Risk factors for postoperative facial swelling at 1 week after bimaxillary orthognathic surgery in Class III patients.

OBJECTIVE: To quantify facial swelling at 1 week after Le Fort I osteotomy and bilateral sagittal splitting ramus osteotomy in Class III patients and to identify factors contributing to the swelling based on clinical, morphologic, and surgical variables. STUDY DESIGN: Data from 63 patients were examined in this single-center, retrospective study. Facial swelling was quantitatively measured by superimposing computed tomography data taken in the supine position at 1 week and 1 year postoperatively and extracting the area of maximum intersurface distance. Age, sex, body mass index, thickness of subcutaneous tissue, and of masseter muscle, maxillary length (A-VRP), mandibular length (B-VRP), and posterior maxillary height (U6-HRP), surgical movement (ΔA-VRP, ΔB-VRP, ΔU6-HRP), drainage method, and usage of facial bandages were examined. Multiple regression analysis was performed using the above factors. RESULTS: The median swelling at 1 week postoperatively was 8.35 IQR (5.99-11.47) mm. Multiple regression analysis revealed three factors that were significantly associated with facial swelling: Use of postoperative facial bandages (P=0.03), masseter muscle thickness (P=0.03), and ΔB-VRP (P=0.04). CONCLUSION: Absence of a facial bandage, thin masseter muscle, and large horizontal mandibular movement are risk factors for facial swelling at 1 week postoperatively.

Stiffness as measured with strain elastography is a prognostic factor for pT1/T2 tongue squamous cell carcinoma with muscle-layer invasion.

OBJECTIVE: The objective was to evaluate stiffness as a prognostic factor for tongue squamous cell carcinoma (TSCC). STUDY DESIGN: This retrospective study included 55 patients with pathologic stage pT1 or T2 TSCC with muscle-layer invasion who underwent preoperative strain elastography of the tongue, followed by surgery, as the primary treatment modality at our cancer center. The stiffness of TSCC was semi-quantified as the ratio of the strain value of a non-tumor site to the strain value of the tumor site (strain ratio [SR]) using ultrasound strain elastography findings. RESULTS: SR cutoff values that maximized the significance of the difference for prognosis of delayed cervical lymph node metastasis (DCLNM) and overall survival (OS) were 7.10 and 7.49, respectively. In univariate analysis, SR, age, depth of invasion, pT stage, and perineural invasion were significant risk factors for DCLNM, whereas SR, sex, and DCLNM were identified as having an association with OS. In multivariate analysis, SR was a significant risk factor for DCLNM (hazard ratio [HR] = 3.102; P = .021) and a non-significant but relevant risk factor for OS (HR = 8.774; P = .073). Age also had an association with OS (HR = 0.382; 95% CI 0.127-1.152; P = .088). CONCLUSION: Tongue stiffness is a prognostic factor in patients with pT1/T2 TSCC with muscle-layer invasion. SR values >7.10 indicate a poor prognosis, thereby warranting a strict follow-up regimen in these cases.

Darvadstrocel for Complex Perianal Fistulas in Japanese Adults with Crohn's Disease: A Phase 3 Study.

BACKGROUND AND AIMS: Previous studies conducted in Europe suggested that darvadstrocel, a suspension of expanded, allogeneic, adipose-derived, mesenchymal stem cells, is safe and effective for treatment-refractory complex perianal fistulas in patients with Crohn's disease. The aim of this study was to evaluate the efficacy and safety of darvadstrocel for the treatment of complex perianal fistulas in Japanese adults with Crohn's disease. METHODS: This is a phase 3, open-label, single-arm study conducted at nine sites in Japan. Adult patients with non-active or mildly active Crohn's disease and complex perianal fistulas received a single 24-mL intralesional injection of darvadstrocel [120 × 106 cells]. The primary endpoint was combined remission (clinically confirmed closure of all treated external openings that were draining at screening, and absence of collections >2 cm, [confirmed by magnetic resonance imaging] among treated fistulas) at Week 24. RESULTS: Between March 6, 2019 and February 1, 2021, 22 patients received darvadstrocel and completed the 52-week follow-up. The proportion of patients achieving combined remission at Week 24 was 59.1% (95% confidence interval [CI], 38.5-79.6). The effect was maintained at Week 52, with 68.2% [95% CI, 48.7-87.6] of patients achieving combined remission. Treatment-related adverse events included: one [4.5%] patient with worsening of Crohn's disease and diarrhoea, and one [4.5%] patient with blood bilirubin increase. No new safety findings were identified in this study. CONCLUSIONS: The efficacy and tolerability of darvadstrocel in Japanese adult patients with treatment-refractory complex perianal fistulas in Crohn's disease were similar to those observed in the previous European study. ClinicalTrials.gov number, NCT03706456.

