Mechanism of the Immediate Effect of Balloon Dilation Therapy in Spinal Muscular Atrophy With Dysphagia: A High-Resolution Manometric Study.

Balloon dilation therapy (BDT) is used to treat pharyngeal dysphagia in patients with impaired upper esophageal sphincter (UES) relaxation due to cricopharyngeal dysfunction. However, the mechanism underlying this immediate effect remains unclear. Here, we present a case in which we investigated the immediate effects of BDT on UES dysfunction using high-resolution manometry (HRM). A 67-year-old man was diagnosed with spinal muscular atrophy (SMA). He gradually developed dysphagia, and a gastrostomy was performed. Despite continuing oral intake of supplemental nutrition, the patient developed dysphagia. Videofluoroscopic (VF) examination of swallowing revealed pharyngeal residue, while HRM showed weak pharyngeal contractility and impaired UES opening. BDT was performed to address the UES dysfunction. Immediately following BDT, VF demonstrated improved pharyngeal bolus passage. As for the UES function during swallowing, HRM revealed that the UES relaxation duration was significantly longer and the UES nadir pressure was significantly decreased. The patient continued the BDT before oral intake. HRM revealed immediate and prolonged UES opening with decreased UES pressure during swallowing as an immediate effect of BDT. This suggests that these findings represent the mechanisms underlying dysphagia in this patient with SMA. BDT resulted in an immediate improvement in UES function, potentially leading to dysphagia improvement. BDT should be combined with conventional rehabilitation for impaired UES opening. However, further studies are needed to confirm the long-term effectiveness of BDT for dysphagia due to SMA.

Development of a New Adjustable Compression Garment (McBoooon) Made of Non-Stretch Self-Adhesive Fabric.

Objectives: To assess the physical features and compression characteristics of a newly developed adjustable compression garment, McBoooon (Mc). Methods: Twelve healthy volunteers were recruited to assess the compression characteristics. The interface pressure (IP) was continuously measured to calculate the static (SSI) and dynamic stiffness indices (DSI). Additionally, the peak flow velocity (PV) of the popliteal vein during ankle dorsiflexion was measured using ultrasonography. Each parameter was compared between ASHIKA stockings (AS), Mc applied at the same resting pressure as AS (Mc1), and Mc applied at a resting pressure approximately twice that of Mc1 (Mc2). Results: SSI and DSI were significantly different, increasing in the order AS < Mc1 < Mc2 (p <0.01). Although the PV was significantly higher in the compression group than in the control group (p <0.05), no significant differences were found among the three groups. Conclusion: The physical features and compression characteristics of Mc were clarified. The high stiffness of this garment improves the adherence to compression therapy and contributes to the treatment of chronic venous insufficiency.

Concordance of Fathers and Mothers in the Assessment of Their 5-Year-Old Child's Dental Fear.

The aim of this study was to evaluate the concordance of parents' assessments of their child's dental fear. Cross-sectional secondary analysis used data from the multidisciplinary FinnBrain Birth Cohort Study. Child dental fear was assessed at age 5 with the Finnish translation of the modified Children's Fear Survey Schedule Dental Subscale (CFSS-M) by both fathers (n = 588) and mothers (n = 1100). Reply alternatives were from 1 = not afraid to 5 = very afraid and 6 = no experience coded as missing and 1. In total, 514 mother-father pairs were eligible for the analyses. Descriptive statistics, percentage agreement and Cohen's Kappa coefficients were used in the analyses. The concordance of parents' assessments was poor (Kappa range 0.072-0.258). The majority of parents replied "No Experience" to items related to invasive treatment or being unable to breathe. Thus, coding of this reply alternative had a significant impact on the mean values of the child's fear. When assessing the fear of a five-year-old child, it might not be safe to rely only on one parent's assessment, and whether or not the child has experience with the question asked should also be considered.

Two-Year Trajectories of Dental Anxiety in Parents and Their Association with Parents' and Children's Oral Healthcare Procedures in FinnBrain Birth Cohort Study.

