Objective: The Rotterdam scoring system (RSS) is useful for prognosis prediction in patients with severe traumatic brain injury (sTBI). It comprises basal cistern, midline shifting (MLS), epidural hematoma (EDH), and subarachnoid hemorrhage (SAH)/intraventricular hemorrhage (IVH) status. Brain computed tomography (CT) is important to assessing patients with sTBI; however, results often change over time. We aimed to determine whether RSS outcome prediction differs by initial brain CT scan time after the trauma in patients with sTBI. Methods: We used data from the second Korea Neurotrauma Data Bank, and analyzed 455 patients; RSS, Glasgow Outcome Scale Extended (GOSE) on 6-months, and the CT scan time were obtained. Unfavorable outcomes were defined as a GOSE score of 1–4. Participants were divided into 2 groups according to when brain CT scan was performed (> or ≤ 2 hours after trauma). The relationship between the prognosis of patients with sTBI and RSS score was examined by calculating the odds ratios. Univariate and multivariate analyses were performed. Results: In both univariate and multivariate analysis, the total RSS and basal cistern status were statistically correlated with prognosis in both groups. EDH and SAH/IVH showed statistically significant difference according to CT scan time. MLS was associated with prognosis in both groups in univariate analysis although not in multivariate analysis. Conclusion The total RSS score predicted prognosis 6 months after trauma in patients with sTBI, regardless of CT scan time. However, the prognostic predictive power of each item constituting the RSS varied according to CT scan time.

PURPOSE: The aim of this study was to characterize the healing in the grafted calvarial defects of rats after adjunctive hyperbaric oxygen therapy. METHODS: Twenty-eight male Sprague-Dawley rats (body weight, 250–300 g) were randomly divided into two treatment groups: with hyperbaric oxygen therapy (HBO; n=14) and without HBO (NHBO; n=14). Each group was further subdivided according to the bone substitute applied: biphasic calcium phosphate (BCP; n=7) and surface-modified BCP (mBCP; n=7). The mBCP comprised BCP coated with Escherichia-coli-derived recombinant human bone morphogenetic protein-2 (ErhBMP-2) and epigallocatechin-3-gallate (EGCG). Two symmetrical circular defects (6-mm diameter) were created in the right and left parietal bones of each animal. One defect was assigned as a control defect and received no bone substitute, while the other defect was filled with either BCP or mBCP. The animals were allowed to heal for 4 weeks, during which those in the HBO group underwent 5 sessions of HBO. At 4 weeks, the animals were sacrificed, and the defects were harvested for histologic and histomorphometric analysis. RESULTS: Well-maintained space was found in the grafted groups. Woven bone connected to and away from the defect margin was formed. More angiogenesis was found with HBO and EGCG/BMP-2 (P<0.05). None of the defects achieved complete defect closure. Increased new bone formation with HBO or EGCG/BMP-2 was evident in histologic evaluation, but it did not reach statistical significance in histometric analysis. A synergic effect between HBO and EGCG/BMP-2 was not found. CONCLUSIONS: Within the limitations of this study, the present findings indicate that adjunctive HBO and EGCG/BMP-2 could be beneficial for new bone formation in rat calvarial defects.
Animals ; Bone Substitutes ; Calcium ; Humans ; Hyperbaric Oxygenation* ; Male ; Osteogenesis ; Parietal Bone ; Rats* ; Rats, Sprague-Dawley ; Transplants*

PURPOSE: The aim of this study was to evaluate the improvement of osteogenic potential of biphasic calcium phosphate (BCP) bone substitute coated with synthetic cell-binding peptide sequences in a standardized rabbit sinus model. METHODS: Standardized 6-mm diameter defects were created bilaterally on the maxillary sinus of ten male New Zealand white rabbits, receiving BCP bone substitute coated with synthetic cell binding peptide sequences on one side (experimental group) and BCP bone substitute without coating (control group) on the other side. Histologic and histomorphometric analysis of bone formation was carried out after a healing period of 4 or 8 weeks. RESULTS: Histological analysis revealed signs of new bone formation in both experimental groups (4- and 8-week healing groups) with a statistically significant increase in bone formation in the 4-week healing group compared to the control group. However, no statistically significant difference in bone formation was found between the 8-week healing group and the control group. CONCLUSIONS: This study found that BCP bone substitute coated with synthetic cell-binding peptide sequences enhanced osteoinductive potential in a standardized rabbit sinus model and its effectiveness was greater in the 4-week healing group than in the 8-week healing group.
Artificial Cells ; Bone Regeneration ; Bone Substitutes ; Calcium ; Durapatite ; Humans ; Hydroxyapatites ; Male ; Maxillary Sinus ; Oligopeptides ; Osteogenesis ; Rabbits

