Dome impaction classification in acetabular fractures: Identifying atypical dome impactions with absence of the gull sign: A retrospective descriptive study.

We aimed to describe variations of dome impaction fractures and their characteristics using a new classification system, to explore the relationship between dome impaction and the gull sign. The present study was a retrospective descriptive study. All 104 cases of acetabular fracture that were treated in our institution from 2013 to 2022 were enrolled. Of these, 22 had dome impaction fractures. The primary outcome variable was to describe the variations and characteristics of dome impaction fractures. They were classified into 3 major subgroups based on reconstructed axial, coronal, and sagittal computed tomography findings: anteromedial, superomedial (SM), and posteromedial. The secondary outcome variable was to explore the relationship between dome impaction on computed tomography findings and the gull sign on plain radiographs. There were 4 cases of anteromedial (18.2%), 13 of SM (59.1%), and 5 of posteromedial (22.7%). There were 15 cases (68.2%) with the gull sign and 7 cases (31.8%) without the gull sign on plain radiographs. Twelve of fifteen cases (80.0%) with the gull sign had dome impaction fractures of the SM type. We found a variety of patterns of dome impaction fracture. Surgeons should be aware of atypical dome impactions not showing the gull sign.

The fibrinogen levels on admission is a predictive marker of the contrast extravasation on enhanced computed tomography in sacral fracture.

ABSTRACT: Sacral fracture is the most frequent posterior injury among unstable pelvic ring fractures and is prone to massive hemorrhage and hemodynamic instability. Contrast extravasation (CE) on computed tomography (CT) is widely used as an indicator of significant arterial bleeding. However, while CE is effective to detect significant arterial bleeding but negative result cannot completely rule out massive bleeding. Therefore, additional factors help to compensate CE for the prediction of early hemodynamically unstable condition.We evaluated the risk factors that predict CE on enhanced computed CT in patients with sacral fractures. Patients were classified into 2 groups: CE positive on enhanced CT of the pelvis [CE(+)] and CE negative [CE(-)]. We compared age, sex, injury severity score (ISS), systolic blood pressure (sBP), type of sacral fracture based on Denis classification, platelet (PLT), base excess, lactate, prothrombin time-international normalized ratio, hemoglobin (Hb), activated partial thromboplastin time, D-dimer, and fibrinogen between the 2 groups.A total of 82 patients were treated for sacral fracture, of whom 69 patients were enrolled. There were 17 patients (10 men and 7 women) in CE(+) and 52 patients (28 men and 24 women) in CE(-). Age, ISS, and blood transfusion within 24 hours were significantly higher in the CE(+) group than in the CE(-) group (P = .023, P < .001, P < .001). sBP, Hb, PLT, fibrinogen were significantly lower in the CE(+) group than in the CE(-) group (P < .001, P < .001, P < .001, P < .001). D-dimer and lactate were higher in the CE(+) group than in the CE(-) group (P = .036, P < .001) with significant differences. On multivariate analysis, the level of fibrinogen was an independent predictor of CE(+). The area under the curve value for fibrinogen was 0.88, and the optimal cut-off value for prediction was 199 mg/dL.The fibrinogen levels on admission can predict contrast extravasation on enhanced CT in patients with sacral fractures. The optimal cut-off value of fibrinogen for CE(+) prediction in sacral fracture was 199 mg/dL. The use of fibrinogen to predict CE(+) could lead to prompt and effective treatment of active arterial hemorrhage in sacral fracture.

Analysis of computed tomography-based infra-acetabular morphometry to assess the feasibility of infra-acetabular screws.

