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This study investigated the effects of a multi-access, metaverse-based early onset schizophrenia nursing simulation program based on Raskin and Rogers’ person-centered therapy. The program’s effectiveness was tested using a nonequivalent control group pre-test/post-test design. A quasi-experimental simulation study with both pre- and post-test designs was adopted. The experimental group (n = 29) used the simulation program, whereas the control group (n = 29) received only an online lecture on schizophrenia nursing. Changes in scores among experimental and control groups were compared using independent t-tests and analyses of covariance with PASW SPSS-WIN 27.0. Post-intervention, the knowledge regarding patients with early onset schizophrenia, critical thinking ability, and the ability to facilitate communication increased significantly in the experimental group compared with the control group. The nursing simulation program for children with early onset schizophrenia using a metaverse improved nursing students’ knowledge, critical thinking ability, and ability to facilitate communication. This training method should be adapted without spatiotemporal constraints by partially supplementing clinical and simulation-based practice. In clinical nursing training, metaverse technical limitations should be identified, and training topics should be selected. Employing EduTech in a metaverse environment can provide clinical education to nurses in psychiatric wards and improve therapeutic communication with their psychiatric patients.

A considerable number of patients who underwent a 2-stage exchange protocol for periprosthetic hip joint infection could not complete the second-stage reimplantation. The aim of this study was to evaluate the results of unintended retention of temporary articulating spacers for the treatment of periprosthetic hip joint infection. Ninety-four patients with infection after total hip arthroplasty were treated by using a 2-stage exchange protocol with temporary articulating spacers. Of the 94 patients, 35 did not complete the 2-stage exchange protocol and retained spacers for more than 12 months. The authors retrospectively investigated the clinical and radiographic results after a mean follow-up of 36.1 months. Thirty-one patients had well-healed wounds without recurrent infection and did not receive further surgery for any reason (success group). Spacers were revised in 2 patients, and the other 2 patients underwent incision and debridement because of recurrent infection (failure group). There were no statistical differences between the 2 groups in terms of demographics or presence of resistant organisms. After 3 years of follow-up, temporary articulating spacers functioned well in 89% of the patients who retained them. These results support that retention of temporary articulating spacers could be considered an alternative treatment option for select patients. [ Orthopedics . 2020;43(4):e251–e257.]

This study aimed to explore the factors explaining the safety of disabled women in the convergence society and was surveyed 374 disabled women nationwide. This study examined the factors that explain the safety of disabled women from the accidents and crimes in terms of individual, familial, and community characteristics. Main findings are as follows: 1) the safety from accident was largely explained by the community type and social capital condition in characteristics of community domain. The material hardship in characteristics of familial domain and disability level in characteristics of individual domain explained the safety from accident also. 2) the safety from crime was largely explained by the material hardship in characteristics of familial domain. And the community type and social support condition in characteristics of community domain and the educational level in characteristics of individual domain explained the safety from crime. Based on the findings, we suggested practical and institutional implications to ensure the disabled women`s safety.

This study was conducted to explore the effect of social support on the quality of life of hemodialysis patients and to verify the moderating effect of public services. To achieve this purpose, parameter analysis using hierarchical moderated multiple regression was carried out with data provided by 156 hemodialysis patients who live in Seoul and Gyeonggi-do. Results of analysis showed that social support, marital status, occupation of patient affected with the quality of life. The findings also showed that public services have moderate effect on relationship between the quality of life of hemodialysis patient and social support. Implications of these results were explored in relation to the importance of public services and measures that could be taken to improve social work practice.

