Iron-generated hydroxyl radicals kill retinal cells in vivo: effect of ferulic acid

Siderosis bulbi is vision threatening. An investigation into its mechanisms and management is crucial. Experimental siderosis was established by intravitreous administration of an iron particle (chronic) or FeSO4 (acute). After siderosis, there was a significant dose-responsive reduction in eletroretinogram (a/b-wave) amplitude, and an increase in •OH level, greater when caused by 24 mM FeSO4 than that by 8 mM FeSO4. Furthermore, the FeSO4-induced oxidative stress was significantly blunted by 100 μM ferulic acid (FA). Siderosis also resulted in an excessive glutamate release, increased [Ca++]i, and enhanced superoxide dismutase immunoreactivity. The latter finding was consistent with the Western blot result. Obvious disorganization including loss of photoreceptor outer segments and cholinergic amacrines together with a wide-spreading ferric distribution across the retina was present, which were related to the eletro-retinographic and pathologic dysfunctions. Furthermore, b-wave reduction and amacrine damage were respectively, significantly, dose-dependently, and clearly ameliorated by FA. Thus, siderosis stimulates oxidative stress, and possibly, subsequent excitotoxicity, and calcium influx, which explains why the retina is impaired electro-physiologically and pathologically. Importantly, FA protects iron toxicity perhaps by acting as a free radical scavenger. This provides an approach to the study and treatment of the iron-related disorders such as retained intraocular iron and Alzheimer disease.

Design and development of a novel automatic valve system for long-term catheterized urinary incontinence patients

It has been estimated that over 3 million patients in the UK suffer from urinary incontinence, the result of which is often long-term catheterization. However, many catheters block prematurely through encrustation and their continuous drainage limits bladder rehabilitation. Although evidence shows that a catheter valve may overcome such weaknesses, only manual valves are currently available and many patients are not able to benefit from these owing to a lack of manual dexterity. A novel electronically controlled automatic valve system, the Shan-Lai (SL) valve system, has been designed and prototyped. The prototype is compact, reliable, and cost effective, and it has low power consumption. The mass of the overall packaged valve system is 34.2 g and it measures 4.5 cm x 4.5 cm x 1.2 cm. With an orifice of 3 mm diameter, the SL valve has achieved high flowrates with relatively low energy consumption. A flowrate-energy relationship (FER) has been introduced to assess the performance of a catheter valve, and the SL valve system prototype has achieved an FER of 0.66 m/s(-1) mJ(-1) while a commercially available electronic valve has an FER of 0.28 m/s(-1) mJ(-1). The valve demonstrated outstanding mechanical reliability after a series of performance tests and also indicated remarkable encrustation resistance in the vicinity of the valve during an in-vitro test.

Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery

BACKGROUND

Endoscopic sinus surgery (ESS) is often affected by intra-nasal bleeding, which can be influenced by various anaesthetics and preoperative conditions. This study compared the surgical condition and the amount of intra-nasal bleeding between patients given sevoflurane/remifentanil (SR) and propofol/remifentanil (PR) anaesthesia.

METHODS

ASA I or II patients undergoing ESS were randomly assigned to group SR (n=20) or group PR (n=20). The extent of the preoperative surgical lesion was classified as high (> 12) and low Lund-Mackay (LM) (< or = 12) scores according to the computed tomography findings. The amount of intraoperative blood loss was calculated from the patients' haemoglobin (Hb) and the amount of blood in the suction canister. The surgeons rated the visibility of the surgical field on a numeric rating scale (NRS).

RESULTS

In the high-LM score patients, the median (1st/3rd quartiles) blood loss for the SR and PR groups was 135 (121/222) and 19 (8/71) ml h(-1), respectively (P<0.01), and the mean (SD) of NRS was 5.8 (2.3) and 2.3 (1.0), respectively (P<0.05). However, in patients with low-LM score, both blood loss and NRS scores were not different between groups SR and PR.

CONCLUSIONS

In the high-LM score patients, PR anaesthesia results in less blood loss and a better surgical conditions for ESS than SR anaesthesia.

