The Emerging Crisis of Stakeholders in Implant-based Augmentation Mammaplasty in Korea

Background@#Korea is no longer safe from the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL); the first reported case was a Korean woman in her 40s who had a 7-year-history of receiving an implant-based augmentation mammaplasty using a textured implant. We conducted this study to discuss the emerging crisis of stakeholders in implant-based augmentation mammaplasty and to propose a multi-disciplinary approach to early detection of its complications. @*Methods@#We analyzed medical examination data that was collected from patients who visited us between August 12 and September 27, 2019. We evaluated a total of 114 women (n = 114) in the current study. They were evaluated for whether they were in healthy condition. Moreover, their baseline characteristics were also examined; these included age, gender, height (cm), weight (kg), duration since surgery (years), possession of a breast implant card, the site of surgical incision, side of symptoms and reasons for outpatient visit. Furthermore, the patients were also evaluated for their subjective awareness of the manufacturer, surface and shape of the breast implant. Potential complications include malrotation, folding, seroma, capsule thickening, upside-down rotation, rupture, capsule mass and breast mass. @*Results@#A majority of the patients had a past history of receiving textured implants. The corresponding percentage was 78.95% (90/114) and 85.09% (97/114) based on their subjective awareness of a breast implant and sonographic findings, respectively. That is, it was slightly increased with the use of a breast ultrasound. @*Conclusion@#Here, we propose the following approaches. First, patient data should be prospectively collected. By tracking outcomes and complications of an implant-based augmentation mammaplasty, both high-quality care and patient safety can be ensured. Second, stakeholders in implant-based augmentation mammaplasty should collaborate with customers and regulatory authorities. Third, surgeons should consider applying imaging modalities for early detection of postoperative complications.

Three-dimensional evaluation of the machinability of monolithic CAD/CAM-generated posterior crowns by nano-hybrid ceramic / 대한치과재료학회지

The purpose of this study comparatively analyzed the machinability of various dental hybrid blocks manufactured by using the CAD/CAM system. Three hybrid composite blocks (Vita enamic, Lava Ultimate, GC Cerasmart) were used for experimental groups and one conventional ceramic block (Vita Mark II) was used for control. The digital impression of the master model and abutment was taken by using a scanner, and then the CAD software program was used to design restorations. The four-axis milling machine (inLab MCXL; Sirona Dental Systems GmbH, Bensheim, Germany) was used four materials. The digitized data was superimposed with 3D inspection software to quantitatively obtain the machinability of a ceramic crown, and visual differences were confirmed with a color map. The root mean square (RMS) values of ceramic crown group were statistically analyzed with one-way ANOVA (α=0.05). While there was a significant difference in the machinability of the internal surface, among four groups, there was statistically significant difference between conventional (VM group) and hybrid ceramic (VE, LU, GC groups) (p<0.05). Consequently, the machinability of VM is lower than that of other hybrid ceramics, and the machinability of VE is better than that of LU and GC. For ceramics as final restorations, manufacturing of dental restorations using hybrid composite ceramic is recommended.

Molecular identification of coagulase-negative staphylococci by rpoB sequence typing / 대한수의학회지

Bovine mastitis (BM) has resulted in enormous economic loss in the dairy industry and coagulase-negative staphylococci (CNS) have caused subclinical BM. Although VITEK 2 GP ID card (VITEK 2) has been used for CNS identification, the probability of identification varies. The rpoB sequence typing (RSTing) method has been used for molecular diagnosis and epidemiology of bacterial infections. In this study, we undertook RSTing of CNS and compared the results with those of VITEK2 and 16S rRNA gene sequencing. As compared VITEK2, the molecular-based methods were more reliable for species identification; moreover, RSTing provided more molecular epidemiological information than that from 16S rRNA gene sequencing.