INTRODUCTION: The number of pelvic fractures based on osteoporosis has been increasing. The infra-acetabular screw (IAS), which connected both osseous columns, is a safe method of screw placement going through the infra-acetabular corridor (IAC). However, the specifics of the anatomy of IAC have been far from completely understood, especially in the Asian population. The purpose of our study was to reveal the details of the IAC using computed tomography (CT) data. MATERIALS AND METHODS: Traumatized in-patients having pelvic CT scans from 2014 to 2016 were enrolled. Pediatric and adult patients with pelvic fractures and hip prostheses were excluded. The male/female ratio and distribution of patients' age were equalized manually; 40 male and 40 female patients were included. The IAC was measured on the plane of the inlet view (25° caudal) in multi-planar reconstructed CT images. MEASUREMENTS: infra-acetabular diameter (IAD), anterior-posterior length of the IAC (APL), length from the starting point of the IAC to the medial edge of the pelvis (LME), length from the starting point of the IAC to the top of the pubic symphysis (LPS), and tilting on inlet plate (TIP). RESULTS: Age was 59 ± 22 (mean ± SD). Height was 159 ± 11 cm, and body mass index (BMI) was 22.9 ± 4.1. IAD, APL, LME, LPS, and TIP was 4.0 ± 1.3 mm, 89.5 ± 7.1 mm, 8.7 ± 3.6 mm, 57.8 ± 4.8 mm, and 4.7 ± 5.2°, respectively. Over 20% of corridors (35 of 160) were not feasible for IAS placement, because of inadequate width (less than 3.0 mm). Nine corridors (5.6%) had curvature in IAC, which meant technically demanding to insert IAS. There was no difference in IAD between male and female patients, while APL, LME, LPS, and TIP had sex-related differences. CONCLUSIONS: Surgeons should pay attention to the fact that over 20% of IACs are not feasible for infra-acetabular screw placement even with the perfect reduction of fragments when treating acetabular fractures.

Fibrinogen level on admission is a predictive marker of the need for massive blood transfusion after pelvic fracture.

OBJECTIVE: This study aimed to evaluate the usefulness of coagulation biomarkers as predictors of the need for massive transfusion (MT) in patients with pelvic fractures. METHODS: Patients who were treated for pelvic fractures in our hospital were divided into 2 groups: MT and non-MT. MT was defined as the transfusion of packed red blood cells (PRBCs) ≧10 units caused by bleeding within 24 h after admission. We compared variables between two groups, including vital signs, the scoring system and blood sample test. Additionally, we performed a multiple logistic regression analysis and a receiver operating characteristic curve analysis to reveal which value was the most useful predictive marker for MT in patients with pelvic fracture. RESULTS: There were 22 patients in the MT group and 78 patients in the non-MT group. Patients in the MT group had significantly higher ISS than did those in the non-MT group. In contrast, the patients in the MT group had significantly lower RTS, TRISS Ps, sBP, Hb, lactate, BE, and Fbg levels. Lower sBP and Fbg levels were independent predictors for MT. The optimal cut-off values for sBP and Fbg levels were ≦109 mmHg and 193.0 mg/dL, respectively. CONCLUSIONS: The results of the study indicated that Fbg levels on admission can be an independent predictor of MT in patients with pelvic fractures. The optimal cut-off value of Fbg for MT prediction in this study was 193.0 mg/dL.

Minimally invasive triangular osteosynthesis for highly unstable sacral fractures: Technical notes and preliminary clinical outcomes.

Triangular osteosynthesis involves unilateral L5 iliac posterior instrumentation combined with an iliosacral screw fixation. The aim of this study was to describe this procedure and report the preliminary clinical results in patients with unstable sacral fractures treated with minimally invasive triangular osteosynthesis (MITO). Between 2012 and 2017, 10 patients (6 men and 3 women, mean age, 50 ±â€Š23 years) with sacral fractures were treated with MITO and were followed up for a mean of 15.0 ±â€Š8.5 months in our institution. Classification of sacral fracture, operative time, intraoperative bleeding, timing of full weight bearing, bone union, complications, and clinical outcomes were investigated. Two cases were classified as Denis zone 1, 2 cases as zone 2, and 6 as zone 3. Four patients had Roy-Camille type 1 fracture and 2 patients had type 2. All patients underwent MITO, which involved bilateral lumbopelvic fixation and a uni/bilateral iliosacral screw with stab incisions for percutaneous fixation or central longitudinal incision. The operative time was a mean of 182 ±â€Š64 minutes, and the amount of intraoperative bleeding was a mean of 63 ±â€Š74 g. Full-weight bearing was initiated at a mean of 8.2 ±â€Š2.4 weeks. Eight fractures healed; 1 patient had pulmonary embolism and 1 had implant loosening. Based on Majeed score, 8 patients had "excellent" clinical outcomes, 1 patient had a "good" clinical outcome, and the other had a "fair" clinical outcome. MITO could be less invasive on the soft tissues and be a reliable procedure for bony union. It might provide sufficient stability to accelerate the commencement of post-operative rehabilitation, even in patients with highly unstable sacral fractures.

[Simultaneous determination of twelve sweeteners and nine preservatives in foods by solid-phase extraction and LC-MS/MS].