We aimed to identify parents' dental anxiety trajectories and the association of the trajectories with the number of parents' and their children's oral healthcare procedures in the FinnBrain Birth Cohort Study. Dental anxiety was measured with the Modified Dental Anxiety Scale at gestational weeks (gw) 14 and 34, as well as 3 and 24 months (mo) after childbirth. Oral healthcare procedures from gw14 to 24 mo were obtained from the national patient data register and categorized as preventive and treatment. Trajectories were identified with latent growth mixture modelling for 2068 fathers and 3201 mothers. Associations between trajectories and procedures adjusted for education were analyzed using unordered multinomial logit models. Fathers' trajectories were stable low (80.1%), stable high (3.4%), stable moderate (11.0%), moderate increasing (3.9%) and high decreasing (1.6%). Mothers' trajectories were stable low (80.7%), stable high (11.2%), moderate increasing (5.3%) and high decreasing (2.8%). Mothers with decreasing dental anxiety had a higher number of preventive and treatment procedures. Fathers with decreasing dental anxiety had a higher number of preventive and treatment procedures, while fathers with increasing dental anxiety had fewer procedures. Children of mothers with stable low dental anxiety had higher number of preventive procedures. There seems to be a two-way association between dental anxiety trajectories and oral healthcare procedures.

Autonomic Nervous System Activity and Dental Anxiety in the Northern Finland Birth Cohort (NFBC1966) Population.

Autonomic nervous system (ANS) activity may be associated with dental anxiety; however, no studies exist on the topic. The aim of this study was to assess if ANS activity and dental anxiety are associated. Data were collected as part of a Northern Finland Birth Cohort Study, NFBC1966, at the age of 46 years with eligible data on 1905 participants. Dental anxiety was measured using the Modified Dental Anxiety Scale (MDAS) categorized as follows: 19-25 = high, 10-18 = moderate, 5-9 = no to low dental anxiety. Heart rate variability (HRV) data were collected using an HR monitor and a standard lead-II electrocardiogram (ECG). Baroreflex sensitivity (BRS) was calculated from continuous ECG and blood pressure signals. Participants were categorized into three groups as follows: Low = the lowest 20th percentile, Mid = medium 21-79th percentile, and High = the highest 20th percentile according to their ANS variables. The associations between the MDAS and ANS activity parameters were evaluated using unordered multinomial logit models adjusted for comorbidities, ß-blockers, BMI, smoking, and education. High heart rate, reduced HRV, low cardiac vagal modulation, and poor BRS were associated with moderate dental anxiety, and high cardiac vagal modulation and good BRS were associated with no to low dental anxiety. Poorer ANS activity might predispose some to dental anxiety, and better ANS activity might protect from dental anxiety.

Associations of sensory sensitivity, pain catastrophizing, and alexithymia with dental anxiety.

We aimed to reveal interrelationships between alexithymia, catastrophic thinking, sensory processing patterns, and dental anxiety among 460 participants who were registrants of a Japanese research company. Measures used were the Modified Dental Anxiety Scale, the Adult Sensory Profile, the Pain Catastrophizing Scale, and the 20-item Toronto Alexithymia Scale. The interrelationships among the constructs were analyzed using structural equation modeling, adjusting for age, gender, and negative dental treatment experience. Data from 428 participants were used in the analyses. Sensory sensitivity and pain catastrophizing were independently associated with anticipatory and treatment-related dental anxiety, while difficulty identifying feelings was not. In the mediation model, sensory sensitivity and pain catastrophizing served as full mediators between difficulty identifying feelings and the dimensions of dental anxiety (indirect effects were between 0.13 and 0.15). The strength of the associations was 0.55 from difficulty identifying feelings to both pain catastrophizing and sensory sensitivity, and between 0.24 and 0.26 to anticipatory and treatment-related dental anxiety. The association between trait-like phenomena, such as alexithymia, and dental anxiety may be mediated by neurophysiological and cognitive factors such as sensory sensitivity and pain catastrophizing. These findings could be crucial for new and innovative interventions for managing dental anxiety.

A Case of a Patient With Spinal Muscular Atrophy With Dysphagia Who Acquired Vacuum Swallowing.