Molecular prophage typing of Staphylococcus aureus isolates from bovine mastitis

Staphylococcus aureus is one of the major pathogens causing bovine mastitis and foodborne diseases associated with dairy products. To determine the genetic relationships between human and bovine or bovine isolates of S. aureus, various molecular methods have been used. Previously we developed an rpoB sequence typing (RSTing) method for molecular differentiation of S. aureus isolates and identification of RpoB-related antibiotic resistance. In this study, we performed spa typing and RSTing with 84 isolates from mastitic cows (22 farms, 72 cows, and 84 udders) and developed a molecular prophage typing (mPPTing) method for molecular epidemiological analysis of bovine mastitis. To compare the results, human isolates from patients (n = 14) and GenBank (n = 166) were used for real and in silico RSTing and mPPTing, respectively. Based on the results, RST10-2 and RST4-1 were the most common rpoB sequence types (RSTs) in cows and humans, respectively, and most isolates from cows and humans clearly differed. Antibiotic resistance-related RSTs were not detected in the cow isolates. A single dominant prophage type and gradual evolution through prophage acquisition were apparent in most of the tested farms. Thus, RSTing and mPPTing are informative, simple, and economic methods for molecular epidemiological analysis of S. aureus infections.

Molecular identification of coagulase-negative staphylococci by rpoB sequence typing

Bovine mastitis (BM) has resulted in enormous economic loss in the dairy industry and coagulase-negative staphylococci (CNS) have caused subclinical BM. Although VITEK 2 GP ID card (VITEK 2) has been used for CNS identification, the probability of identification varies. The rpoB sequence typing (RSTing) method has been used for molecular diagnosis and epidemiology of bacterial infections. In this study, we undertook RSTing of CNS and compared the results with those of VITEK2 and 16S rRNA gene sequencing. As compared VITEK2, the molecular-based methods were more reliable for species identification; moreover, RSTing provided more molecular epidemiological information than that from 16S rRNA gene sequencing.

Leukotriene B(4) receptor 2 gene polymorphism (rs1950504, Asp196Gly) leads to enhanced cell motility under low-dose ligand stimulation

Recently, single-nucleotide polymorphisms (SNPs) in G-protein-coupled receptors (GPCRs) have been suggested to contribute to physiopathology and therapeutic effects. Leukotriene B4 receptor 2 (BLT2), a member of the GPCR family, plays a critical role in the pathogenesis of several inflammatory diseases, including cancer and asthma. However, no studies on BLT2 SNP effects have been reported to date. In this study, we demonstrate that the BLT2 SNP (rs1950504, Asp196Gly), a Gly-196 variant of BLT2 (BLT2 D196G), causes enhanced cell motility under low-dose stimulation of its ligands. In addition, we demonstrated that Akt activation and subsequent production of reactive oxygen species (ROS), both of which act downstream of BLT2, are also increased by BLT2 D196G in response to low-dose ligand stimulation. Furthermore, we observed that the ligand binding affinity of BLT2 D196G was enhanced compared with that of BLT2. Through homology modeling analysis, it was predicted that BLT2 D196G loses ionic interaction with R197, potentially resulting in increased agonist-receptor interaction. To the best of our knowledge, this report is the first to describe a SNP study on BLT2 and shows that BLT2 D196G enhances ligand sensitivity, thereby increasing cell motility in response to low-dose ligand stimulation.

Identification of microbiome with 16S rRNA gene pyrosequencing and antimicrobial effect of egg white in bovine mastitis

Bovine mastitis is an important microbial disease in the dairy industry. We investigated the frequencies of bacterial pathogens in 62 farms and pathogen antibiotic resistance from mastitis samples (n = 748). We tested the antimicrobial activity of chicken and duck egg white and lysozyme purified from chicken egg white. Moreover, we compared the microbiomes of normal and mastitic raw milk obtained by 16S rRNA gene pyrosequencing and culture methods. The results showed that the frequencies of Gram-positive pathogens (Enterococcus faecalis 37% and Staphylococcus aureus 36%) were higher than that of a Gram-negative pathogen (Escherichia coli 15%). Resistance frequencies to ampicillin and norfloxacin were lowest in Staphylococcus aureus (21%), Enterococcus faecalis (23%), and Escherichia coli (33%), and the antimicrobial activity of chicken egg white was higher than those of lysozyme and duck egg white. Pyrosequencing results revealed clear differences between the microbiomes of mastitic and normal raw milk samples and revealed a slightly similar, but clearly different, composition of pathogens compared to that from the culture method. Thus, pyrosequencing may be useful for elucidating changes in microbiomes during mastitis progression and treatment. A chicken egg white and antibiotic combination may help with mastitis treatment; however, further studies are needed.