In this study, nitric oxide (NO) production in a macrophage-lymphocyte co-culture system was used to assess the cytokine producing capability of cells during endotoxin tolerance in mice. Incubation of peritoneal macrophages with interferon-γ (IFN-γ) in the presence of lipopolysaccharide (LPS) augmented NO synthesis. Exogenous tumor necrosis factor-α (TNF-α) could also replace LPS for the stimulation of NO production. Macrophages co-cultured with splenic lymphocytes showed augmented NO synthesis by LPS alone. However, pretreatment of mice with 2.5 ㎎/㎏ LPS completely prevented the lethality and the increase of blood TNF-α and IFN-γ after the second challenge with a lethal dose of LPS. In addition, when macrophages prepared from LPS-tolerant mice were co-cultured with normal splenocytes, LPS also could not induce the production of NO, even in the presence of exogenous TNF-α. Moreover, when normal macrophages were co-cultured with splenocytes obtained from LPS-tolerant mice, stimulation with LPS could not evoke the NO production enhancement. However, this down-regulation was able to reverse by exogenous IFN-γ or concanavalin A (ConA), a stimulator of IFN-γ production. Our results indicate that not only macrophages but also lymphocytes contribute to LPS tolerance. As INF-γ can enhance the expression of TNF-α, the decrease of INF-γ synthesis from lymphocytes may orchestrate with the decrease of TNF-α synthesis from LPS-tolerant macrophages for the production of tolerant state and the prevention of excessive inflammation. Therefore, LPS tolerance may be exploited for prophylaxis of severe sepsis in patients at risk.

The shell of Reeve's turtle has been used as a traditional folk medicine in Korea. We produced a hot water extract from Reeve's turtle shell according to the traditional medical practice. To release bioactive peptides, the hot water extract was enzymatically hydrolyzed with various proteases, and the free radical scavenging activity of the hydrolysate was investigated against 1,1-diphenyl-2-picryl-hydrazyl (DPPH), hydroxyl and peroxyl radicals. The free radical scavenging activity of the enzymatic hydrolysates varied from 1 to 79% depending on the enzymes, free radical species, and concentration. The values demonstrated that the enzymatic hydrolysates of hot water extract from the shell of Reeve's turtle are potential antioxidants.

Glioblastoma multiforme (GBM) is the most frequently occurring brain cancer. Although the existence of cancer stem cells (CSCs) in GBM has been established, there is little evidence to explain the link between CSCs and chemoresistance. In this study, we investigated that only a few cells of A172 and established GBM2 survived after 1,3-bis(2-chloroethyl)-1-nitrosourea (BiCNU) exposures and these survived cells resist the subsequent BiCNU treatment. In addition, these BiCNU-resistant small populations derived from GBM cells increased the phosphorylations of Erk and Akt and highly expressed CD133 stem cell surface marker. Furthermore, we observed that the BiCNU-resistant cancer cells derived from GBM have grown tumors when transplanted into severe combined immuno-deficient (SCID) mouse brain. These results demonstrate that BiCNU-resistant subpopulation cells derived from GBM have cancer stem-like cell properties. Therefore, it may provide provide further evidence that CSCs in GBM have chemotherapeutic drug resistance.

Capsaicin (8-methyl-N-vanillyl-6-nonenamide), a pungent ingredient of hot chili peppers, has been reported to possess substantial anticarcinogenic and antimutagenic activities. In the present study, we investigated the effect of capsaicin on induction of apoptosis in highly metastatic B16-F10 murine melanoma cells. Capsaicin inhibited growth of B16-F10 cells in a concentration-dependent manner. Proapoptotic effect of capsaicin was evidenced by nuclear condensation, internucleosomal DNA fragmentation, in situ terminal nick-end labeling of fragmented DNA (TUNEL), and an increased sub G1 fraction. Treatment of B16-F10 cells with capsaicin caused release of mitochondrial cytochrome c, activation of caspase-3, and cleavage of poly (ADP-ribose) polymerase in a dose-dependent manner. Furthermore, Bcl-2 expression in the B16-F10 cells was slightly down-regulated by capsaicin treatment. In contrast, there were no alterations in the levels of Bax in capsaicin-treated cells. Collectively, these findings indicate that capsaicin-induces apoptosis of B16-F10 melanoma cells via down-regulation the Bcl-2.

[Purpose] The purpose of the present study was to investigate the effect of TENS applied to the skin overlying the bellies of the gastrocnemius muscles of the lower limbs on balance and plantar pressure of healthy adults. [Subjects and Methods] Twenty-eight healthy college students were the subjects of this study. Adhesive transcutaneous electrical nerve stimulation (TENS) electrodes were attached to the medial and lateral belly of the gastrocnemius muscle. Before and after the application of the TENS, subjects' balance ability and maximum plantar pressure were measured and compared. [Results] The scores improved in the balance tests, including the fall risk test and the stability limit test, after the application of TENS, and a statistically significant difference was noted in the stability limit test. The maximum plantar pressure after the application of TENS decreased except beneath the big toe, and statistically significant difference was found under the forefoot. [Conclusion] The results of present study suggest that TENS applied to the skin overlying gastrocnemius muscles is useful strategy that improves the balance ability of healthy adults.