We present a case of acquired vacuum swallowing in a patient with spinal muscular atrophy associated with dysphagia. A 67-year-old male presented with spinal muscular atrophy. Even though he was able to eat orally, he required a long time to eat and faced difficulty while swallowing saliva, resulting in frequent spitting. Instructions regarding vacuum swallowing to eliminate pharyngeal residue were provided, and a reduction in meal duration and improved saliva swallowing were observed. High-resolution manometry revealed a significant increase in pharyngeal contractile integral and a significant decrease in esophageal pressure with vacuum swallowing, which enabled the passage of a bolus through the pharynx compared with non-vacuum swallowing. Furthermore, an increase in the lower esophageal sphincter pressure, reflecting diaphragmatic contraction, was also observed. Therefore, this case report elucidates that a patient with neuromuscular disorders could acquire vacuum swallowing with proper instructions.

Dental Treatment Under General Anesthesia With Nasal Intubation in a Patient With Selective Immunoglobulin A Deficiency.

Immunoglobulin A (IgA) deficiency is one of the most common immune disorders characterized by increased susceptibility to infections, especially involving the respiratory tract and mucosal surfaces of the mouth, gingiva, and nasal sinus. Because dental surgery and general anesthesia may pose an increased risk for systemic infections, management of IgA-deficient patients requires caution during dental procedures and intubated general anesthesia. We report a 5-year-old female patient with IgA deficiency who underwent extraction of 18 deciduous teeth under general anesthesia. Antibiotic prophylaxis and antiseptic mouthwash were used perioperatively to reduce bacteremia risks. Nasotracheal intubation was carefully performed after applying topical disinfectants and epinephrine-containing gauze packing into the nasal cavity to minimize trauma. The patient was carefully monitored overnight in the hospital and discharged without any signs or symptoms of infection the next day. Dental anesthesia providers must be aware of the potential implications for safe practice when managing patients with IgA deficiency.

Psychometric evaluation of the Japanese version of the fear of pain questionnaire-III and its association with dental anxiety: a cross-sectional study.

BACKGROUND: Fear of pain is a significant concern related to chronic pain and its impact on daily functioning. It is also associated with dental anxiety, highlighting its relevance in dental practice. This study aimed to validate the Japanese version of the Fear of Pain Questionnaire-III (FPQ-III) and explore its relationship with dental anxiety. METHODS: 400 participants completed the Japanese version of the FPQ-III, with 100 participants re-evaluated after one month. Convergent validity was tested against dental anxiety and pain catastrophizing, while discriminant validity was assessed by examining general anxiety and depression correlations. Confirmatory factor analysis was used to examine the factorial validity of the FPQ-III and a shortened version of the FPQ-III (FPQ-9). Item response theory was applied for each subscale to estimate the discriminative power of each item and draw a test information curve. Structural equation modeling (SEM) was used to investigate the relationship between fear of pain and dental anxiety. RESULTS: Data from 400 participants (200 women, 44.9 ± 14.5 years) were analyzed. The FPQ-III showed good internal validity, intra-examiner reliability, discriminant validity, and convergent validity. Confirmatory factor analysis results supported a three-factor structure, and the FPQ-9 showed a good fit. Test information curves demonstrated that the FPQ-9 maintained high accuracy over a similarly wide range as the FPQ-III. SEM revealed that fear of minor pain was associated with dental anxiety via fear of medical pain even in individuals without painful medical or dental experiences (indirect effect 0.48 [95% CI: 0.32-0.81]). Fear of severe pain tended to be higher in individuals with chronic pain compared to those without (latent mean values 0 vs. 0.27, p = 0.002) and was also associated with dental anxiety via fear of medical pain in women (indirect effect 0.15 [95% CI: 0.01-0.34]). CONCLUSION: The Japanese version of the FPQ-9 demonstrated high reliability and validity, making it a valuable tool in dental clinical and research settings. It provides insights into the fear of pain among individuals with chronic pain and dental anxiety, informing potential intervention strategies.

The methods and use of questionnaires for the diagnosis of dental phobia by Japanese dental practitioners specializing in special needs dentistry and dental anesthesiology: a cross-sectional study.