Measurement of fetal urine production by three-dimensional ultrasonography in normal pregnancy

OBJECTIVES

Measurement of fetal urine production may provide a means of evaluating amniotic fluid volume, which is difficult to measure directly, and predicting fetal hypoxia. Although there have been some reports on fetal urine production, most of these have used two-dimensional (2D) ultrasonography to measure bladder volume. Three-dimensional (3D) ultrasonography is, however, known to be superior to 2D ultrasonography in some organ volume measurements. Thus, we undertook this study to measure bladder volumes using 3D ultrasonography and to establish a nomogram of fetal urine production rate (UPR) according to gestational age (GA).

METHODS

One hundred and fifty-four women with a normal singleton pregnancy at 24 to 40 weeks' gestation were enrolled in this cross-sectional study. The women had no medical or obstetric complications affecting amniotic fluid volume. Fetal bladder volume was measured using 3D ultrasound imaging and Virtual Organ Computer-aided AnaLysis (VOCAL) with a rotational angle of 30 degrees and manual surface tracing technique. Bladder volume was measured two or three times within a 5-10-min interval and fetal UPR was calculated from serial measurements. When measurements were performed more than twice, we used the mean rate of calculated UPRs. UPR was then plotted against GA to establish the nomogram.

RESULTS

Fetal UPR increased with GA from a median value of 7.3 mL/h at 24 weeks' gestation to 71.4 mL/h at term, and could be calculated from GA using the formula: Ln(UPR) = - 6.29582 + (0.43924 x GA) + (0.000432 x GA2), r2 = 0.63, P = 0.0046. Growth percentiles of UPR according to age are presented.

CONCLUSIONS

Fetal UPR can be easily measured by 3D ultrasound assessment of bladder volume. This modality may be a promising alternative to conventional methods of amniotic fluid volume measurement such as amniotic fluid index and single deepest pocket, and might be an alternative option for predicting fetal hypoxia.

Effects of triethyl phosphate and nitrate on electrokinetically enhanced biodegradation of diesel in low permeability soils

Bench-scale experiments for electrokinetically enhanced bioremediation of diesel in low permeability soils were conducted. An electrokinetic reactor (ER) was filled with kaolin that was artificially contaminated with diesel at a level of 2500 mg kg(-1). A constant voltage gradient of 1.0 V cm(-1) was applied. In phosphorus transport experiments, KH2PO4 was not distributed homogeneously along the ER, and most of the transported phosphorus was converted to water-insoluble aluminum phosphate after 12 days of electrokinetic (EK) operation. However, the advancing P front of triethyl phosphate (TEP) progressed with time and resulted in uniform P distribution. The treatments employed in the electrokinetically enhanced bioremediation of diesel were control (no addition of nitrogen and phosphorus), NP (KNO3+ KH2PO4), NT (KNO3+ TEP), UP (urea+ KH2PO4), and UT (urea+TEP). Analysis of effluent collected during the first 12 days of EK operation showed that diesel was not removed from the kaolin. After nutrient delivery, using the EK operation, the ER was transferred into an incubator for the biodegradation process. After 60 days of biodegradation, the concentrations of diesel in the kaolin for the NP, NT, UP, UT, and control treatments were 1356, 1002, 1658, 1612, and 2003 mg kg(-1), respectively. The ratio of biodegraded diesel concentration to initial concentration (2465 mg kg(-1)) in NP, NT, UP, UT, and control were 45.0%, 59.4%, 32.7%, 34.6%, and 18.7%, respectively. This result showed that TEP, treated along with NO3-, was most effective for the biodegradation of diesel. TEP was delivered more efficiently to the target zones and with less phosphorus loss than KH2PO4. However, this facilitated phosphorus delivery was effective in biodegrading diesel under anaerobic conditions only when electron acceptors, such as NO3-, were present.

Determinants of diagnostic bronchial washing in peripheral lung cancers

OBJECTIVE

To establish clinical determinants affecting the diagnostic yield of bronchial washing.

SETTING

We performed bronchial washing in 241 consecutive patients with bronchoscopically invisible lung tumours. Of these, 150 patients known to have lung cancer were enrolled for the final analysis.

DESIGN

A multi-centre study.

RESULTS

Bronchial washing provided a diagnosis of lung cancer in 30 of the 150 patients (20%). Tumour size > or = 3 cm (P = 0.005), the location of the tumour within 8 cm of the carina (P = 0.003), and exposed type bronchus sign of tumour (P < 0.001) were factors affecting diagnostic bronchial washing for bronchoscopically invisible lung cancers. However, multivariate logistic regression revealed that exposed type bronchus sign was the sole determinant (OR 19.22, 95% CI 4.23-87.46, P < 0.001).