Cytokines produced by immune cells in pancreatic islets infiltrating are important mediators of beta-cell destruction in insulin-dependent diabetes mellitus. In this study, the effects of retinoic acid (RA) on cytokine-induced beta-cell dysfunction were examined. RA significantly protected interleukin-1 beta (IL-1) and interferon-gamma (IFN-gamma)-mediated cytotoxicity of rat insulinoma cell (RINm5F), and also reduced in IL-1 and IFN-gamma-induced nitric oxide (NO) production, which correlated well with reduced levels of the inducible form of NO synthase (iNOS) mRNA and protein. The molecular mechanism, by which RA inhibited iNOS gene expression, appeared to involve the inhibition of NF-kappa B activation. Our results suggest possible therapeutic value of RA for the prevention of diabetes mellitus progression.

The effect of Acanthopanax senticosus (AS) leaves on lipoprotein lipase (LPL) was investigated in 3T3-L1 adipocytes. A water extract of AS leaves increased the LPL activity in culture medium of adipocytes in a dose- and time-dependent manner. The AS extract contained heparin-like LPL releasing components, however, the increase of medium LPL activity was continued up until 12 h, in contrast to the rapid decline after heparin treatment. The increase of LPL mRNA was also observed after AS extract treatment, suggesting that LPL induction occurs at the transcriptional level. The AS extract could partially reverse the LPL suppression by tumour necrosis factor-alpha in 3T3-L1 adipocytes. These results of an AS extract-induced increase of LPL activity in vitro suggest the possible action of AS as a facilitator of plasma triglyceride clearance.

Restoration of skin reactivity to 1 TU of tuberculin (RT23) by repeated tests at 10 days interval has been investigated in the BCG vaccinated or unvaccinated primary school children. The results obtained are as follows. 1) Tuberculin reactors showing 6 mm or larger induration to the first tests were 20.0% in the first grade school children and 33.3% in the sixth grade children. Six millimeter or larger reaction than that of the first reaction was found in 14.9% of the first grade children and in 34.6% of the sixth grade children. 2) Six millimeter or larger reactors were 10.8% of the first grade children without BCG scar against both first and second tests and 11.8% of the sixth grade children on first tests and 10.6% on second tests. There was none or very few, if any, in number of 6 mm or larger difference between the first and second tests among children without BCG scar. In addition, there was no children shown 6 mm or larger second reaction than that of the first reaction and thus those reactors seemed to be natural infection. 3) From questionaire survey, parents of 73.3% of the first grade children and of 72.7% of the sixth grade children were aware of BCG vaccination of their children, while parents of 15.1% and 24.6% of the first and sixth grade children did not know their children's vaccination history even if children possessed BCG scar. 4) Of the first grade children whose parents remembered their BCG vaccination, 65.6% were vaccinated within 4 weeks after birth and 25.5% between 4 weeks and one year. Six millimeter or larger reaction on the first tests was observed in 20.2% of the former group and 15.9% of the latter group, however reactors on the second tests were 32.1% and 31.9% respectively. BCG scar was not observed in 13.9% of children. 5) The majority of children (87.3%) were vaccinated in the skin of deltoid area and some (7.7%) at buttock or other areas. Children received first vaccination at the health centers were 68.5% and 30.3% at hospitals. More than 5 mm reaction was found in 18.7% of the former children and in 15.0% of the latter children. From this study restoration of tuberculin reactivity by repeated tests was found very common among the vaccinated children and thus it should be taken into account for the vaccination policy if it is performed after tuberculin testing.

Capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide), the major pungent ingredient of red pepper, has been reported to possess anti-carcinogenic and anti-mutagenic activities. In this study, the anti-migration activity of capsaicin on highly metastatic B16-F10 melanoma cells was investigated. Capsaicin significantly inhibited the migration of melanoma cells without showing obvious cellular cytotoxicity at low doses. This effect correlated with the down-regulation of phosphatidylinositol 3-kinase (PI3-K) and its downstream target, Akt. Although B16-F10 cell migration was increased by the PI3-K activator through the activation of Akt, these PI3-K activator-induced phenomena were attenuated by capsaicin. Moreover, capsaicin was found to significantly inhibit Rac1 activity in a pull-down assay. These results demonstrate that capsaicin inhibits the migration of B16-F10 cells through the inhibition of the PI3-K/Akt/Rac1 signal pathway. The present investigation suggests that capsaicin targets PI3-K/Akt/ Rac1-mediated cellular events in B16-F10 melanoma cells. Consequently, capsaicin administration should be considered an effective approach for the suppression of invasion and metastasis in malignant melanoma chemotherapy.

