Long-Term Survival Rate of Autogenous Tooth Transplantation: Up to 162 Months.

Background and Objectives: The purpose of this study is to observe the usefulness of autogenous tooth transplantation by examining the cumulative survival rate according to the period of auto-transplanted teeth as pre-implant treatment. Materials and Methods: This study was conducted on 111 patients who visited Kyungpook National University Dental Hospital and underwent autogenous tooth transplantation between November 2008 and January 2021 (about 13 years). The cumulative survival rate of autogenous tooth transplantation according to the causes of extraction of the recipient tooth (caries, periapical lesion, crack, crown fracture, periodontitis) and condition of opposing teeth (natural teeth vs. fixed prosthesis). The cumulative survival rate of autogenous tooth transplantation according to the age (under 30 vs. over 30) was also investigated and it was examined whether there were any differences in each factor. Results: The average follow-up period was 12 months, followed by a maximum of 162 months. The 24-month cumulative survival rate of all auto-transplanted teeth was 91.7%, 83.1% at 60 months and the 162-month cumulative survival rate was 30.1%. There were no statistical differences between the causes of extraction of the recipient's teeth, differences in the condition of the opposing teeth, and differences under and over the age of 30. Conclusions: The survival rate of autogenous tooth transplantation appears to be influenced by the conditions of the donor tooth rather than the conditions of the recipient tooth. Although autogenous tooth transplantation cannot completely replace implant treatment, it is meaningful in that it can slightly delay or at least earn the time until implant placement is possible.

A soft biomolecule actuator based on a highly functionalized bacterial cellulose nano-fiber network with carboxylic acid groups.

Upcoming human-related applications such as soft wearable electronics, flexible haptic systems, and active bio-medical devices will require bio-friendly actuating materials. Here, we report a soft biomolecule actuator based on carboxylated bacterial cellulose (CBC), ionic liquid (IL), and poly (3,4-ethylenedioxythiophene)-poly(styrenesulfonate) ( PEDOT: PSS) electrodes. Soft and biocompatible polymer-IL composites were prepared via doping of CBC with ILs. The highly conductive PEDOT: PSS layers were deposited on both sides of the CBC-IL membranes by a dip-coating technique to yield a sandwiched actuator system. Ionic conductivity and ionic exchange capacity of the CBC membrane can be increased up to 22.8 times and 1.5 times compared with pristine bacterial cellulose (BC), respectively, resulting in 8 times large bending deformation than the pure BC actuators with metallic electrodes in an open air environment. The developed CBC-IL actuators show significant progress in the development of biocompatible and soft actuating materials with quick response, low operating voltage and comparatively large bending deformation.

Fit of lithium disilicate crowns fabricated from conventional and digital impressions assessed with micro-CT.

STATEMENT OF PROBLEM: Although the number of lithium disilicate crowns fabricated with computer-aided design and computer-aided manufacturing (CAD-CAM) technology has increased, the accuracy of the prostheses produced by using digital pathways remains unknown. PURPOSE: The purpose of this in vitro study was to compare marginal and internal discrepancies of lithium disilicate crowns fabricated from digital and conventional impressions. MATERIAL AND METHODS: A typodont mandibular first molar was prepared for a lithium disilicate crown, and 20 duplicate dies were fabricated by milling poly(methyl methacrylate) resin blocks from laboratory scans. Four groups of 5 lithium disilicate crowns each were created by using a CS3500 (Carestream Dental) intraoral digital impression; Trios (3shape) intraoral digital impression; Ceramill Map400 (Amann Girrbach) extraoral digital impression; and a heat-press technique as a control group. All of the IPS e.max CAD (Ivoclar Vivadent AG) crowns were produced using a 5-axis milling engine (Ceramill Motion2). The lithium disilicate crowns were cemented with zinc phosphate cement under finger pressure. Marginal and internal discrepancies were measured using micro-computed tomography (SkyScan1172). One-way ANOVAs with the Tukey honest significant differences test were used for statistical analysis of the data (α=.05). RESULTS: The mean marginal discrepancies of CS3500 lithium disilicate crowns were 129.6 µm, 200.9 µm for Ceramill Map400, and 207.8 µm 176.1 µm for the heat-press technique; and the internal discrepancy volumes for CS3500 were 25.3 mm3, 40.7 mm3 for Trios, 29.1 mm3 for Ceramill Map400, and 29.1 and 31.4 mm3 for the heat-press technique. The CS3500 group showed a significantly better marginal discrepancy than the other 3 groups and a smaller internal discrepancy volume than the Trios group (P<.05). CONCLUSIONS: Significant differences were found between IPS e.max CAD crowns produced using 2 intraoral digital impressions, whereas no differences were found between IPS e.max CAD crowns produced from an extraoral digital impression and IPS e.max Press crowns produced using a heat-press technique.