BACKGROUND: Dental phobia is covered by medical insurance; however, the diagnostic methods are not standardized in Japan. Therefore, the aim of this study was to investigate the methods and use of questionnaires for the diagnosis of dental phobia by Japanese dental practitioners specializing in special needs dentistry and dental anesthesiology. METHODS: We conducted an online survey to obtain information from the members of the Japanese Society for Disability and Oral Health (JSDH, n = 5134) and the Japanese Dental Society of Anesthesiology (JDSA, n = 2759). Response items included gender, qualification, affiliation type, methods of diagnosis and management of dental phobia, use of questionnaire, need to establish standardized diagnostic method for dental phobia, and others. The chi-squared test was used to compare answers between the three groups: JSDH only, JDSA only, and both JSDH and JDSA. Multiple logistic regression analysis was conducted to identify factors associated with the use of an assessment questionnaire. RESULTS: Data were obtained from 614 practitioners (JSDH only, n = 329; JDSA only, n = 195; both JSDH and JDSA: n = 90, response rate: 7.8% [614/7,893], men: n = 364 [58.5%]). Only 9.7% of practitioners used questionnaires to quantify the level of dental anxiety. The members of both JSDH and JDSA group used questionnaires more frequently than members of the JSDH only (19% and 7.1%, respectively; Bonferroni corrected p < 0.01). Most practitioners (89.1%) diagnosed dental phobia based on patient complaints of fear of treatment. Furthermore, majority of the participants (73.3%) felt the need to establish standardized diagnostic method for "dental phobia." Multiple logistic regression analysis showed that membership of the JSDH only was negatively related (odds ratio [OR] 0.28, 95% confidence interval [CI] 0.13-0.60), and use of behavioral therapy was positively related (OR 2.34, 95% CI 1.18-4.84) to the use of a questionnaire. CONCLUSIONS: The results of this study showed that the use of questionnaires was very low, patients' subjective opinions were commonly used to diagnose dental phobia, and a standardized diagnostic criterion was thus needed among practitioners. Therefore, it is necessary to establish diagnostic criteria for dental phobia in line with the Japanese clinical system and to educate dentists about them.

A Retrospective Observational Study of Adverse Reactions Associated With Intravenous Immunoglobulin Infusion.

Background: Although intravenous immunoglobulin (IVIG) therapy is generally safe and well tolerated, adverse reactions (ARs) do occur. The majority of these ARs are mild and transient. Risk factors for ARs associate with IVIG infusions are not well established. This study investigated possible risk factors influencing the occurrence of IVIG-associated ARs. Study Design and Methods: This was a retrospective observational analysis of data accumulated over 5 years, including patient demographics, clinical condition, IVIG dosing regimens, number of IVIG infusions, and any ARs. Results: ARs were associated with IVIG in 4.9% of patients and 2.5% of infusions. By univariate analyses, ARs correlated with female sex, adult age, high dose IVIG, and autoimmune disease. Multivariate logistic regression identified three statistically significant of risk factors: on a per-patient basis, being female (p=0.0018), having neuromuscular disease (p=0.0002), and receiving higher doses of IVIG per patient body weight (p<0.001), on a per-infusion basis, being female (p < 0.001), being adolescents to middle age (p < 0.001), and having neuromuscular disease (p < 0.001). Conclusion: Neuromuscular disease emerged as one of the significant factors for ARs to IVIG.

In vivo tracking of transplanted macrophages with near infrared fluorescent dye reveals temporal distribution and specific homing in the liver that can be perturbed by clodronate liposomes.

Macrophages play an indispensable role in both innate and acquired immunity, while the persistence of activated macrophages can sometimes be harmful to the host, resulting in multi-organ damage. Macrophages develop from monocytes in the circulation. However, little is known about the organ affinity of macrophages in the normal state. Using in vivo imaging with XenoLight DiR®, we observed that macrophages showed strong affinity for the liver, spleen and lung, and weak affinity for the gut and bone marrow, but little or no affinity for the kidney and skin. We also found that administered macrophages were still alive 168 hours after injection. On the other hand, treatment with clodronate liposomes, which are readily taken up by macrophages via phagocytosis, strongly reduced the number of macrophages in the liver, spleen and lung.