PURPOSE: The aim of this study was to determine whether biphasic calcium phosphate (BCP) bone substitute with two different concentrations of Escherichia coli-expressed recombinant human bone morphogenetic protein 2 (ErhBMP-2) enhances new bone formation in a standardized rabbit sinus model and to evaluate the concentration-dependent effect of ErhBMP-2. METHODS: Standardized, 6-mm diameter defects were made bilaterally on the maxillary sinus of 20 male New Zealand white rabbits. Following removal of the circular bony windows and reflection of the sinus membrane, BCP bone substitute without coating (control group) was applied into one defect and BCP bone substitute coated with ErhBMP-2 (experimental group) was applied into the other defect for each rabbit. The experimental group was divided into 2 subgroups according to the concentration of ErhBMP-2 (0.05 and 0.5 mg/mL). The animals were allowed to heal for either 4 or 8 weeks and sections of the augmented sinus and surrounding bone were analyzed by microcomputed tomography and histologically. RESULTS: Histologic analysis revealed signs of new bone formation in both the control and experimental groups with a statistically significant increase in bone formation in experimental group 1 (0.05 mg/mL ErhBMP-2 coating) after a 4-week healing period. However, no statistically significant difference was found between experimental group 1 and experimental group 2 (0.5 mg/mL ErhBMP-2 coating) in osteoinductive potential (P<0.05). CONCLUSIONS: ErhBMP-2 administered using a BCP matrix significantly enhanced osteoinductive potential in a standardized rabbit sinus model. A concentration-dependent response was not found in the present study.
Animals ; Bone Morphogenetic Protein 2 ; Bone Morphogenetic Proteins ; Bone Regeneration ; Bone Substitutes ; Calcium ; Durapatite ; Escherichia coli ; Humans ; Hydroxyapatites ; Male ; Maxillary Sinus ; Membranes ; Osteogenesis ; Rabbits ; X-Ray Microtomography

PURPOSE: The aim of this study was to evaluate the enhancement of osteogenic potential of biphasic calcium phosphate (BCP) bone substitute coated with Escherichia coli-derived recombinant human bone morphogenetic protein-2 (ErhBMP-2) and epigallocatechin-3-gallate (EGCG). METHODS: The cell viability, differentiation, and mineralization of osteoblasts was tested with ErhBMP-2-/EGCG solution. Coated BCP surfaces were also investigated. Standardized, 6-mm diameter defects were created bilaterally on the maxillary sinus of 10 male New Zealand white rabbits. After removal of the bony windows and elevation of sinus membranes, ErhBMP-2-/EGCG-coated BCP was applied on one defect in the test group. BCP was applied on the other defect to form the control group. The animals were sacrificed at 4 or 8 weeks after surgery. Histologic and histometric analyses of the augmented graft and surrounding tissue were performed. RESULTS: The 4-week and 8-week test groups showed more new bone (%) than the corresponding control groups (P<0.05). The 8-week test group showed more new bone (%) than the 4-week test group (P<0.05). CONCLUSIONS: ErhBMP-2-/EGCG-coated BCP was effective as a bone graft material, showing enhanced osteogenic potential and minimal side effects in a rabbit sinus augmentation model.
Animals ; Bone Morphogenetic Protein 2 ; Bone Substitutes ; Calcium ; Cell Survival ; Escherichia ; Humans ; In Vitro Techniques ; Male ; Maxillary Sinus ; Membranes ; Miners ; Osteoblasts ; Rabbits ; Transplants