The global distribution of special needs dentistry across dental school curricula.

INTRODUCTION: Special needs dentistry (SND) is an emerging dental specialty, with ongoing developments in education and clinical practice focused towards the tailored management of individuals with special needs (SN). Patients with SN have a higher prevalence of oral diseases and unmet dental needs compared to the general population. Although inadequate training and experience in managing patients with SN has been highlighted as a significant barrier to accessing care, there is limited data about the extent of SND teaching at the entry-to-practice or higher levels. METHODS: This work is the first to map SND curricula globally, across 180 countries and 1265 dental schools. RESULTS: Although 74.62% of dental schools were found in developing economies, the distribution of programs that reported SND in their courses was highly skewed towards developed countries. In terms of advanced degrees, beyond basic entry-to-practice training, the USA delivered 60% of the SND programs, followed by Canada (15.56%), UK (13.33%), and Australia (8.89%). The term SND appeared in 33.95% of entry-to-practice level program curricula and was less commonly used in transitioning economies. Only 112 SND-specialized practitioners enter the workforce globally each year from developed economies, and all but three advanced degrees are found in G7 countries. CONCLUSION: By exploring the impact of economic status on its distribution, this paper highlighted the lack of SND representation in dental curricula, especially amongst programs in transitioning or developing economies. Education of both general dentists and specialists is critical as a collaborative effort is needed to manage the growing population of patients with SN.

Risk factors for neurologic complications of hand, foot and mouth disease in the Republic of Korea, 2009.

In 2009, the first outbreak of hand, foot and mouth disease (HFMD) or herpangina (HP) caused by enterovirus 71 occurred in the Republic of Korea. This study inquired into risk factors associated with complications of HFMD or HP. A retrospective medical records review was conducted on HFMD or HP patients for whom etiologic viruses had been verified in 2009. One hundred sixty-eight patients were examined for this investigation. Eighty patients were without complications while 88 were accompanied by complications, and 2 had expired. Enterovirus 71 subgenotype C4a was the most prevalent in number with 67 cases (54.9%). In the univariate analysis, the disease patterns of HFMD rather than HP, fever longer than 4 days, peak body temperature over 39℃, vomiting, headache, neurologic signs, serum glucose over 100 mg/dL, and having an enterovirus 71 as a causative virus were significant risk factors of the complications. After multiple logistic analysis, headache (Odds ratio [OR], 10.75; P < 0.001) and neurologic signs (OR, 42.76; P < 0.001) were found to be the most significant factors. Early detection and proper management of patients with aforementioned risk factors would be necessary in order to attain a better clinical outcome.

Mechanistic study of ultrasound-assisted chromatography using plastic and stainless steel columns.

Based on the previous ultrasound-assisted chromatography (UAC) studies on plastic and stainless steel (SS) columns, this study explores the UAC mechanism by comparatively analyzing ultrasound effects on plastic and SS columns with C18 stationary phase when separating a mixture of polycyclic aromatic hydrocarbons (PAHs) under various ultrasound intensities. The results showed a substantial difference in H values between the PEEK and SS columns under the influence of ultrasound agitation. Specifically, for the pyrene peak, as the ultrasonic intensity increased from 0% to 100% of 900 W, the H values of the SS column slightly rose from 8.82 µm to 9.86 µm. Conversely, the corresponding values for the PEEK column exhibited a significant 12-fold increase from 11.5 µm to 134 µm. The findings demonstrated poor penetration of ultrasound energy through the SS column, and the temperature rise of the medium induced by the ultrasound was the primary contributing factor to PAH separation. However, ultrasound easily penetrated through the plastic column, resulting in acoustic cavitation within the C18 polyether ether ketone (PEEK) column. Cavitation induced heat generation and contributed to a decrease in retention time and the magnitude of peak broadening or distortion, depending on the specific ultrasonic energy. Based on the estimated change in inlet temperature of the PEEK column due to an acoustic effect, the comparison with temperature effects under non-sonic conditions consistently demonstrated a stronger acoustic effect in reducing the retention time, by 2-9%, depending on specific peaks and pairs. We revisited the previously described separation mechanism of ultrasound-assisted ion chromatography and conjoined with our findings to infer and establish a thorough explanation for the previously unexplained separation mechanism of chiral separation and size exclusion chromatography by UAC using SS columns.