CONCLUSION

Bronchial washing is a useful procedure for the diagnosis of bronchoscopically invisible lung cancers. As the tumour-bronchus relationship is the most important determinant of a diagnostic yield, the routine use of bronchial washing should be considered for tumours with exposed type bronchus sign.

An Efficient Adaptive Feedback cancellation using by Independent component analysis for hearing aids

In this paper, we proposed a feedback cancellation algorithm based on independent component analysis (ICA) for digital hearing aids. In conventional adaptive feedback cancelling systems, the normalized least mean squares (NLMS) algorithm used to reduce acoustic feedback in which hearing aids occurs, generally at high gains. But primary input signal depend on the acoustic feedback signal in higher-order statistics, proposed algorithm was better acoustic feedback cancelling performance than the conventional NLMS algorithm when the input signal has a Laplacian distribution with high-order processing in real-time simulation of TMS320C 6711 DSK.

Phenylpropanolamine contained in cold remedies and risk of hemorrhagic stroke

In this study, we sought to elucidate whether phenylpropanolamine (PPA) in cold remedies (small and divided doses) increases the risk of hemorrhagic stroke (HS). PPA exposure significantly increased the risk, and the risk was much higher in women. In women, linear trends were also found in recency, duration, and dosage of PPA exposure. PPA contained in cold remedies increases the risk of HS, particularly in women.

Application of iron-coated sand and manganese-coated sand on the treatment of both As(III) and As(V)

In this study, manganese-coated sand (MCS) and iron-coated sand (ICS) were applied in the oxidation of As(III) and adsorption of As(V), respectively. ICS and MCS were prepared by mixing FeCl3 and Mn(NO3)2, respectively, with Joomoonjin sand at 150 degrees C. In the batch adsorption isotherms, adsorption of As(III) and As(V) onto ICS followed a Langmuir type. ICS showed a greater capacity in the removal of As(V) than As(III) and also in the removal of As(V) compared with MCS. Three different configurations of ICS and MCS were used to investigate the oxidation of As(III) and adsorption of As(V) in a column. In the homogenised system, arsenic breakthrough was approximately two-times delayed compared with the separately packed systems. After breakthrough of arsenic, concentration of As(III) in the effluents was below 40 ppb for the entire reaction period in all configurations, and most arsenic was identified as As(V) owing to near complete conversion of As(III) to As(V) by MCS. The catalytic activity of MCS on the oxidation of As(III) was maintained up to 700 pore volumes, which corresponds to the treatment of at least 300 mg As(III) based on the 1 kg MCS. Compared with the homogenised column, the released Mn(II) concentration from two-staged and four-staged columns was great for the entire reaction period. In the case where the same amount of ICS and MCS was packed in a filtration system, the homogenised column was identified as a better configuration compared with the two-staged and four-staged columns when considering the arsenic breakthrough time as well as the released concentration of Fe(III) and Mn(II).

Potential application of manganese coated sand in the removal of Mn(II) from aqueous solutions

The aim of this study was to explore the applicability of manganese coated sand (MCS) in the presence and absence of sodium hypochlorite for the removal of Mn(II) (2 mg/L) from aqueous solutions. Sand itself is widely used as a filter media for the treatment of wastewaters and it was reported that during the treatment, Mn(II), which is present in the wastewater, is to be deposited on the surface of sand in the form of manganese dioxide. The present investigation dealt with various MCS samples, prepared in the laboratory by various doses of Mn(II) (i.e. from 0.05 to 0.2 mol/L) and the samples were obtained from the pilot plant and naturally coated in the water treatment plant for the removal of Mn(II) in the batch and column studies. Moreover, it was realised that the role of hypochlorite is multifunctional as it not only enhances the uptake of Mn(II) on the surface of MCS through oxidation of Mn(II) into Mn(IV) and hence the formation of manganese dioxide, but it was also supposed to disinfect the bacteria or harmful pathogens from the waste/surface waters. The results obtained clearly inferred that various MCS samples used for the removal of Mn(II) from aqueous solutions showed comparable removal efficiency. However, the presence of sodium hypochlorite greatly enhanced the removal of Mn(II) as more than 80% Mn(II) was removed in the presence of sodium hypochlorite at around pH 6.5. Similarly, while comparing the column data it was again noted that the breakthrough points occurred after the 4,100 and 6,500 bed volumes, respectively, in the absence and in the presence of sodium hypochlorite (2 mg/L).