Optimized clade 2.3.2.1c H5N1 recombinant-vaccine strains against highly pathogenic avian influenza

A/Puerto Rico/8/34 (PR8)-derived recombinant viruses have been used for seasonal flu vaccines; however, they are insufficient for vaccines against some human-fatal H5N1 highly pathogenic avian influenza (HPAI) viruses (HPAIV) due to low productivity. Additionally, the polymerase basic 2 (PB2) protein, an important mammalian-pathogenicity determinant, of PR8 possesses several mammalian-pathogenic mutations. We previously reported two avian PB2 genes (01310 and 0028) related to efficient replication in embryonated chicken eggs (ECEs) and nonpathogenicity in BALB/c mice. In this study, we generated PR8-derived H5N1 recombinant viruses harboring hemagglutinin (attenuated) and neuraminidase genes of a clade 2.3.2.1c H5N1 HPAIV (K10-483), as well as the 01310 or 0028 PB2 genes, and investigated their replication and immunogenicity. Compared with a control virus harboring six internal PR8 genes (rK10-483), the recombinant viruses possessing the 01310 and 0028 PB2 genes showed significantly higher replication efficiency in ECEs and higher antibody titers in chickens. In contrast to rK10-483, none of the viruses replicated in BALB/c mice, and all showed low titers in Madin-Darby canine kidney cells. Additionally, the recombinant viruses did not induce a neutralization antibody but elicited decreased protective immune responses against K10-483 in mice. Thus, the highly replicative and mammalian nonpathogenic recombinant H5N1 strains might be promising vaccine candidates against HPAI in poultry.

Effect of the fourth nucleotide at the 3′ end of neuraminidase and matrix viral genomic RNA on the pathogenicity of influenza virus A/PR/8/34

Twelve nucleotides located at the 3′ end of viral genomic RNA (vRNA) are conserved among influenza A viruses (IAV) and have a promoter function. Hoffmann's 8-plasmid reverse genetics vector system introduced mutations at position 4, C nucleotide (C4) to U nucleotide (U4), of the 3′ ends of neuraminidase (NA) and matrix (M) vRNAs of wild-type A/PR/8/34 (PR8). This resulted in a constellation of C4 and U4 vRNAs coding for low (polymerases) and relatively high (all others) copy number proteins, respectively. U4 has been reported to increase promoter activity in comparison to C4, but the constellation effect on the replication efficiency and pathogenicity of reverse genetics PR8 (rgPR8) has not been fully elucidated. In the present study, we generated 3 recombinant viruses with C4 in the NA and/or M vRNAs and rgPR8 by using reverse genetics and compared their pathobiological traits. The mutant viruses showed lower replication efficiency than rgPR8 due to the low transcription levels of NA and/or M genes. Furthermore, C4 in the NA and/or M vRNAs induced lower PR8 virus pathogenicity in BALB/c mice. The results suggest that the constellation of C4 and U4 among vRNAs may be one of the multigenic determinants of IAV pathogenicity.

MyD88-BLT2-dependent cascade contributes to LPS-induced interleukin-6 production in mouse macrophage

Endotoxic responses to bacterial lipopolysaccharide (LPS) are triggered by Toll-like receptor 4 (TLR4) and involve the production of inflammatory mediators, including interleukin-6 (IL-6), by macrophages. The detailed mechanism of IL-6 production by macrophages in response to LPS has remained unclear, however. We now show that LPS induces IL-6 synthesis in mouse peritoneal macrophages via the leukotriene B4 receptor BLT2. Our results suggest that TLR4-MyD88 signaling functions upstream of BLT2 and that the generation of reactive oxygen species (ROS) by NADPH oxidase 1 (Nox1) and consequent activation of the transcription factor nuclear factor (NF)-kappaB function downstream of BLT2 in this response. These results suggest that a TLR4-MyD88-BLT2-Nox1-ROS-NF-kappaB pathway contributes to the synthesis of IL-6 in LPS-stimulated mouse macrophages.