A rapid and simple method for the simultaneous determination of twelve sweeteners and nine preservatives in various foods by liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed. The sweeteners and preservatives were extracted from solid samples with 80% and 50% methanol and from liquid samples with 80% methanol, followed by Oasis WAX cartridge cleanup. The LC separation was performed on a XSelect CSH Phenyl-Hexyl column (5 µm, 2.1 mm ×150 mm) with a mobile phase of 10 mmol/L acetate buffer (pH 4.0)-acetonitrile and MS detection with negative ion electrospray ionization. The quantification limits of acesulfame K (AK), alitame (AL), aspartame (ASP), cyclamic acid (CYC), neotame (NEO), saccharin Na (SAC), p-hydroxybenzoic acid methyl (PHBA-Me), p-hydroxybenzoic acid ethyl (PHBA-Et), p-hydroxybenzoic acid isopropyl (PHBA-iPr), p-hydroxybenzoic acid propyl (PHBA-Pr), p-hydroxybenzoic acid isobutyl (PHBA-iBu) and p-hydroxybenzoic acid butyl (PHBA-Bu) were 0.001 g/kg, those of dulcin (DU), glycyrrhizic acid (GLY), neohesperidin dihydrochalcone (NHDC), rebaudioside A (REB), stevioside (STV), sucralose (SUC) and benzoic acid (BA) were 0.005 g/kg, and those of sorbic acid (SOA) and dehydroacetic acid (DHA) were 0.02 g/kg. The mean recoveries from ten kinds of foods fortified at the levels of 0.02 and 0.2 g/kg were 70.9-119.0%, and their relative standard deviations were 0.1-11.7%.

[Detection of Pacific cod and capelin roes in Alaska pollack roe product by real-time PCR assay].

A rapid and sensitive TaqMan real-time PCR assay for the detection of Pacific cod (Gadus macrocephalus) and capelin (Mallotus villosus) roes in Alaska pollack (Theragra chalcogramma) roe product was developed. The primers and the TaqMan MGB (minor groove binder) probes were designed based on the gene encoding cytochrome b for the specific detection of Alaska pollack, Pacific cod and capelin. This real-time PCR assay had the detection limit of 0.002 ng/microL mitochondrial DNA and showed no cross-reaction with 48 other species. The calculated r(2) values of the standard curves for the three species were 1.000. This assay was applied for the detection of Pacific cod and capelin roes in mixture samples: Pacific cod or capelin roes were added to Alaska pollack roes at 0.1, 1 and 10%. The threshold cycle values were obtained from both of the mixture samples at 0.1%. Practical applicability of this assay was examined with 64 samples of Alaska pollack roe products. In all cases, the species detected from the samples corresponded with species described on the food label.

[Determination of nonvolatile amines in foods by liquid chromatography following excimer-forming fluorescence derivatization and solid-phase extraction].

A method for the determination of nonvolatile amines (putrescine, cadaverine, histamine, tyramine and spermidine) in foods by solid-phase extraction and excimer-forming derivatization was investigated. Nonvolatile amines in a solid sample were extracted with 3% trichloroacetic acid, and the amines in a liquid sample were extracted with water. The extract was applied to polymer-based strong cation exchange mini-column, which was then rinsed with phosphate buffer of pH 6.8 and water. Nonvolatile amines were eluted with 100 mmol/L potassium carbonate solution. The solution was mixed with 6 mmol/L 1-pyrenebutylyl chloride solution and derivatized. Derivatives of nonvolatile amines were analyzed by LC-FLD, and the identity of the amines was confirmed by LC-MS/MS without derivatization. The limit of detection (S/N> or =3) of nonvolatile amines in all samples was 0.04 microg/g, and the limit of quantitation (S/N> or =10) was 0.1 microg/g. Recoveries of nonvolatile amines from fish tissues, miso, shoyu and red wine were in the range of 80.4-111%.

Proliferative response of gingival cells to ultrasonic and/or vibration toothbrushes.