Removal of toxic heavy metals by iron-coated starfish

In this study, the applicability of calcined starfish (SF) and iron-coated SF (ICSF) as potential adsorbents for the treatment of wastewater containing heavy metal ions was evaluated. ICSF was prepared by mixing FeCl(3) solution previously adjusted to pH 7 approximately 9 with SF at 105 degrees C. From the dissolution test at pH 2, ICSF showed strong acid-proof properties. In the batch adsorption, Cu(II) adsorption onto ICSF was completed within 150 minutes, while 47% Cu(II) was removed with SF alone. This result clearly suggests that the coated Fe(III) serves additional adsorption sites, resulting in the enhanced removal of heavy metal ions. The removed fraction of both Cu(II) and Pb(II) increased with increasing solution pH and nearly complete removals of Pb(II) and Cu(II) were observed at around pH 6 and 8, respectively. From the adsorption isotherm of Cu(II) onto SF and ICSF at pH 3.0, the removed amount of Cu(II) by ICSF was greater than that by SF over the entire concentration range studied. In the column test, the breakthrough of Cu(II) in the ICSF column was greatly retarded compared to that in the SF column. Based on the drinking water regulations for Cu(II), SF and ICSF were able to remove 3400 and 8600 mg/kg of Cu(II) from the wastewater, respectively.

Clinical Trials Assessing the Optimal Management of Brain Metastases — the State of Play

These three clinical trials offer the opportunity to answer the controversies and uncertainties that exist in managing patients with brain metastases: for patients with solitary brain metastasis there is the EORTC trial, for patients with NSCLC, where there is a certainty that the patient should receive radiotherapy, there is TACTIC, and where there is uncertainty of the benefit of radiotherapy there is QUARTZ. We would encourage all clinical oncologists seeing patients with brain metastases to consider patients for entry into any one of these trials.

STM, QCM, and the windshield wiper effect: a joint theoretical-experimental study of adsorbate mobility and lubrication at high sliding rates

We have observed that when mobile adsorbed films of benzene, tricresyl phosphate, and tertiary-butyl phenyl phosphate are present on the surface electrode of a quartz crystal microbalance (QCM), oscillation of the QCM produces clearer scanning tunneling microscope (STM) images of the electrode surface. This is in contrast to an immobile overlayer of iodobenzene, where oscillation of the QCM does not affect image quality. This observation is attributed to a "windshield wiper effect", where at MHz frequencies the tip motion maintains a region of the surface where the absorbate concentration is reduced, which leads to a clearer image. A straightforward model is presented that supports this conclusion and that provides guidelines for effective lubrication of contacts operating at MHz frequencies.

The Impact of Arteriovenous Malformation Radiosurgery on the Brain: From Morphology and Perfusion to Neurocognition

The therapeutic aims of brain arteriovenous malformation (AVM) radiosurgery are multiple. Protecting patients from rebleeding is the prime goal. Among the others, hemodynamics, perfusion and neurocognition recovery are interesting and important. Anatomically AVM contains an abnormal cluster of vascular networks (nidus) between arteries and veins. Hemodynamically the nidus contains a low resistance and causes high-flow transnidal shunts between both sides of the nidus. The shunts cause hypotension in the neighboring arteries and diversion of blood from the adjacent brain tissues. The diversion disturbs brain hemodynamics. Radiosurgery, by eliminating the nidus, reconstitutes normal brain hemodynamics. From the early stage after radiosurgery, the abnormal transnidal flows gradually decrease, and the adjacent hemodynamics recovers toward normal. For nonhemorrhagic AVM, improvement of seizure control and stable or improved neurological status are observed clinically. The radiosurgical effects are also reflected in the recovery of metabolism in the adjacent brain and neurocognitive function paralleling the hemodynamic normalization. Morphological cure of AVM and the associated recovery of brain hemodynamics, metabolism and neurocognitive function form the therapeutic rationale of AVM radiosurgery.

Molecular characterization of Enterococcus faecium isolated from hospitalized patients in Korea

AIMS

Multilocus sequence typing (MLST) was performed for vancomycin-resistant Enterococcus faecium (VREF) from diverse geographical areas in Korea to obtain insights into the genetic relationships with other molecular profiles. To understand the diversity of lineages, vancomycin-susceptible E. faecium (VSEF) were included.

