According to recent evidence, ferroptosis is a major cell death mechanism in the pathogenesis of kidney injury and fibrosis.Despite the renoprotective effects of classical ferroptosis inhibitors, therapeutic approaches targeting kidney ferroptosis remain limited. In this study, we assessed the renoprotective effects of melatonin and zileuton as a novel therapeutic strategy against ferroptosis-mediated kidney injury and fibrosis. First, we identified RSL3-induced ferroptosis in renal tubular epithelial HK-2 and HKC-8 cells. Lipid peroxidation and cell death induced by RSL3 were synergistically mitigated by the combination of melatonin and zileuton. Combination treatment significantly downregulated the expression of ferroptosis-associated proteins, 4-HNE and HO-1, and upregulated the expression of GPX4. The expression levels of p-AKT and p-mTOR also increased, in addition to that of NRF2 in renal tubular epithelial cells. When melatonin (20 mg/kg) and zileuton (20 mg/kg) were administered to a unilateral ureteral obstruction (UUO) mouse model, the combination significantly reduced tubular injury and fibrosis by decreasing the expression of profibrotic markers, such as α-SMA and fibronectin. More importantly, the combination ameliorated the increase in 4-HNE levels and decreased GPX4 expression in UUO mice. Overall, the combination of melatonin and zileuton was found to effectively ameliorate ferroptosis-related kidney injury by upregulating the AKT/mTOR/ NRF2 signaling pathway, suggesting a promising therapeutic strategy for protection against ferroptosis-mediated kidney injury and fibrosis.

Background/Aims: Global distribution of dominant liver cancer aetiologies has significantly changed over the past decades. This study analyzed the updated temporal trends of liver cancer aetiologies and sociodemographic status in 204 countries and territories from 1990 to 2019. Methods: The Global Burden of Disease 2019 report was used for statistical analysis. In addition, we performed stratification analysis to five quintiles using sociodemographic index and 21 geographic regions. Results: The crude numbers of liver cancer disease-adjusted life years (DALYs) and deaths significantly increased during the study period (DALYs; 11,278,630 in 1990 and 12,528,422 in 2019, deaths; 365,215 in 1990 and 484,577 in 2019). However, the Age-standardized DALY and mortality rates decreased. Hepatitis B virus (HBV) remains the leading cause of liver cancer DALYs and mortality, followed by hepatitis C virus (HCV), alcohol consumption, and non-alcoholic steatohepatitison-alcoholic fatty liver disease (NASH/NAFLD). Although Age-standardized DALY and mortality rates of liver cancer due to HBV and HCV have decreased, the rates due to alcohol consumption and NASH/NAFLD have increased. In 2019, the population of the East Asia region had the highest Age-standardized DALY and mortality rates, followed by high-income Asia-Pacific and Central Asia populations. Although East Asia and high-income Asia-Pacific regions showed a decrease during the study period, Age-standardized DALY rates increased in Central Asia. High-income North American and Australasian populations also showed a significant increase in Age-standardized DALY. Conclusions Liver cancer remains an ongoing global threat. The burden of liver cancer associated with alcohol consumption and NASH/NAFLD is markedly increasing and projected to continuously increase.

Purpose: The objective of this study was to propose a method for developing a clinical phantom to reproduce various diseases that are clinically prevalent in the field of dentistry. This could facilitate diverse clinical research without unnecessarily exposing patients to radiation.Material and MethodsThis study utilized a single dry skull, which was visually and radiographically examined to evaluate its condition. Existing lesions on the dry skull were preserved, and other relevant lesions were artificially created as necessary. These lesions were then documented using intraoral radiography and cone-beam computed tomography. Once all pre-existing and reproduced lesions were confirmed by the consensus of 2 oral and maxillofacial radiologists, the skull was embedded in a soft tissue substitute. To validate the process, cone-beam computed tomography scans and panoramic radiographs were obtained of the fabricated phantom. All acquired images were subsequently evaluated. Results: Most lesions could be identified on panoramic radiographs, although some sialoliths and cracked teeth were confirmed only through cone-beam computed tomographic images. A small gap was observed between the epoxy resin and the bone structures. However, 2 oral and maxillofacial radiologists agreed that this space did not meaningfully impact the interpretation process. Conclusion The newly developed phantom has potential for use as a standardized phantom within the dental field. It may be utilized for a variety of imaging studies, not only for optimization purposes, but also for addressing other experimental issues related to both 2- and 3-dimensional diagnostic radiography.

Mucocele of the paranasal sinuses is a benign, slow-growing, expansile lesion. Maxillary sinus mucoceles are usually associated with painless bulging of the cheek; however, orbital expansion is rarely observed. Maxillary sinus mucoceles can be classified as primary or secondary according to their etiology. An impediment to sinus ostium ventilation is thought to be the cause of primary mucocele, while sequestering of residual mucosa after surgery in thewound and long-term retention of tissue fluid have been suggested to lead to the formation of secondary mucocele. This report presents 2 cases of primary and secondary mucoceles, with a focus on radiographic features. As primary and superiorly positioned secondary maxillary sinus mucoceles are uncommon and their close proximity to the orbit predisposes the patient to significant morbidity, the authors expect that this report will contribute to a better understanding and diagnosis of maxillary sinus mucocele involving the orbit.