1,3-Bis(2-chloroethyl)-1-nitrosourea (BCNU) is the most commonly used chemotherapeutic agent in the treatment of human glioblastoma multiforme (GBM). However, BCNU chemotherapy fails due to subpopulations of intrinsic resistant-cells within the tumor mass. In our previous study, we dissociated BCNU-resistant cancer stem cells (CSCs) and observed the over-expression of multiple ion channel genes related to drug efflux. In the present study, we identified chloride intracellular channel 1 (CLIC1) in dissociated-BCNU-resistant CSCs using 2-DE and MALDI-TOF/MS analysis. To develop the specific target therapy of BCNU-resistant CSCs, we evaluated the drug-sensitivity of these CSCs using the chloride channel blocker, 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS). When combined with BCNU, DIDS synergistically increased the apoptotic events of BCNU-resistant CSCs in vitro and augmented BCNU sensitivity ex vivo. These findings suggest that CLIC1 is involved in the resistance of BCNU-resistant CSCs and BCNU/DIDS combined-therapy can provide valuable insight for promoting apoptosis or sensitizing glioblastomas to BCNU chemotherapy.

Glioblastoma multiforme (GBM) is the most frequently occurring brain cancer. Although the existence of cancer stem cells (CSCs) in GBM has been established, there is little evidence to explain the link between CSCs and chemoresistance. In this study, we developed a dissociated cell system of human GBM cells, A172 and established GBM2 cells, that have shown resistance to 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). After exposure to a lethal dose of BCNU, the small population of GBM cancer cells survived and proliferated, as opposed to direct inhibition of the apoptosis and activation of the proliferation signal. Also, these cells contained subpopulations of stem-like cells, expressing CD133, CD117, CD90, CD71, and CD45 cell-surface markers, and had the capacity for multipotency. Moreover, we observed that BCNU-resistant subpopulations derived from GBM cancer cells can be grown to tumors when transplanted into severe combined immunodeficient (SCID) mouse brain. These results demonstrated that BCNU-resistant subpopulations derived from GBM have cancer stem-like cell properties. These findings provide further evidence that CSCs in GBM display chemotherapeutic drug resistance. Hopefully, it will be possible to improve the therapeutic outcome of GBM, leading to better anticancer strategies.

Capsaicin (8-methyl-N-vanillyl-6-nonenamide), the major pungent ingredient of red pepper, has been reported to possess anti-carcinogenic and anti-mutagenic activities. In this study, the effects of capsaicin on human glioblastoma A172 cells were investigated. Treatment of A172 cells with capsaicin inhibited cell growth and induced apoptosis through down-regulation of Bcl-2 and activation of caspase-3. Interestingly, synergistic induction of morphological alternation was observed when A172 cells were treated with capsaicin. A double immunostaining analysis indicated that capsaicin stimulated terminal differentiation predominantly to astrocyte-like cells. Moreover, capsaicin increased the transcription levels of glial fibrillary acidic protein (GFAP) and neuronal microtubule-associated protein 2ab (MAP2ab). These results demonstrated that capsaicin inhibits A172 cell growth through apoptosis and terminal differentiation. Consequently, this research may provide further support for capsaicin-based anti-tumor therapies and consideration should be given to developing capsaicin for use in chemotherapy for malignant human glioblastoma.

The effect of Acanthopanax senticosus (AS) leaves on lipoprotein lipase (LPL) was investigated in 3T3-L1 adipocytes. A water extract of AS leaves increased the LPL activity in culture medium of adipocytes in a dose- and time-dependent manner. The AS extract contained heparin-like LPL releasing components, however, the increase of medium LPL activity was continued up until 12 h, in contrast to the rapid decline after heparin treatment. The increase of LPL mRNA was also observed after AS extract treatment, suggesting that LPL induction occurs at the transcriptional level. The AS extract could partially reverse the LPL suppression by tumour necrosis factor-alpha in 3T3-L1 adipocytes. These results of an AS extract-induced increase of LPL activity in vitro suggest the possible action of AS as a facilitator of plasma triglyceride clearance.

