 1 log CFU/cm2 of biofilm cells developed at 25°C for 5 days. However, inactivation was found to be over 2 log CFU/cm2 under other development conditions. An extracellular polymeric substances (EPS) quantification using 96-well plates and stainless steel coupons was conducted. In the 96-well plate experiment, it was found that the highest amount of polysaccharide was secreted at 25°C (p < 0.05), while total biomass and protein contents were greatest at 37°C (p < 0.05). No significant difference in EPS content was observed for stainless steel, but the results displayed a similar trend to the 96-well plate. In particular, biofilms developed at 25°C tended to secret the highest amount of polysaccharide, which aligned with the current literature. This finding indicated that polysaccharide was the main contribution to the enhanced resistance of S. aureus biofilms. Overall, it was shown that biofilms formed at 25°C for 5 days exhibited the greatest resistance to thermal and nonthermal treatments due to the elevated exopolysaccharide secretion. This study demonstrates that temperature and maturation period significantly affect the resistance of S. aureus biofilms to thermal and non-thermal treatments.

Synergistic effect of 222-nm krypton-chlorine excilamp and mild heating combined treatment on inactivation of Escherichia coli O157:H7 and Salmonella Typhimurium in apple juice.

Simultaneous treatment with 222-nm KrCl excilamp and mild heating (EX-MH) at 45, 50 and 55 °C showed synergistic bactericidal effects on non-acid and acid adapted cells of Escherichia coli O157:H7 and Salmonella Typhimurium in apple juice. In particular, acid-adapted pathogens exhibited increased resistance to EX-MH compared to pathogenic bacteria that were not acid-adapted. Also, elucidation of the synergistic bactericidal mechanism of EX-MH was performed through several assays and this mechanism was described as follows: (i) when KrCl excilamp (EX) and mild heating (MH) are applied simultaneously, MH reversibly inactivates the antioxidant enzyme, superoxide dismutase (SOD), thereby increasing accumulation of reactive oxygen species (ROS) generated by EX and thus inducing synergistic ROS generation, (ii) ROS production induces lipid peroxidation occurrence in the cell membrane, (iii) this lipid peroxidation occurrence in the cell membrane induces synergistic destruction of cell membrane, resulting in synergistic cell death. While EX-MH of 45, 50, or 55 °C reduced E. coli O157:H7 (the pathogen most resistant to EX-MH) in apple juice by 5-log, the qualities such as color (L*, a*, and b*), total phenolic compounds (TPC), and DPPH free radical scavenging activity of apple juice did not change significantly (P > 0.05). This study not only suggests the applicability of EX-MH to the apple juice industry, but also can be used as baseline data for future relevant research.

Multiple foreign bodies causing an orocutaneous fistula of the cheek.

Foreign bodies impacted in the maxillofacial region are often a diagnostic challenge. They can be a source of chronic inflammatory reactions and infections leading to the formation of an orocutaneous fistula. Such orocutaneous fistulas cause significant morbidity in most patients, eventually requiring surgery. Recently, we encountered a very rare case of an orocutaneous fistula caused by multiple foreign bodies in the cheek. Precise removal of the foreign bodies was required, and a double-sided anterolateral thigh free flap was used to reconstruct the defect. Surgeons should be aware of the complications of multiple foreign bodies and should be able to diagnose these on careful clinical examination.