Periadnexal Mucin as an Additional Histopathologic Feature of Chronic Eczematous Dermatitis

BACKGROUND: Cutaneous mucinoses are a heterogeneous group of disorders characterized by an abnormal amount of mucin in the skin. However, the pathomechanism of an excessive mucin deposition in the skin is still unknown. Eczematous dermatitis is sub-classified histologically into acute, subacute, and chronic variants. The characteristic histopathologic findings for chronic eczema are variable. However, periadnexal mucin deposition is not known as a feature of chronic eczema. OBJECTIVE: To evaluate the presence of periadnexal mucin deposition in chronic eczematous dermatitis. METHODS: We analyzed the skin biopsy specimens from 36 patients who were pathologically diagnosed with chronic eczematous dermatitis. Alcian blue, colloidal iron, and periodic acid-Schiff stains were used to evaluate the mucin deposition in histologic sections. Two dermatologists and two dermatopathologists evaluated the degree of mucin deposition using a 4-point scale. RESULTS: Various amounts of mucin deposition were observed in the periadnexal area of patients who were diagnosed with chronic eczema. Mucin deposition was more visible after staining with mucin-specific stains. Evaluation of the staining analysis scores revealed that the staining intensities were significantly higher in patients with chronic eczema than age- and site-matched controls (normal, acute to subacute eczema, and psoriasis vulgaris). CONCLUSION: Periadnexal mucin (secondary mucinoses) may be an additional finding of chronic eczematous dermatitis.

Impact of surface roughness of gypsum materials on adaptation of zirconia cores

PURPOSE: The present study investigated the influences of various gypsum materials on the precision of fit of CAD/CAM-fabricated prostheses and analyzed their correlation with surface roughness. MATERIALS AND METHODS: The master model of the mandibular right first molar was replicated, and four experimental groups based on two types of Type IV stone (GC Fujirock EP, Die keen) and two types of scannable stone (Aesthetic-Basegold, Everest Rock) were created to include a total of 40 specimens, 10 in each group. The surface roughness of the working models for the respective experimental groups was measured. Once the zirconia cores had been fabricated, the marginal and internal fits were measured with a digital microscope using the silicone replica technique. The mean and standard deviation of the respective points of measurement were computed and analyzed through the one-way ANOVA and Tukey's HSD test. The correlation between surface roughness and the precision of fit of the zirconia core was analyzed using the Pearson correlation analysis (alpha=.05). RESULTS: The zirconia cores fabricated from the scannable stone working models exhibited a superior precision of fit as compared to those fabricated from the Type IV stone working models. The correlation analysis results showed a clear positive correlation between surface roughness and the precision of fit of zirconia cores in all of the experimental groups (P<.05). CONCLUSION: The results confirmed that the surface roughness of dental working models has a decisive influence on the precision of fit of zirconia cores.

Establishment of a live vaccine strain against fowl typhoid and paratyphoid / 대한수의학회지

To develop a live vaccine strain against fowl typhoid and paratyphoid caused by Salmonella serovar Gallinarum biovar Gallinarum (Salmonella Gallinarum) and Salmonella serovar Enteritidis (Salmonella Enteritidis), respectively, several nalidixic acid resistant mutants were selected from lipopolysaccharide (LPS) rough strains of Salmonella Gallinarum that escaped from fatal infection of a LPS-binding lytic bacteriophage. A non-virulent and immunogenic vaccine strain of Salmonella Gallinarum, SR2-N6, was established through in vivo pathogenicity and protection efficacy tests. SR2-N6 was highly protective against Salmonella Gallinarum and Salmonella Enteritidis and safer than Salmonella Gallinarum vaccine strain SG 9R in the condition of protein-energy malnutrition. Thus, SR2-N6 may be a safe and efficacious vaccine strain to prevent both fowl typhoid and paratyphoid.

rpoB gene sequencing for phylogenetic analysis of avian pathogenic Escherichia coli / 대한수의학회지