The present study was undertaken to explore whether retinoids, which are known to have immunomodulatory actions, could attenuate tumor necrosis factor-alpha (TNF)-stimulated inducible nitric oxide synthase (iNOS) expression in 3T3-L1 adipocytes. Adipocytes incubated with TNF induced dose- and time-dependent accumulation of nitrite in the culture medium through the iNOS induction as confirmed by Western blotting. Treatment of cells with TNF in the presence of all-trans-retinoic acid (RA) significantly decreased their ability to produce nitrite and iNOS induction. Both 13-cis- and all- trans-RA-induced suppression was dose-dependent, and all-trans-RA was somewhat potent than 13-cis-RA. The inhibitory effect of RA on TNF-induced iNOS induction was reversible, completely recovered after 2 days, and was exerted through the inhibition of NF-kappaB activation. TNF also suppressed the lipoprotein lipase (LPL) activity of 3T3-L1 adipocytes. RA could not reverse the TNF- induced LPL suppression at RA levels causing near complete inhibition of the TNF-induced NO production. These results indicate that RAs attenuate iNOS expression reversibly in TNF-stimulated 3T3-L1 adipocytes, and that the TNF-induced LPL suppression is not the result of NO overproduction.

Implantation of a penile prosthesis in men with complicated fibrosis of corpus cavernosum is very difficult and even impossible. Cavernosal dilation requires sharp intracavernosal dissection to implant prosthesis, however complete removal of the fibrotic tissue is often impossible. We introduce a new technique using electric resection and electrovaporization of fibrotic tissue for implantation of penile prosthesis in a patient with severe corporeal fibrosis.

Purpose: This study was to investigate the effect of music therapy as intervention on peripheral neuropathic pain and anxiety of gynecologic cancer patients who were undergoing paclitaxel chemotherapy. Methods: Hospitalized 62 patients were assigned to an experimental group (n=30) and a control group (n=33) in this quasi-experimental study. The experimental group participated in music therapy that includes listening, singing and song writing during 1 hour. The peripheral neuropathic pain, anxiety and depression were examined as pre-intervention evaluation by using pain scale, anxiety scale (20 questions) and depression scale (20 questions) in both groups. There were no further treatments for the control group while the experimental group involved in music therapy. The peripheral neuropathic pain and anxiety were evaluated in both groups as post-intervention evaluation. Results: Outcomes were verified through hypothesis testing. The level of peripheral neuropathic pain and anxiety in the experimental group was decreased, compared to the control group. Conclusion: According to the study, music therapy is a beneficial intervention that reduces peripheral neuropathic pain and anxiety in gynecologic cancer patients. These findings are encouraging and suggest that music therapy can be applied as an effective intervention for minimizing chemotherapy related symptoms.

Background: The treatment success rates in patients with tuberculosis are known to be lower in the private sector compared to the public sector. To improve treatment outcomes in the private sector we developed a public-private collaboration model for strengthening health education and case holding activities with public health nursing in the private sector. Methods: We performed a prospective cohort study in new smear positive pulmonary tuberculosis patients treated at private hospitals, selected by non-randomization, with an intervention consisting of health education and case holding activities by specially trained public health nurses (intervention group) results were compared with cases treated without the intervention (conventional group). Physicians were asked to treat both groups routinely. The treatment outcomes of patients under treatment by the National Tuberculosis Programme were also analyzed for comparison. Results: There were 172 cases each in the intervention and conventional groups. The mean age was 48.9±19.0 and 48.2±19.7 in the respective groups (p=0.66). The PHN interacted with the cases in the intervention group by initial face to face interview and telephone calls an average of 7.1±9.2 times during the initial six months. The intervention group showed a significantly higher treatment success rate, 91.6%, (Rate Ratio [RR]; 1.23, 95% Confidence Interval [CI]; 1.12 ∼1.36), lower default, 3.6%, (RR; 0.31, 95% CI; 0.13∼0.75) and transfer-out rate, 3.0%, (RR; 0.32, 95% CI; 0.12∼0.86) than the conventional group where they were: 75.0%, 11.6%, 9.3%, respectively. The success rate was even higher than the rate (80.5%) of 1,027 cases treated in health centers (RR; 1.11, 95% CI; 1.05∼1.17). Of the completed cases in the intervention group, 82.2% regarded the role of the public health nurse as very helpful. Conclusion: The treatment success rate, of tuberculosis patients in the private sector, was significantly improved by an intervention using a public-private collaboration model.