Epithelial-specific deletion of FAM20A leads to short root defects.

Short Root Defects defined by a reduced ratio of root to crown, may culminate in root resorption and subsequent tooth loss, in spite of the absence of apparent symptoms. Such defects present considerable impediments to orthodontic treatment and restoration. Recent identification of Fam20a, an emergent pseudokinase, has been associated with enamel development and tooth eruption, yet its definitive role in root formation and eruption remains ambiguous. In this research, we initially ascertained that the targeted knockout of Fam20a within the epithelium led to truncated tooth roots, irregular breaks in the epithelial root sheath initiation of the WNT signaling pathway, and decreased expression of the cell polarity-related transcription factor Cdc42 in murine models. This was concomitant with the participation of the associated epithelial root sheath developmental pathways BMP2, Gli1, and Nfic. Furthermore, we observed that Fam20a predominantly affects the intraosseous eruption phase of tooth emergence. During this phase, the osteoclast peak around the mandibular first molar in cKO mice is delayed, leading to a slower formation of the eruption pathway, ultimately resulting in delayed tooth eruption in mice. The findings of this study enrich the extant knowledge regarding the role of Fam20a, suggesting its potential regulatory function in tooth root development through the WNT/ß-catenin/Cdc42 pathway.

Comparison between the use of polyether ether ketone and stainless steel columns for ultrasonic-assisted extraction under various ultrasonic conditions.

The ultrasound-assisted extraction (UAE) was conducted using the stainless steel (SS) and polyether ether ketone (PEEK) columns and analyzed with high-performance liquid chromatography (HPLC) to understand the mechanism of ultrasound-assisted chromatography (UAC). Empty SS and PEEK columns were used to extract dyes from a fabric under identical conditions with several parameters including the initial ultrasonic bath temperatures (30 °C and 40 °C), ultrasound power intensities (0, 20, 40, 60, 80, and 100 %), ultrasound operation modes (normal and sweep), and ultrasound frequencies (25 kHz, 40 kHz, and 132 kHz) to compare their extraction capabilities. After 30 min of extraction, the amount of extract was determined by HPLC. The PEEK material was significantly affected by ultrasonic radiation compared to the SS material, especially at a higher temperature (40 °C), power intensity (100 %), and frequency (132 kHz) with sweep mode. At a maximum power density of 45 W/L, the extraction effectiveness ratio of PEEK to SS was in the range of 1.8 - 3.9 depending on the specific frequency, initial temperature, and with or without temperature control. The most optimal ultrasound frequencies, in terms of enhancing extraction effectiveness, are in the order of 132 kHz, 40 kHz, and 25 kHz. Unlike the SS material, the PEEK material was more affected by temperature and acoustic effects under identical conditions, especially at 132 kHz ultrasound frequency. In contrast, at lower frequencies of 40 kHz and 25 kHz, no significant differences in the acoustic effects were observed between the PEEK and SS materials. The findings of this study contribute to elucidating the roles of column materials in UAE and UAC.

Role of ferroptosis-related genes in periodontitis based on integrated bioinformatics analysis.