METHODS AND RESULTS

A total of 60 E. faecium isolates were analysed by MLST and esp profile. Molecular typing of Tn1546 of 30 VREF strains was evaluated by overlapping PCR of Tn1546 and DNA sequencing. Seven sequence types (ST) were found among 30 VSEF isolates, and four STs were found among 30 VREF isolates. The types most frequently encountered were ST 78 (26 isolates) and ST 203 (16 isolates). Of the 60 E. faecium isolates, 35 isolates were positive for the esp gene. On molecular typing of Tn1546, all VREF isolates were divided into four main types. Strains with the same ST showed divergence in Tn1546 types and strains with the same Tn1546 type represented different STs.

CONCLUSIONS

An association between Tn1546 typing and MLST was not found.

SIGNIFICANCE AND IMPACT OF THE STUDY

These results suggest that the horizontal spread of Tn1546 between strains plays a major role in the dissemination of vancomycin resistance in Korea.

Posterior circulation ischemic stroke in Korean population

To understand the characteristics of posterior circulation ischemic stroke (PCS) in the Korean population better, we retrospectively reviewed the data from the Hallym Stroke Registry (HSR). We analyzed the demographic features, risk factors, stroke subtypes, lesion distributions and clinical outcomes of 591 consecutive patients with PCS, enrolled in HSR between January 1996 and July 2002. PCS was 39.8% of all ischemic strokes. Mean age of PCS patients was 63.4 years and 55.7% were men. Hypertension was the most common risk factor (69.9%). However, potential cardioembolic sources were found only in 11.0%. The most frequent stroke subtype was large artery disease (50.0%), followed by small vessel disease (33.8%). Only 5.2% of patients were classified as affected with cardioembolism. The most common location of infarcts was in the middle territory (36.5%), followed by distal (28.1%), proximal (19.0%), and multiple territories (16.4%). The hospital mortality rate (4.1%) and discharge outcome of PCS were comparable with those of the anterior circulation stroke (ACS). In conclusion, the etiology and lesion topography of PCS in the Korean population appeared to be different from those of the Caucasians.

Essential protective roles of reactive astrocytes in traumatic brain injury

Astrocytes respond to traumatic brain injury (TBI) by altered gene expression, hypertrophy and proliferation that occur in a gradated fashion in relation to the severity of the injury. Both beneficial and detrimental effects have been attributed to reactive astrocytes, but their roles after brain injury are not well understood. To investigate these roles, we determined the effects on cortical tissue of ablating reactive astrocytes after contusion injury generated by controlled cortical impact (CCI) of different severities in transgenic mice that express a glial fibrillary acidic protein-herpes simplex virus-thymidine kinase transgene. Treatment of these mice with the antiviral agent, ganciclovir, conditionally ablates proliferating reactive astrocytes. Moderate or severe CCI were generated with a precisely regulated pneumatic piston, and forebrain tissue was evaluated using immunohistochemistry and quantitative morphometry. Moderate CCI in control mice triggered extensive and persisting reactive astrogliosis, with most neurons being preserved, little inflammation and an 18% loss of cortical tissue beneath the impact site. Ablation of reactive astrocytes after moderate CCI in transgenic mice caused substantial neuronal degeneration and inflammation, with a significantly greater 60% loss of cortical tissue. Severe CCI in control mice caused pronounced neuronal degeneration and loss of about 88% of cortical tissue that was not significantly altered by ablating reactive astrocytes in transgenic mice. Thus, ablation of dividing reactive astrocytes exacerbated cortical degeneration after moderate CCI, but did not alter cortical degeneration after severe CCI. These findings indicate that the reactive astrocytes play essential roles in preserving neural tissue and restricting inflammation after moderate focal brain injury.

Association of Br polymorphism of platelet GP Ia gene and immune thrombocytopenic purpura

Studies on the molecular structure underlying Br(a)/Br(b) (HPA-5) platelet alloantigen show that a single base polymorphism at position 1648 on platelet mRNA coding for GP Ia results in a amino acid substitution at position 505 on the mature GP Ia which is associated with the two serologically defined Br types. While this polymorphism has no known effects on platelet function, the possible influence of this polymorphism in immune thrombocytopenia ITP is again unexplored. Therefore, the genotype frequency of Br polymorphism in ITP was compared with that of healthy general Korean population. Interestingly, there was a statistical difference (P=0.03) in genotype frequency of Br polymorphism. The association of Br(a)/Br(b) (HPA-5)genotype and occurrence of ITP may suggest the possible influence of genetic polymorphism on the pathogenesis of ITP.