Background: The mortality rate from tuberculosis in Korea is the highest among OECD countries. However, general public's knowledge of tuberculosis is limited. Currently, exposure to tuberculosis in high school students is a big problem. Methods: A written questionnaire was distributed to 78 high school students in Busan. Results: Almost all the students had heard of tuberculosis (95%). However, their knowledge of tuberculosis was very superficial and limited. The attitude about tuberculosis was 'nothing to worry about' and there was no systemic education in the school or home. Conclusion: Although tuberculosis is quite serious in Korea, most people know little about it and have the wrong attitude. In particular, high school students are easily exposed to tuberculosis because they spend most of their time as a group. Therefore, education of high school students on tuberculosis is strongly recommended in schools and the home. In addition, medical practitioners should play a role in education and prevention programs.

Purpose:The purpose of this study was to evaluate the types of lymphadenitis after BCG vaccination and the effect of local rifampicin instillation on the treatment of suppurative BCG lymphadenitis. Methods:A total of 32 otherwise healthy infants with suppurative BCG lymphadenitis, who visited the Department of Pediatrics of Chonbuk National University Hospital, from March 2002 through June 2004, were enrolled in this study. They were treated with needle aspiration and local rifampicin instillation. We investigated the time the lymphadenitis took to be suppurative, accompanying clinical manifestations, and the treatment effects. Results:Of the 32 infants, 19 were male and 13 were female. They were full term babies and one preterm baby with a gestational age of 30 weeks. They received intradermal administration, with the BCG vaccine of PasteurⓇ(French) strain mostly on the left deltoid area(96.9 percent). Regional lymphadenitis occurred in 1 to 11 months after BCG vaccination, mostly 1-5 months after vaccination (78.1 percent). Among the infants, 87.5 percent had unilocular lesion but 12.5 percent had more than one enlarged lymph node cares. Most of the lymphadenitis presented in the left axillary area(77.8 percent), and the left supuraclavicular area(11.1 percent). After one to three times of needle aspiration with rifampin instillation, all infants recovered completely without surgical excision or severe complication. Conclusion:The regional lymphadenitis is the most common complication in infants who receive intradermal BCG vaccination. This study supports that in suppurative BCG lymphadenitis the needle aspiration and local rifampicin instillation is very effective and can be a more economical treatment modality.

Highlights • Expert tibia nail can be one of the treatment options for subtrochanteric femoral fracture with narrow medullary can. • With expert tibia nail, greater trochanter can be used as an entry point and locking screw can be inserted into the femoral head. • Preoperative evaluation of the medullary canal size for these risky fractures is important., Introduction Subtrochanteric femoral fractures are relatively uncommon, accounting for 7–15% of all hip fractures and treatment of these fractures are considered challenge for orthopaedic surgeons. Although several treatment options are reported with up to 90% of satisfactory results, the choice of the appropriate implant is still a matter of debate. Some authors reported thermal injury after reaming for intramedullary nail fixation in patients with narrow medullary canal. Presentation of case A 21-year-old female patient was admitted to our hospital because of right subtrochanteric femoral fracture. The narrowest diameter of medullary canal of her femur was about 7 mm but she refused open reduction and internal fixation with plate due to large scar formation. We used expert tibia nail instead of femoral intramedullary nail to prevent thermal injury. Discussion Subtrochanteric femoral fractures are difficult to treat because of their biomechanical and anatomical characteristics. Although several implants are reported for the surgical treatment of these fractures, intramedullary nails have been advocated due to their biological and biomechanical advantages. However, under certain circumstances with associated injury or anatomic difference we might consider another treatment options. Conclusion Expert tibia nail may be considered one of the treatment options for subtrochanteric femoral fracture with narrow medullary canal. We also emphasize the importance of preoperative evaluation of the medullary canal size for these risky fractures.