The present study was conducted to determine the full rpoB and eight house-keeping gene sequences of 78 and 35, respectively, avian pathogenic E. coli (APEC) strains. Phylogenetic comparison with 66 E. coli and Shigella strains from GenBank and EMBL was also conducted. Based on the full rpoB sequence, 50 different rpoB sequence types (RSTs) were identified. RST 1 was assigned to a major RST that included 34.7% (50/144) of the analyzed strains. RST 2 to RST 50 were then assigned to other strains with higher nucleotide sequence similarity to RST 1 in order. RST 1, 11, and 23 were mixed with APEC along with human commensal and pathogenic strains while RST 2, 6, 9, 13-15, 22, 24, 25, 33, 34, 36, and 41 were unique to APEC strains. Only five APEC strains grouped into RST 32 and 47, which contained human pathogenic E. coli (HPEC). Thus, most of the APEC strains had genetic backgrounds different from HPEC strains. However, the minor APEC strains similar to HPEC should be considered potential zoonotic risks. The resolution power of multi-locus sequence typing (MLST) was better than RST testing. Nevertheless, phylogenetic analysis of rpoB was simpler and more economic than MLST.

Comparison of prosthetic models produced by traditional and additive manufacturing methods

PURPOSE: The purpose of this study was to verify the clinical-feasibility of additive manufacturing by comparing the accuracy of four different manufacturing methods for metal coping: the conventional lost wax technique (CLWT); subtractive methods with wax blank milling (WBM); and two additive methods, multi jet modeling (MJM), and micro-stereolithography (Micro-SLA). MATERIALS AND METHODS: Thirty study models were created using an acrylic model with the maxillary upper right canine, first premolar, and first molar teeth. Based on the scan files from a non-contact blue light scanner (Identica; Medit Co. Ltd., Seoul, Korea), thirty cores were produced using the WBM, MJM, and Micro-SLA methods, respectively, and another thirty frameworks were produced using the CLWT method. To measure the marginal and internal gap, the silicone replica method was adopted, and the silicone images obtained were evaluated using a digital microscope (KH-7700; Hirox, Tokyo, Japan) at 140X magnification. Analyses were performed using two-way analysis of variance (ANOVA) and Tukey post hoc test (alpha=.05). RESULTS: The mean marginal gaps and internal gaps showed significant differences according to tooth type (P<.001 and P<.001, respectively) and manufacturing method (P<.037 and P<.001, respectively). Micro-SLA did not show any significant difference from CLWT regarding mean marginal gap compared to the WBM and MJM methods. CONCLUSION: The mean values of gaps resulting from the four different manufacturing methods were within a clinically allowable range, and, thus, the clinical use of additive manufacturing methods is acceptable as an alternative to the traditional lost wax-technique and subtractive manufacturing.

Psychiatric Characteristics According to Tinnitus Severity

OBJECTIVES: The purpose of this study was to examine the psychiatric characteristics of outpatients with tinnitus. METHODS: A total of 88 subjects were included in this study. According to Tinnitus Handicap Inventory (THI) scores, the subjects were classified into two group ; a mild tinnitus symptoms (mild-tinnitus) group and a severe tinnitus symptoms (severe-tinnitus) group. A questionnaire was used for an assessment of demographic characteristics, and the THI, the Visual Analogue Scale (VAS) about tinnitus, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) are applied for evaluation of other clinical psychiatric characteristics. RESULTS: Higher THI scores were positively correlated with tinnitus course, the number of accompanying symptoms, and the VAS. BDI total scores, BDI factors, and BAI total scores were significantly higher in the severe-tinnitus group than in the mild-tinnitus group. Also suicidal ideation, interpersonal problems, sleep problems, occupational impairment, and fatigue were significantly higher in the severe-tinnitus group than in the mild-tinnitus group. CONCLUSIONS: Tinnitus is a common disorder of hearing which is associated frequently with psychiatric problems. This study suggests that psychiatric interventions should be taken into consideration in the treatment of patients suffering from tinnitus.

Acute allergic reaction caused by hyaluronidase used in the pain management: a case report and literature review: A case report

Hyaluronidase is a protein enzyme extracted from goat or ovine testis. It breaks down hyaluronic acid in connective tissues, thereby reducing swelling and edema and increasing drug penetration into tissues after injection. Because of these properties, it is being increasingly used in the field of pain management. The most frequently reported hyaluronidase-induced complications are allergic reactions, and are usually reported in cases involving eye surgery. However, there are only a few cases of allergic reactions reported in the field of pain management. Here, we report a case involving a 52-year-old patient diagnosed with an allergic reaction after receiving epidural administration of hyaluronidase. A literature review and comparison of our case with similar cases suggested the potential mechanisms underlying these allergic reactions and emphasized the importance of considering the possibility of these reactions in patients receiving hyaluronidase during the course of pain management procedures.