BACKGROUND: Cell survival or death is one of the key scientific issues of inflammatory response. To regulate cell death during the occurrence and development of periodontitis, various forms of programmed cell death, such as pyroptosis, ferroptosis, necroptosis, and apoptosis, have been proposed. It has been found that ferroptosis characterized by iron-dependent lipid peroxidation is involved in cancer, degenerative brain diseases and inflammatory diseases. Furthermore, NCOA4 is considered one of ferroptosis-related genes (FRGs) contributing to butyrate-induced cell death in the periodontitis. This research aims to analyze the expression of FRGs in periodontitis tissues and to explore the relationship between ferroptosis and periodontitis. METHOD: Genes associated with periodontitis were retrieved from two Gene Expression Omnibus datasets. Then, we normalized microarray data and removed the batch effect using the R software. We used R to convert the mRNA expression data and collected the expression of FRGs. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), transcription factor (TF) and protein-protein interaction (PPI) network analyses were used. In addition, we constructed a receiver operating characteristic curve and obtained relative mRNA expression verified by quantitative reverse-transcription polymerase chain reaction (PCR). RESULTS: Eight and 10 FRGs related to periodontitis were upregulated and downregulated, respectively. GO analysis showed that FRGs were enriched in the regulation of glutathione biosynthetic, glutamate homeostasis, and endoplasmic reticulum-nucleus signaling pathway. The top TFs included CEBPB, JUND, ATF2. Based on the PPI network analysis, FRGs were mainly linked to the negative regulation of IRE1-mediated unfolded protein response, regulation of type IIa hypersensitivity, and regulation of apoptotic cell clearance. The expression levels of NCOA4, SLC1A5 and HSPB1 using PCR were significantly different between normal gingival samples and periodontitis samples. Furthermore, the diagnostic value of FRGs for periodontitis were "Good". CONCLUSIONS: We found significant associations between FRGs and periodontitis. The present study not only provides a new possible pathomechanism for the occurrence of periodontitis but also offers a new direction for the diagnosis and treatment of periodontitis.

Comparison of Osseointegration of Dental Implants Placed in Rabbit Tibia Using Two Dental Laser and Implant Handpiece Systems.

The present study aimed to confirm the usefulness of a multi-laser handpiece system currently under development. Implants were placed in the tibia of rabbits using a conventional separate laser-implant handpiece system (control group; SurgicPro+; NSK, Kanuma, Japan and Epic 10; Biolase, Irvine, CA, USA) and a multi-laser handpiece system (experimental group; BLP 10; Saeshin, Daegu, Korea). Implants were placed in left and right tibias of five rabbits using a conventional laser-implant handpiece system and a multi-laser handpiece system (N = 5 per group). Subsequently, micro-computed tomography (micro-CT; bone-to-implant contact evaluation), implant stability quotient (ISQ) measurement, and histological evaluations were performed to confirm the implant placement results. The independent t-test and the paired t-test were used to compare the ISQ values and the results of the two implant-laser handpiece groups (α = 0.05), respectively. No statistically significant difference in micro-CT, ISQ, and histological evaluations was observed between implant placement by the two systems (p > 0.05) except implant initial stability. The use of the multi-laser handpiece system is expected to produce the same results as a conventional separate laser-implant handpiece system with the higher implant initial stability. Additionally, it will potentially make the clinical environment more pleasant and will provide convenience for the clinicians.

Electro-active Polymer Actuator Based on Sulfonated Polyimide with Highly Conductive Silver Electrodes Via Self-metallization.

We report here a facile synthesis of high performance electro-active polymer actuator based on a sulfonated polyimide with well-defined silver electrodes via self-metallization. The proposed method greatly reduces fabrication time and cost, and obviates a cation exchange process required in the fabrication of ionic polymer-metal composite actuators. Also, the self-metallized silver electrodes exhibit outstanding metal-polymer adhesion with high conductivity, resulting in substantially larger tip displacements compared with Nafion-based actuators.

Epithelial Bone Morphogenic Protein 2 and 4 Are Indispensable for Tooth Development.

The Bmp2 and Bmp4 expressed in root mesenchyme were essential for the patterning and cellular differentiation of tooth root. The role of the epithelium-derived Bmps in tooth root development, however, had not been reported. In this study, we found that the double abrogation of Bmp2 and Bmp4 from mouse epithelium caused short root anomaly (SRA). The K14-cre;Bmp2 f/f ;Bmp4 f/f mice exhibited a persistent Hertwig's Epithelial Root Sheath (HERS) with the reduced cell death, and the down-regulated BMP-Smad4 and Erk signaling pathways. Moreover, the Shh expression in the HERS, the Shh-Gli1 signaling, and Nfic expression in the root mesenchyme of the K14-cre;Bmp2 f/f ;Bmp4 f/f mice were also decreased, indicating a disrupted epithelium- mesenchyme interaction between HERS and root mesenchyme. Such disruption suppressed the Osx and Dspp expression in the root mesenchyme, indicating an impairment on the differentiation and maturation of root odontoblasts. The impaired differentiation and maturation of root odontoblasts could be rescued partially by transgenic Dspp. Therefore, although required in a low dosage and with a functional redundancy, the epithelial Bmp2 and Bmp4 were indispensable for the HERS degeneration, as well as the differentiation and maturation of root mesenchyme.