We evaluated the antibacterial, anti-inflammatory, and inhibitory effect of osteoclast differentiation of Brachypodium sylvaticum (BS) to find out the possibility of preventing periodontal disease. The inhibition of Porphyromonas gingivalis (P. gingivalis) growth by BS and the sustainability of the antibacterial activity was assessed. The production of pro-inflammatory cytokines from lipopolysaccharide (LPS)-induced RAW 264.7 cells were measured using enzyme-linked immunosorbent assays (ELISA), and the production of nitric oxide (NO) and cell viability were measured. Osteoclast differentiation was evaluated by Tartrate-resistant acid phosphatase (TRAP) staining, and TRAP activity. BS showed significant antibacterial activity and sustainable antibacterial activity in P. gingivalis. We also found out that the BS significantly decreased secretion of pro-inflammatory cytokines [tumor necrosis factor (TNF-α) and interleukin-6 (IL-6)] and NO production without cytotoxicity. Furthermore, BS inhibited the differentiation of bone marrow macrophages (BMMs) obtained from mouse bone marrow cells into osteoclasts without cytotoxicity. Taken together, BS can be a promising candidate for a preventive and improving agent of periodontal disease having antibacterial, anti-inflammatory, and inhibitory effects of osteoclast differentiation.

Traumatic retropharyngeal hematoma is a potentially life-threatening complication of cervical spine injury due to possible airway obstruction. Treatment by securing airway and subsequent conservative care is often adequate. However, a rapidly expanding large hematoma requires surgical evacuation. We present a case of 55-year-old man with a retropharyngeal hematoma secondary to cervical vascular injury without associated cervical fracture. The patient was successfully treated with endovascular arterial embolization and subsequent percutaneous drainage under fluoroscopic guidance without any sequelae.

Shunt malfunction is the most common cause of ventriculoperitoneal shunt failure. In literature, occlusion of the tube with brain parenchyma, choroid plexus, blood, and proteinaceous debris has been suggested as a mechanism of obstruction. We herein report a case of shunt malfunction without any identifiable occlusion. Our case findings suggest that unapparent abdominal pathology, including inflammation and fibrosis, should be considered when treating shunt failures.

The purpose of this study was to evaluate the shear bond strengths between various hybrid computer-aided design (CAD)/computer-aided manufacturing (CAM) restorative materials and repairing resin. Two resin network-based hybrid (Lava Ultimate and Polyglass), one ceramic framework-based hybrid (Enamic), and one zirconia (Zenotec Zr bridge) CAD/CAM restorative materials were used in this study. The shear bond strength test and failure modes of four experimental groups designated LUS (Lava Ultimate), ENA (Enamic), PGB (Polyglass), and ZBR (zirconia control group) were characterized in this study. The hybrid CAD/CAM restorative materials showed stronger shear bond strengths in the sequence of PGB, LUS, and ENA (P < 0.05). The shear bond strengths of PGB and LUS groups showed significantly higher than those of ZBR (P < 0.05), while ENA did not show any significant difference from ZBR (P < 0.05). The PEG and LUS groups mostly exhibited cohesive failure, but the ENA and ZBR groups predominantly showed adhesive failure. Therefore, resin network-based hybrid CAD/CAM restorative materials such as Lava Ultimate and Polyglass should be more useful for intra-oral repairs.
Adhesives ; Ceramics ; Composite Resins ; Computer-Aided Design ; Prostaglandins B

The aim of this study was to investigate the antibacterial effect of fluoride varnish with antibacterial agents on Streptococcus mutans (S. mutans). Experimental fluoride varnish (EFV) with 5% NaF was fabricated. Five antibacterial agents were tested with 1 mM and 10 mM concentrations, respectively: Bakuchiol (BAK), Bavachalcone (BCC), Isobavachromene (IBC), and Bavachromene (BCM). MIC and MBC test was performed by antibacterial agents with and without EFV using 1.1 × 10¹⁰ CFU/ml of S. mutans. Cell viability test were performed using MTT test. Statistical analysis was done with ANOVA and Duncan's multiple range test at α=0.05. In the antibacterial agents without EFV, the MIC of BAK, BCC, and IBC was the lowest (0.015 mM), and the MBC of BAK was the lowest (0.031 mM). For the antibacterial agents with EFV, the MIC (0.031 mM) and MBC (0.062 mM) of BAK was the lowest, respectively. In MTT test, 1 mM BCM showed the highest cell viability (P < 0.05). This study suggest that BAK can be applied the fluoride varnish under the control of the concentration to develop antibacterial fluoride varnish.
Anti-Bacterial Agents ; Cell Survival ; Fluorides ; Microbial Sensitivity Tests ; Paint ; Streptococcus mutans