Accuracy and precision of polyurethane dental arch models fabricated using a three-dimensional subtractive rapid prototyping method with an intraoral scanning technique / 대한치과교정학회지

OBJECTIVE: This study aimed to evaluate the accuracy and precision of polyurethane (PUT) dental arch models fabricated using a three-dimensional (3D) subtractive rapid prototyping (RP) method with an intraoral scanning technique by comparing linear measurements obtained from PUT models and conventional plaster models. METHODS: Ten plaster models were duplicated using a selected standard master model and conventional impression, and 10 PUT models were duplicated using the 3D subtractive RP technique with an oral scanner. Six linear measurements were evaluated in terms of x, y, and z-axes using a non-contact white light scanner. Accuracy was assessed using mean differences between two measurements, and precision was examined using four quantitative methods and the Bland-Altman graphical method. Repeatability was evaluated in terms of intra-examiner variability, and reproducibility was assessed in terms of inter-examiner and inter-method variability. RESULTS: The mean difference between plaster models and PUT models ranged from 0.07 mm to 0.33 mm. Relative measurement errors ranged from 2.2% to 7.6% and intraclass correlation coefficients ranged from 0.93 to 0.96, when comparing plaster models and PUT models. The Bland-Altman plot showed good agreement. CONCLUSIONS: The accuracy and precision of PUT dental models for evaluating the performance of oral scanner and subtractive RP technology was acceptable. Because of the recent improvements in block material and computerized numeric control milling machines, the subtractive RP method may be a good choice for dental arch models.

Use of intravenous immunoglobulin in a disseminated varicella infection in an immunocompromised child / 소아과

Varicella-zoster virus infection can lead to severe illness in immunocompromised patients. Further the mortality rate of disseminated varicella infection is extremely high particularly in immunocompromised children. We report a case of disseminated varicella infection in a child with acute lymphoblastic leukemia who was receiving chemotherapy, but was initially admitted with only for acute abdominal pain. The patient rapidly developed severe complications, including acute respiratory distress syndrome, acute hepatitis, disseminated intravascular coagulation, and encephalopathy. Acyclovir is a highly potent inhibitor of varicella-zoster virus infection. However, owing to rapid disease progression, it might not be sufficient to control a disseminated varicella infection, especially in immunocompromised patients. Immunoglobulin neutralize virus invasion and suppress viremia, acting synergistically with acyclovir. In this case, early administration of acyclovir and a high-dose of immunoglobulin, combined with mechanical respiratory support, proved adequate for treatment of this severe illness.

Prevalence and characteristics of Shiga toxin-producing Escherichia coli (STEC) from cattle in Korea between 2010 and 2011

A total of 156 Shiga-like toxin producing Escherichia coli (STEC) were isolated from fecal samples of Korean native (100/568, 18%) and Holstein dairy cattle (56/524, 11%) in Korea between September 2010 and July 2011. Fifty-two STEC isolates (33%) harbored both of shiga toxin1 (stx1) and shiga toxin2 (stx2) genes encoding enterohemolysin (EhxA) and autoagglutinating adhesion (Saa) were detected by PCR in 83 (53%) and 65 (42%) isolates, respectively. By serotyping, six STEC from native cattle and four STEC from dairy cattle were identified as O-serotypes (O26, O111, O104, and O157) that can cause human disease. Multilocus sequence typing and pulsed-field gel electrophoresis patterns highlighted the genetic diversity of the STEC strains and difference between strains collected during different years. Antimicrobial susceptibility tests showed that the multidrug resistance rate increased from 12% in 2010 to 42% in 2011. Differences between isolates collected in 2010 and 2011 may have resulted from seasonal variations or large-scale slaughtering in Korea performed to control a foot and mouth disease outbreak that occurred in early 2011. However, continuous epidemiologic studies will be needed to understand mechanisms. More public health efforts are required to minimize STEC infection transmitted via dairy products and the prevalence of these bacteria in dairy cattle.