PURPOSE: To evaluate the effects of ultrasonic and/or vibration toothbrushes on cell proliferation and collagen synthesis. METHODS: In eight dogs, teeth and gingivae were stimulated once a day as follows: the first quadrant with an ultrasonic toothbrush (1.6 MHz); the second one with a mechanical vibratory toothbrush (141 Hz); and the third one with a toothbrush generating both the ultrasound and the vibration. The fourth quadrant served as a control. Proliferative activity and collagen synthesis of gingival cells were evaluated by assaying the expression of proliferating cell nuclear antigen (PCNA) and procollagen type I C-peptide (PIP), respectively. RESULTS: After 5 weeks, ultrasonic or vibratory toothbrushes increased the numbers of PCNA-positive fibroblasts and PIP-positive fibroblasts. Toothbrushing with a combination of ultrasound and mechanical vibration increased the numbers of PIP-positive fibroblasts, total fibroblasts and vascular endothelial cells to a greater extent than the one with only ultrasound alone. Vibratory toothbrush, but not the ultrasonic one, induced an increase in collagen density without gingival overgrowth.

Radiographic evaluation of periapical status and prevalence of endodontic treatment in an adult Japanese population.

OBJECTIVES: To determine the prevalence of periapical radiolucencies and endodontic treatment in an adult Japanese population. STUDY DESIGN: Periapical status and length of root fillings of 672 adult patients attending Okayama University Hospital of Dentistry were evaluated using full mouth intraoral radiographs. RESULTS: Overall, 87% of the subjects had root-filled teeth, and 70% exhibited an apical radiolucency. Of the 16,232 teeth examined, 21% had been root-filled, and, of these, 40% exhibited an apical radiolucency. Root-filled teeth that were overfilled or that were mandibular incisors had the highest prevalence of apical radiolucencies. CONCLUSIONS: The prevalence of root-filled teeth appears higher in this Japanese population than in Europe or America; however, the ratio of teeth with an apical radiolucency to root-filled teeth was within the range of that reported for other countries. Overfilled teeth and mandibular incisors are most likely to exhibit apical radiolucencies.

Detection of Tannerella forsythia and/or Prevotella intermedia might be useful for microbial predictive markers for the outcome of initial periodontal treatment in Koreans.

A proportion of diseased sites in periodontal disease do not respond to the initial treatment, which might be due in part to the presence of specific microbial pathogens. The aim of this study was to clarify the value of microbial screening for predicting the outcome of periodontal treatment in Koreans using a polymerase chain reaction (PCR). This study enrolled 32 adults with periodontal disease. Microbial and clinical examinations were performed at the baseline and after the initial treatment (professional toothbrushing, scaling, and root planing). Subgingival plaque samples were taken from four sites in each subject (total 128 samples). PCR was used to detect the four putative pathogenic bacteria. There was an improvement in the average of each clinical measurement after the initial treatment. However, approximately half of the sites exhibiting bleeding upon probing (BOP) at the baseline still exhibited bleeding after treatment. There was a close association between the presence of BOP and the presence of Tannerella forsythia (formerly Bacteroides forsythus) and/or Prevotella intermedia. Furthermore, the sites harboring both T. forsythia and P. intermedia at the baseline had a poorer response to treatment than the sites where these two species were not detected. Therefore, microbial screening for T. forsythia and P. intermedia might be useful for predicting the treatment outcome in Koreans.

Effects of toothbrushing frequency on proliferation of gingival cells and collagen synthesis.

BACKGROUND: Mechanical stimulation by toothbrushing enhances proliferation of fibroblasts and junctional epithelium (JE). These changes in gingiva may depend on the interval between toothbrushing. The effects of toothbrushing frequency on proliferation of gingival fibroblasts and basal cells of JE were evaluated. METHODS: Twelve mongrel dogs were used. Each tooth was brushed for 20 s at 1.96 N. The subepithelial connective tissue of JE was examined for proliferating cell nuclear antigen (PCNA)-positive fibroblasts and procollagen type-I C-peptide (PIP)-positive fibroblasts. JE was examined for PCNA-positive basal cells. RESULTS: Gingiva that received brushing twice a day showed increases in the density of fibroblasts and ratio of PCNA-positive fibroblasts to total fibroblasts at 4 weeks. The ratio of PIP-positive fibroblasts increased at 8 weeks in gingiva brushed twice a day and once a day. PCNA-positive basal cell ratio increased at 4 weeks in gingiva brushed twice a day and once a day. CONCLUSIONS: A high frequency of brushing was associated with increased numbers of PCNA-positive fibroblasts, PIP-positive fibroblasts and PCNA-positive basal cells. Gingival cell proliferation increased and reached a plateau earlier in gingiva brushed twice a day than in gingiva brushed once a day.

Spatial extent of gingival cell activation due to mechanical stimulation by toothbrushing.