Seroprevalence of Neutralizing Antibodies Against Candidate Serotypes of Enterovirus Vaccines Among Korean Children.

Hand, foot, and mouth disease (HFMD) is a pediatric public health concern in Asia. Surveillance data on the circulating serotypes of HFMD suggest that Enterovirus A71 (EV-A71) and coxsackieviruses A6, A10, and A16 (CVA6, CVA10, and CVA16) are the major serotypes causing HFMD. Asian countries, including Korea, are currently developing a multivalent vaccine targeting these serotypes. However, the immunity of children against specific serotypes, indicating past infection, should also be considered while selecting candidate serotypes for vaccine development. Therefore, we aimed to identify the age-stratified serological statuses of Korean children to determine candidate serotypes for HFMD vaccine development. This study included 220 participants, categorized into four age groups, 7 months-2 years, 3-5 years, 6-10 years, and 11-15 years. A neutralization test was performed to quantitate the neutralizing antibodies (NtAbs) in the sera of the participants. Only EV-A71 and CVA6 were found suitable as candidate serotypes for vaccine development, whereas further study is needed for CVA10 and CVA16. The highest seropositivity and NtAb titer ranges were observed for CVA6 in all age groups, suggesting that the participants had been predominantly exposed to CVA6. For EV-A71, seropositivity and NtAb titer ranges steadily increased with age, suggesting that children were currently exposed to EV-A71. For CVA10, the 3-5 years group showed the highest seropositivity rate and higher NtAb titer ranges than the older age groups, indicating that the exposure to CVA10 had mainly occurred in recent years. Future studies will identify whether the exposure to CVA10 was transient or will continue. For CVA16, seropositivity and NtAb titer ranges were generally low, indicating that only a few participants had been exposed to CVA16. We identified discrepancies between the sentinel surveillance data and our findings. This study provides a new perspective for HFMD vaccine development and policy making in Asian countries.

Polyethylenimine-alginate nanocomposites based bone morphogenetic protein 2 gene-activated matrix for alveolar bone regeneration.

The repair and treatment of lost or damaged alveolar bone is of great significance in dentistry. Gene-activated matrix (GAM) technology provides a new way for bone regeneration. It is a local gene delivery system, which can not only recruit cells, but also influence their fate. For this purpose, we fabricated a bone morphogenetic protein 2 (BMP-2) gene-loaded absorbable gelatin sponge (AGS) and studied its effect on promoting alveolar bone formation and preventing resorption following tooth extraction in rats. In order to obtain better transfection efficiency, polyethylenimine-alginate (PEI-al) nanocomposites were synthesized and used as gene vectors to deliver BMP-2 cDNA plasmids (PEI-al/pBMP-2). The transfection efficiency, BMP-2 protein expression and osteogenic differentiation of the cells were investigated in vitro. In vivo, we established an alveolar bone regeneration model by extracting the rats' left mandibular incisors. The rats were randomly assigned into 3 groups: control group, unfilled sockets; AGS group, sockets filled with PEI-al solution-loaded gelatin sponges; AGS/BMP group, sockets filled with PEI-al/pBMP-2 solution-loaded gelatin sponge. Radiological and histological assays were performed at 4 and 8 weeks later. In vitro transfection assays indicated that PEI-al/pBMP-2 complexes could effectively transfect MC3T3-E1 cells, promoting the secretion of BMP-2 protein for at least 14 days, as well as increasing the expression of osteogenesis-related gene, ALP activity and calcium deposition. In vivo, western blot analysis showed BMP-2 protein was expressed in bone tissues of AGS/BMP group. The relative height of the residual alveolar ridge and bone mineral density (BMD) of the AGS/BMP group were significantly greater than those in the AGS and control groups at 4 and 8 weeks, respectively. Histological examination showed that, at 4 weeks, osteoblasts had grown in a cubic shape around the new bone in the AGS/BMP group, suggesting new bone formation. In conclusion, the combination of PEI-al/pBMP-2 complexes and gelatin sponge could promote alveolar bone regeneration, which may provide an easy and valuable method for alveolar ridge preservation and augmentation.