Effects of stellate ganglion block on postoperative trigeminal neuropathy after dental surgery: a propensity score matching analysis.

This study aimed to evaluate the effects of stellate ganglion block (SGB) on postoperative trigeminal neuropathy (TNP) after dental surgery. This was a retrospective study based on the medical records of all patients with postoperative TNP at Kyushu Dental University Hospital from 2014 to 2019. Patients were divided into the SGB group (received SGB) and non-SGB group (did not receive SGB). We evaluated the severity of TNP at 3 months after surgery and the incidence rate of abnormal sensations. Abnormal sensations were counted using patients' reports of uncomfortable symptoms during the treatment, including dysaesthesia, allodynia, and hyperalgesia. A propensity score (PS) matching analysis was performed to evaluate these data. After PS matching, amongst others, the force equivalent values of the Semmes-Weinstein test at 3-months post-treatment were significantly lower in the SGB group than in the non-SGB group (2.00 ± 0.44 vs 2.30 ± 0.48; p < 0.05). In addition, after PS matching, the incidence rate of abnormal sensations during the treatment was significantly lower in the SGB group than in the non-SGB group (10 cases [4.7%] vs 22 cases [10.3%]; p < 0.05). Collectively, the findings support that SGB may improve the recovery from postoperative TNP and reduce the incidence rate of abnormal sensations after dental surgery.

Kinase activity-independent role of EphA2 in the regulation of M-phase progression.

Cell division is a tightly regulated, essential process for cell proliferation. Very recently, we reported that EphA2 is phosphorylated at Ser897, via the Cdk1/MEK/ERK/RSK pathway, during M phase and contributes to proper M-phase progression by maintaining cortical rigidity via the EphA2pSer897/ephexin4/RhoG pathway. Here, we show that EphA2 kinase activity is dispensable for M-phase progression. Although EphA2 knockdown delayed this progression, the delay was rescued by an EphA2 mutant expression with an Asp739 to Asn substitution, as well as by wild-type EphA2. Western blotting analysis confirmed that the Asp739Asn mutant lost its EphA2 kinase activity. Like wild-type EphA2, the Asp739Asn mutant was localized to the plasma membrane irrespective of cell cycle. While RhoG localization to the plasma membrane was decreased in EphA2 knockdown cells, it was rescued by re-expression of wild-type EphA2 but not via the mutant containing the Ser897 to Ala substitution. This confirmed our recent report that phosphorylation at Ser897 is responsible for RhoG localization to the plasma membrane. In agreement with the M-phase progression's rescue effect, the Asp739Asn mutant rescued RhoG localization in EphA2 knockdown cells. These results suggest that EphA2 regulates M-phase progression in a manner independent of its kinase activity.

The Reliability and Validity of the Japanese Version of the Modified Dental Anxiety Scale among Dental Outpatients.

INTRODUCTION: A careful assessment of dental anxiety is necessary for its management. The Modified Dental Anxiety Scale (MDAS) is one of the most commonly used questionnaires to measure dental anxiety in the world. The reliability and validity of the Japanese version of MDAS have been demonstrated using undergraduates and a few patients with dental anxiety. The aim of the present study was to examine the reliability and validity of the Japanese version of the MDAS using a wide range of age samples in dental clinics. METHODS: A total of 275 outpatients (145 men and 130 women; 21-87 years) from two dental clinics participated in the present study. Dental anxiety was assessed using the Japanese version of the MDAS and the Dental Fear Survey (DFS). The psychometric evaluation included exploratory factor analysis, and Cronbach's α was used to evaluate for internal consistency. Criterion validity was assessed by correlating the MDAS and DFS scores using Spearman's correlation coefficient. validity was evaluated by examining related factors' differences in the MDAS score (e.g., sex and negative dental experiences). RESULTS: Six patients (2.2%) reported high levels of dental anxiety (MDAS score ≥ 19). The internal consistency of the MDAS score was high (Cronbach's α = 0.88). Dental anxiety was significantly higher among women (P=0.007), in patients with previous negative dental experiences (P < 0.001), and among those with lower frequencies of dental visits (P < 0.001). The MDAS score was significant and related to age (r = 0.48) and the DFS score (r = 0.87). Factor analysis revealed all items measured only one construct. CONCLUSIONS: The Japanese version of the MDAS score was found to be a reliable and valid measure of dental anxiety among dental outpatients. It could be useful for the Japanese dental practitioner to measure dental anxiety in a clinical setting.