A case of sparganosis mimicking a varicose vein

Recent advances in radiological and serological techniques have enabled easier preoperative diagnosis of sparganosis. However, due to scarcity of cases, sparganosis has been often regarded as a disease of other etiologic origin unless the parasite is confirmed in the lesion. We experienced a case of sparganosis mimicking a varicose vein in terms of clinical manifestations and radiological findings. Sparganosis should be included among the list of differential diagnosis with the varicose vein.

The effects of the exaggerated lithotomy position for radical perineal prostatectomy on respiratory mechanics

The exaggerated lithotomy position is used during radical perineal prostatectomy to increase perineal exposure. The aim of this study was to evaluate the effects of the exaggerated lithotomy position on respiratory mechanics and arterial blood gases. In the exaggerated lithotomy position, dynamic compliance and static compliance were found to be significantly decreased by 27.4% and 34.8%, respectively, whilst peak, plateau, and mean airway pressures increased significantly by 34.0%, 45.8% and 31.7%, respectively. The physiological dead space/tidal volume ratio and total inspiratory work of breathing increased significantly by 11.1% and 33.7%, respectively. Arterial oxygen tension was significantly decreased by 26.9%; however, no significant differences were seen in end-tidal or arterial carbon dioxide tension. These results indicate that the exaggerated lithotomy position under general anaesthesia can cause significant effects on respiratory system mechanics and arterial oxygenation and highlights the need for careful monitoring of patients placed in this position for surgery.

Prognostic factors for surgical resection in patients with multidrug-resistant tuberculosis

Although surgical lung resection could improve prognosis in some patients with multidrug-resistant tuberculosis (MDR-TB), there are no reports on the optimal candidates for this surgery. The aim of the present study was to elucidate the prognostic factors for surgery in patients with MDR-TB. Patients who underwent lung resection for the treatment of MDR-TB between March 1993 and December 2004 were included in the present study. Treatment failure was defined as greater than or equal to two of the five cultures recorded in the final 12 months of treatment being positive, any one of the final three cultures being positive, or the patient having died during treatment. The variables that affected treatment outcomes were identified through univariate and multivariate logistic regression analysis. In total, 79 patients with MDR-TB were included in the present study. The treatment outcomes of 22 (27.8%) patients were classified as failure. A body mass index <18.5 kg x m(-2), primary resistance, resistance to ofloxacin and the presence of a cavitary lesion beyond the range of the surgical resection were associated with treatment failure. Low body mass index, primary resistance, resistance to ofloxacin and cavitary lesions beyond the range of resection are possible poor prognostic factors for surgical lung resection in multidrug-resistant tuberculosis patients.

Effect of water-soluble reduced chitosan on Streptococcus mutans, plaque regrowth and biofilm vitality

The purpose of the present study was to examine the effects of a newly developed water-soluble reduced chitosan on Streptococcus mutans, plaque regrowth, and biofilm vitality. A 1.0%, water-soluble reduced chitosan, with pH ranging from 6.0 to 6.5, molecular weights between 3,000 and 5,000 Da, and 70% degree of deacetylation, was used. To determine antibacterial and antiplaque potency of chitosan, minimal inhibitory concentrations (MICs) for S. mutans and S. sanguinis (formerly S. sanguis), short-term exposure to S. mutans, and clinical trial of plaque regrowth and biofilm vitality were conducted. Twelve dental students volunteered to participate in the 6-week, double blind, randomized clinical trial using the classical 4-day plaque regrowth design. The MIC of water-soluble reduced chitosan for S. mutans was 1.25 g/l. While the cells exposed to distilled water (DW) grew rapidly, with a maximum turbidity reached by 16 h postinoculation, S. mutans exposed to chitosan (5.0 g/l) exhibited a substantial delay in growth and reached a maximum turbidity by 32 h postinoculation. The chitosan solution reduced the plaque index and the vitality of the plaque flora significantly when compared to DW, but this was less than the reductions found with the positive control of 0.1% chlorhexidine solution. The water-soluble reduced chitosan exhibited potent antibacterial effect on S. mutans, and displayed a significant antibacterial and plaque-reducing action during the 4-day plaque regrowth.