Lentiviral­mediated Shh reverses the adverse effects of high glucose on osteoblast function and promotes bone formation via Sonic hedgehog signaling.

Patients with diabetes tend to have an increased incidence of osteoporosis, which may be associated with hyperglycemia; however, the pathogenic mechanisms governing this interaction remain unknown. The present study sought to investigate whether elevated extracellular glucose levels of bone mesenchymal stem cells (BMSCs) could influence osteoblastic differentiation and whether the intracellular Sonic hedgehog (Shh) pathway could adjust the effects. Furthermore, to verify the results in vivo, a rat tooth extraction model was constructed. BMSCs were incubated in eight types of culture medium, including low glucose (LG), LG + lentivirus (Lenti), LG + Lenti­small interfering RNA (Lenti­siRNA), LG + Lenti­Shh, high glucose (HG), HG + Lenti, HG + Lenti­siRNA and HG + Lenti­Shh. The lentiviral transfection efficiency was observed using a fluorescence microscope; protein and mRNA expression was detected by western blotting and reverse transcription­quantitative polymerase chain reaction (RT­qPCR). The matrix mineralization and alkaline phosphatase (ALP) activity of BMSCs were examined by Alizarin red staining and ALP activity assays, respectively. The expression of osteogenesis­related genes in BMSCs were quantified by RT­qPCR. The alveolar ridge reduction was measured and histological sections were used to evaluate new bone formation in the tooth socket. With high concentrations of glucose, Shh expression, matrix mineralization nodules formation, ALP activity and the levels of bone morphogenic protein 4 (BMP4), bone sialoprotein (BSP) and osteopontin (OPN) expression were greatly reduced compared with LG and corresponding control groups. Whereas activated Shh signaling via Lenti­Shh could increase the number of matrix mineralization nodules, ALP activity, and the expression levels of BMP4, BSP and OPN in BMSCs. Additionally, in vivo assays demonstrated that Lenti­Shh induced additional bone formation. Collectively, the results of the present study indicated that HG inhibited the Shh pathway in osteoblasts and resulted in patterning defects during osteoblastic differentiation and bone formation, while the activation of Shh signaling could suppress these deleterious effects.

Additional fixation of medial plate over the unstable lateral locked plating of distal femur fractures: A biomechanical study.

INTRODUCTION: Lateral locked plating is a standard treatment option for distal femur fractures. However, the unstable conditions after lateral locked plating are increasing. The objective of this study was to investigate the biomechanical strength of additional medial plate fixation over the unstable lateral locked plating of distal femur fractures. MATERIALS AND METHODS: A distal femur fracture model (AO/OTA 33-A3) was created with osteotomies in the composite femur. Three study groups consisting of 6 specimens each were created for single-side lateral locked plating with 6 distal locking screws (LP-6), single-side lateral locked plating with 4 distal locking screws (LP-4), and additional medial locked plating on LP-4 construct (DP-4). A compressive axial load (10 mm/min) was applied in the failure test. Mode of failure, load to failure, and ultimate displacement were documented. RESULTS: All single-side lateral locked plating (LP-4 and LP-6) showed plate bending at the fracture gap, while none of the DP-4 showed plate bending at the fracture gap. Load to failure of DP-4 (mean 5522 N) was 17.1% greater than that of LP-6 (mean 4713.3 N, p < 0.05) and 29.2% greater than that of LP-4 (mean 4273.2 N, p < 0.05). Ultimate displacement of DP-4 (mean 5.6 mm) was significantly lower than that of LP-6 (mean 8.8 mm, p < 0.05) and LP-4 (mean 9.1 mm, p < 0.05). CONCLUSIONS: Additional fixation of medial plate significantly increased the fracture stability in distal femur fractures fixed with the lateral locked plating. Especially in the clinical situations where sufficient stability cannot be provided at the distal segment, the medial plate may be considered as a useful biomechanical solution to obtain adequate stability for fracture healing.

Staged lower lip reconstruction following gangrenous stomatitis in an immunosuppressed patient.