Association between sensory processing and dental fear among female undergraduates in Japan.

Objectives: The aim of cross-sectional study was to investigate the association between sensory processing patterns and dental fear among female undergraduates. Material and methods: Three hundred and ten female university students were included in the present study. Dental fear and sensory processing patterns were measured using the Dental Fear Survey and Adolescent/Adult Sensory Profile with other possible confounders, respectively. Sensory processing patterns were categorized into sensory sensitivity, sensory avoidance, low registration and sensation seeking. We conducted structural equation modelling based on the hypothesis that sensory processing directly affects dental fear, including the confounding role of negative experiences with dentistry, autistic traits and the mediating role of trait anxiety. Results: Based on our proposed model, sensory processing patterns, excluding sensation seeking and negative experiences significantly contributed to dental fear (ß = 0.33, p < .001 and ß = 0.32, p < .001, respectively) and autistic traits and trait anxiety did not significantly contribute to dental fear. Conclusions: Extreme sensory processing patterns seem to be associated with a high level of dental fear; thus, the difference in sensory processing might play an important role in the aetiology of dental fear.

Inhibition of post-transcriptional gene silencing of chalcone synthase genes in petunia picotee petals by fluacrypyrim.

In petals of picotee petunia (Petunia hybrida) cultivars, margin-specific post-transcriptional gene silencing (PTGS) of chalcone synthase A (CHSA) inhibits anthocyanin biosynthesis, resulting in marginal white tissue formation. In this study, we found that a low molecular mass compound, fluacrypyrim, inhibits PTGS of CHSA, and we explored the site-specific PTGS mechanism of operation. Fluacrypyrim treatment abolished the picotee pattern and eliminated site-specific differences in the levels of anthocyanin-related compounds, CHSA expression, and CHSA small interfering RNA (siRNA). In addition, fluacrypyrim abolished the petunia star-type pattern, which is also caused by PTGS of CHSA. Fluacrypyrim treatment was effective only at the early floral developmental stage and predominantly eliminated siRNA derived from CHS genes; i.e. siRNA derived from other genes remained at a comparable level. Fluacrypyrim probably targets the induction of PTGS that specifically operates for CHS genes in petunia picotee flowers, rather than common PTGS maintenance mechanisms that degrade mRNAs and generate siRNA. Upon treatment, the proportion of colored tissue increased due to a shift of the border between white and colored sites toward the margin in a time- and dose-dependent manner. These findings imply that the fluacrypyrim-targeted PTGS induction is completed gradually and its strength is attenuated from the margins to the center of petunia picotee petals.

New merosesquiterpenes from a Vietnamese marine sponge of Spongia sp. and their biological activities.

The investigation of the Vietnamese marine sponge Spongia sp. led to the isolation of three new sesquiterpene phenols, langconols A-C (1-3), and one new sesquiterpene hydroxyquinone, langcoquinone C (4), together with two known meroterpenoids (5 and 6). Their structures were determined on the basis of spectroscopic analyses and comparisons with published data. Furthermore, the antibacterial assays of the isolates 1-6 suggested that 4 and 6 had significant antibacterial activities against Bacillus subtilis and Staphylococcus aureus, with MICs ranging from 6.25 to 25.0µM, while 1 and 3 possessed significant antibacterial activities against B. subtilis with MICs of 12.5 and 25.0µM, respectively. In contrast, cytotoxic assays of the isolated compounds 1-6, as well as compounds 7-15 previously isolated from this sponge, indicated that 1 and the previously reported anti-B. subtilis and anti-S. aureus sesquiterpene phenol 9 lacked cytotoxic activities against three human cancer cell lines (A549, lung cancer; MCF7, breast cancer; HeLa, cervix cancer) and a human normal cell line (WI-38 fibroblast).