Purpose: This study was conducted to measure the radiation exposure and image quality of various cone-beam computed tomography (CBCT) machines under common clinical conditions and to analyze the correlation between them. Materials and Methods: Seven CBCT machines used frequently in clinical practice were selected. Because each machine has various sizes of fields of view (FOVs), 1 large FOV and 1 small FOV were selected for each machine. Radiation exposure was measured using a dose-area product (DAP) meter. The quality of the CBCT images was analyzed using 8 image quality parameters obtained using a dental volume tomography phantom. For statistical analysis, regression analysis using a generalized linear model was used. Results: Polymethyl-methacrylate (PMMA) noise and modulation transfer function (MTF) 10% showed statistically significant correlations with DAP values, presenting positive and negative correlations, respectively (P<0.05). Image quality parameters other than PMMA noise and MTF 10% did not demonstrate statistically significant correlationswith DAP values. Conclusion As radiation exposure and image quality are not proportionally related in clinically used equipment, it is necessary to evaluate and monitor radiation exposure and image quality separately.

McCune-Albright syndrome (MAS) is a rare multisystem disorder characterized by a clinical triad of polyostotic fibrous dysplasia (FD), skin pigmentation, and hyperfunctioning endocrinopathies. A 42-year-old man visited our medical hospital for the treatment of intermittent headaches and was diagnosed with MAS with acromegaly. This patient showed various clinical features of MAS, including pituitary adenoma, polyostotic FD, and hypogonadotropic hypogonadism. The FD lesions showed characteristic radiographic features, such as widespread, sclerotic bony lesions in the cranial bones, mixed radiolucent-radiopaque multilocular lesions in the mandible, and radiolucent lesions in the axial and appendicular skeleton. Over the years, the patient had been hospitalized multiple times due to accidental bony fractures associated with the fragile bony state of FD. This report presents a retrospective description of a case of MAS, with a review of the relevant literature.

Background: Treatment remains a challenge in massive and irreparable rotator cuff tears (RCTs), and superior capsular reconstruction (SCR) has become an increasingly popular choice. The objective of this study was to evaluate clinical and radiological outcomes after SCR using an Achilles tendon allograft in irreparable massive RCTs. Methods: From December 2015 to March 2018, 11 patients (mean age, 66.3 ± 5.8 years) with irreparable massive RCTs who underwent SCR using an Achilles tendon allograft were enrolled in this study. The range of motion (ROM), visual analog scale (VAS), clinical scores, muscle strength, and acromiohumeral distance (AHD) were measured preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 months postoperatively to assess the global fatty degeneration index and graft failure. Ultrasonography was also conducted preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively to assess graft continuity. Results: The mean follow-up period was 27.6 months (range, 24–32 months). The shoulder ROM at final follow-up increased significantly in forward flexion (p = 0.023), external rotation (p = 0.018), internal rotation (p = 0.016), and abduction (p = 0.011). All patients showed improvement in VAS score (p = 0.005) and clinical scores (p < 0.001) compared with the preoperative state. Pseudoparalysis improved in all patients. The AHD was 3.88 mm (± 1.21 mm) preoperatively, 7.75 mm (± 1.52 mm, p = 0.014) at 6 months postoperatively, and 6.37 mm (± 1.72 mm, p = 0.031) at final follow-up. Graft removal and synovectomy were performed in 1 patient who developed postoperative infections. Radiological failure on follow-up MRI occurred in 2 patients at 6 and 12 months postoperatively, respectively. Conclusions SCR using an Achilles tendon allograft in irreparable massive RCTs achieved functional and clinical improvement. The use of Achilles tendon allograft also has the advantages of short operation time without donor site morbidity, sufficient thickness, and robustness; therefore, this allograft can be a useful graft for SCR.

Background: Treatment remains a challenge in massive and irreparable rotator cuff tears (RCTs), and superior capsular reconstruction (SCR) has become an increasingly popular choice. The objective of this study was to evaluate clinical and radiological outcomes after SCR using an Achilles tendon allograft in irreparable massive RCTs. Methods: From December 2015 to March 2018, 11 patients (mean age, 66.3 ± 5.8 years) with irreparable massive RCTs who underwent SCR using an Achilles tendon allograft were enrolled in this study. The range of motion (ROM), visual analog scale (VAS), clinical scores, muscle strength, and acromiohumeral distance (AHD) were measured preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 months postoperatively to assess the global fatty degeneration index and graft failure. Ultrasonography was also conducted preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively to assess graft continuity. Results: The mean follow-up period was 27.6 months (range, 24–32 months). The shoulder ROM at final follow-up increased significantly in forward flexion (p = 0.023), external rotation (p = 0.018), internal rotation (p = 0.016), and abduction (p = 0.011). All patients showed improvement in VAS score (p = 0.005) and clinical scores (p < 0.001) compared with the preoperative state. Pseudoparalysis improved in all patients. The AHD was 3.88 mm (± 1.21 mm) preoperatively, 7.75 mm (± 1.52 mm, p = 0.014) at 6 months postoperatively, and 6.37 mm (± 1.72 mm, p = 0.031) at final follow-up. Graft removal and synovectomy were performed in 1 patient who developed postoperative infections. Radiological failure on follow-up MRI occurred in 2 patients at 6 and 12 months postoperatively, respectively. Conclusions SCR using an Achilles tendon allograft in irreparable massive RCTs achieved functional and clinical improvement. The use of Achilles tendon allograft also has the advantages of short operation time without donor site morbidity, sufficient thickness, and robustness; therefore, this allograft can be a useful graft for SCR.

Herpes zoster ophthalmicus (HZO) is an infectious disease that results from the reactivation of latent varicella zoster virus in the ophthalmic branch of the trigeminal ganglia. HZO manifests with herpes zoster-like symptoms such as rash with or without signs of ocular involvement. Cavernous sinus thrombosis (CST) is a life-threatening condition accompanied by signs and symptoms involving the eyes and the cranial nerves. Case: We report a case of septic cavernous sinus thrombosis (caused by Streptococcus constellatus ssp. constellatus) which was masked by the simultaneous occurrence of HZO in this patient, resulting in delayed diagnosis. Conclusions: CST may be obscured by HZO, prompt diagnosis and treatment is necessary when such case arrive.