A 70-year-old male with a history of diabetes mellitus, hypertension, and coronary stent insertion visited our hospital 7 days after biting his lower lip. Swelling and inflammation had worsened despite debridement and antibiotic treatment. On the 8th hospital day, fungal infection with Candida albicans and superimposed bacterial infection with Klebsiella pneumoniae were found on tissue culture. Extensive necrosis resulted in a defect of approximately 3/4 of the entire lower lip and a full-layer skin defect from the vermilion to the gingivobuccal sulcus at the right corner of the mouth. To correct drooling, incomplete lip sealing, and trismus, staged reconstruction was performed with consideration of cosmetic and functional features. The treatment process using staged reconstruction and antifungal treatment for an extensive lower lip defect caused by fungal stomatitis is described.

Aspirin promotes osteogenic differentiation of human dental pulp stem cells.

Human dental pulp stem cells (hDPSCs) possess self­renewal and osteogenic differentiation properties, and have been used for orofacial bone regeneration and periodontal treatment. Aspirin has been demonstrated to enhance the regeneration of bone marrow mesenchymal stem cells (MSCs); however, the impact of aspirin on the osteogenic differentiation of hDPSCs remains unknown. In the present study, hDPSCs were characterized by flow cytometry, while their clonogenic potential and multipotency were assessed using alizarin red, Oil red O and alcian blue staining. The effect of aspirin on hDPSC viability was assessed using Cell Counting Kit­8 assay. Osteogenic capacity was examined by alkaline phosphatase activity, alizarin red staining, reverse transcription­polymerase chain reaction and western blotting. Furthermore, in vivo cranial defects were established in Sprague­Dawley rats to evaluate the effect of aspirin on hDPSC­based bone regeneration. Anorganic bovine bone was used as a bone replacement material and as the carrier for hDPSCs. New bone formation was observed through radiographic and histological analysis. The study demonstrated that hDPSCs expressed MSC markers and possessed multipotency in vitro. Aspirin was non­toxic to hDPSCs at a concentration of ≤100 µg/ml and enhanced the osteogenesis of hDPSCs in vitro. Aspirin significantly increased hDPSC­based bone formation in the rat cranial defect model at 8 or 12 weeks post­implantation (P<0.05). The data suggested that aspirin promotes the osteogenic potential of hDPSCs in vitro and in vivo. Overall, the present study indicated that aspirin improves the bone regeneration capacity of hDPSCs.

Serum interleukin-6 levels as an indicator of aseptic meningitis among children with enterovirus 71-induced hand, foot and mouth disease.

OBJECTIVES: The enterovirus EV71 is a major pathogen of hand, foot, and mouth disease (HFMD) in children. Aseptic meningitis is the most common neurologic complication of EV71-induced HFMD. Lumbar puncture is a crucial procedure in the diagnosis of aseptic meningitis. It is often performed based on physicians' clinical suspicion. A diagnostic method that can aid in deciding whether this procedure should be performed is necessary. Cytokines are speculated to be associated with neurologic complications. In this study, we aimed to find an indicator of the presence of aseptic meningitis in children with EV71-induced HFMD. METHODS: This cross-sectional study included children with EV71-induced HFMD. The children underwent lumbar puncture due to suspected aseptic meningitis. They were categorized into an aseptic meningitis complicated group (n = 54) and uncomplicated group (n = 47) based on the results of cerebrospinal fluid examination. Healthy children were included as controls (n = 51). The sample serum levels of tumor necrosis factor-α, interferon-γ, interleukin (IL)-1ß, IL-2, IL-6, IL-8, IL-10, and IL-13 were detected using multiplexed fluorescent bead-based immunoassays. RESULTS: The levels of all cytokines were significantly higher in children with EV71-induced HFMD complicated with aseptic meningitis than in children with uncomplicated EV71-induced HFMD and controls (p < 0.001). Binary logistic regression analysis demonstrated that IL-6 had the strongest association with aseptic meningitis of all cytokines examined. According to receiver operating characteristic analysis, the optimal cutoff value for IL-6 was 66 pg/mL with maximum sensitivity and specificity. CONCLUSIONS: The results of this study suggest the association between higher production of cytokine and aseptic meningitis among children with EV71-induced HFMD. IL-6 was also suggested as an indicator of aseptic meningitis. Rapid measurement of IL-6 could be useful in deciding whether physicians should perform lumbar puncture on children.