BACKGROUND: Mechanical stimulation by toothbrushing enhances gingival fibroblast proliferation and collagen synthesis, and reduces inflammatory cell infiltration. The aim of this study was to investigate the spatial extent of proliferation of fibroblasts and endothelial cells in dog gingiva in response to mechanical stimulation by toothbrushing. METHODS: All maxillary fourth premolars and mandibular first molars of 6 mongrel dogs were used. Dental plaque was removed with a curet. One of each pair of bilateral teeth (in the same jaw) was assigned to the brushing group, and the corresponding tooth (opposite side) was assigned to the control group. The Bass method was used to brush the limited mesial half of the tooth at 1.96 N for 20 seconds with a fitted plastic stent. Immediately before fixation of tissue, the surface of brushed gingiva was notched to indicate the borderline between the brushed and non-brushed areas. Histometrical analyses of the sections were performed using assays for proliferating cell nuclear antigen (PCNA) and von Willebrand factor. RESULTS: The numbers of fibroblasts and PCNA-positive fibroblasts in the subepithelial connective tissue adjacent to oral sulcular epithelium significantly increased in brushed gingiva, not only in the brushed area but also in the non-brushed area 0 to 0.5 mm from the notch. Increased numbers of vascular endothelial cells were observed only in the brushed area. CONCLUSION: The effect of mechanical stimulation by toothbrushing on gingival cell proliferation was not observed more than 0.5 mm from the brushed area. These results indicate that effective activation of gingival cell proliferation requires mechanical stimulation of gingiva in all areas.

Optimum force and duration of toothbrushing to enhance gingival fibroblast proliferation and procollagen type I synthesis in dogs.

BACKGROUND: Toothbrushing enhances gingival fibroblast proliferation, which promotes wound healing. Optimum force and duration of toothbrushing for stimulation of fibroblast proliferation are key factors in maximizing effects of toothbrushing on periodontal wound healing. We therefore evaluated the effects of different durations and forces of toothbrushing on proliferative activity and procollagen synthesis of gingival fibroblasts. METHODS: Twelve dogs were used. In each dog, buccal gingivae of 12 teeth were examined for 3 weeks. Nine of these 12 teeth were each assigned to 1 of 9 different combinations of brushing force (0.98, 1.96, or 2.45 N) and duration (10, 20, or 40 seconds). The remaining 3 teeth received plaque removal without brushing, via a scaler. RESULTS: Force and duration of toothbrushing affected both proliferating cell nuclear antigen (PCNA)-positive and procollagen Type I C-peptide (PIP)-positive fibroblast ratios (P < 0.05). The highest ratio of PCNA-positive fibroblasts was produced by brushing at 1.96 N for 20 seconds. The highest ratio of PIP-positive fibroblasts was produced by brushing at 1.96 N for 10 seconds. CONCLUSIONS: Toothbrushing at certain forces and durations enhanced the proliferative activity and procollagen synthesis of gingival fibroblasts. The toothbrushing duration that increased procollagen synthesis (10 seconds) was shorter than that which increased fibroblast proliferative activity (20 seconds).

The effect of duration and force of mechanical toothbrushing stimulation on proliferative activity of the junctional epithelium.

BACKGROUND: Gingival bleeding is frequently accompanied by an ulcerated epithelium, with repair depending on the proliferative activity of the epithelial cells. The present study examined the proliferative activity of the junctional epithelium (JE) under several different methods of toothbrushing stimulation. METHODS: Twelve dogs were used in this 3-week experiment. Prior to the experiment, all teeth underwent daily removal of plaque and calculus using a scaler. Teeth were then divided into quadrants: 9 teeth in 3 quadrants (test, 3 per quadrant) were mechanically stimulated by toothbrushing for various time intervals (10, 20, or 40 seconds) and at various forces (100, 200, or 250 gf). The 3 teeth in the fourth quadrant served as controls. The proliferative activity of the basal cells of the junctional epithelium was evaluated for expression of proliferating cell nuclear antigen (PCNA). The numbers of PCNA-positive basal cells and total basal cells were counted, and the width of the junctional epithelium was measured. RESULTS: Toothbrushing force significantly affected the PCNA-positive basal cell ratio (P < 0.05). The 200 g toothbrushing force produced the highest PCNA-positive basal cell ratio, which was significantly higher than that using the 100 g force (P < 0.05). CONCLUSION: In junctional epithelium stimulated with a toothbrush, the PCNA-positive basal cell ratio is more sensitive to toothbrushing force than to duration.