Risk factors of neurosensory disturbances at 1 year postoperatively after bilateral sagittal split osteotomy.

OBJECTIVE: To investigate morphologic and surgical risk factors causing neurosensory disturbances (NSDs) after bilateral sagittal split osteotomy (BSSO). STUDY DESIGN: A total of 237 patients (with 474 sides) who underwent BSSO were followed up for 1 year. Parameters examined included age, sex, asymmetry, mandibular movement direction, mandible cutting devices, split type, intraoperative exposure of the inferior alveolar nerve (IAN), contact between the IAN and screw, distance between mandibular canal and inner surface of the cortical bone (distance A), distance from lateral osteotomy to mental foramen (distance B), and NSD at 1 year postoperatively. RESULTS: NSD was observed in 62 (13.1%) sides of 51 patients. Exploratory factor analysis determined 4 factors (factor 1: distance A; factor 2: direction of mandibular movement; factor 3: distance B and cutting devices; factor 4: IAN exposure). Logistic regression analysis was performed using the above factors and age, sex, and asymmetry, making a total of 7 variables. Age, factor 1, and factor 4 were significant predictors of NSD. CONCLUSIONS: Advanced age, close distance between mandibular canal and inner surface of the cortical bone, and IAN intraoperative exposure are risk factors for NSD 1 year postoperatively. Cases at high risk for NSD must be treated with great care.

Stiffness of tongue squamous cell carcinoma measured using strain elastography correlates with the amount of collagen fibers in the tumor.

OBJECTIVES: To evaluate the stiffness of tongue squamous cell carcinoma (TSCC) using ultrasound strain elastography, a relatively new sonographic imaging technique, and to identify the factors that affect this stiffness. METHODS: We treated 62 patients diagnosed with muscle invasive TSCC, who were treated at the department of oral surgery of our institution. Each patient's tumor stiffness was semi-quantified according to the ratio of cancer to tongue muscle strain measured using ultrasound strain elastography (the strain ratio). Histopathological diagnosis was made on the same section as the ultrasound strain elastography. We set the following histopathological parameters: cancer cell content in the tumor area (%CCC), collagen fiber content in the tumor area (%CFC), and tumor-infiltrating inflammatory cell content in the stromal compartment (%TIIC). Spearman's rank correlation (rs) was used to assess correlations, and P values < 0.05 were considered significant. RESULTS: The mean strain ratio was 9.7 ± 9.8. The mean %CCC was 38.4 ± 11.3%, and % CFC was 31.1 ± 7.8%, % TIICs was 19.9 ± 8.9%. Log (strain ratio) by ultrasound strain elastography was positively correlated with %CFC (rs = 0.379, P = 0.024). %CFC was negatively correlated with %TIICs (rs = - 0.318, P = 0.012). No correlations were observed between other clinico-histopathological factors and either strain ratio, or %CFC. CONCLUSION: The strain ratio of the cancer to the strain of the tongue muscle measured through ultrasound strain elastography positively correlates with the collagen fiber content of the tumor area.

Benefit-Risk Assessment of Alogliptin for the Treatment of Type 2 Diabetes Mellitus.

The dipeptidyl peptidase-4 inhibitor (DPP-4i) alogliptin is an oral, antidiabetic treatment that is approved in many countries to treat patients with type 2 diabetes mellitus (T2DM), including the USA, Europe, and Japan. Alogliptin is efficacious both as monotherapy and as add-on/combination therapy with other commonly prescribed T2DM treatments, such as metformin and pioglitazone. Overall, alogliptin is well-tolerated in patients with T2DM, including older patients, those with renal and/or hepatic impairment, and those at high risk of cardiovascular events. There is a low risk of hypoglycemia, weight gain, acute pancreatitis, and gastrointestinal adverse events with alogliptin treatment, as demonstrated in long-term trials (lasting up to 4.5 years) and in a real-world setting. Additionally, alogliptin has a generally favorable or similar safety profile in comparison to other antidiabetic agents (metformin, thiazolidinediones, sulfonylureas, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, α-glucosidase inhibitors, and insulin). However, further evaluation would be required to determine the mechanism and effect of alogliptin on heart failure, bullous pemphigoid, and inflammatory bowel disease. Of note, due to the ethnic diversity in the epidemiology of T2DM, alogliptin has been shown to be more efficacious in Asian patients than in non-Asian patients with T2DM, but with a similar tolerability profile. These data indicate that DPP-4is, including alogliptin, are important treatment options, especially for Asian patients with T2DM, for whom they have potential as a first-line therapy. This benefit-risk assessment aims to place alogliptin within the current armamentarium of T2DM and aid physicians when choosing optimal diabetes treatment for their patients.

C-H Arylation of Phenanthrene with Trimethylphenylsilane by Pd/o-Chloranil Catalysis: Computational Studies on the Mechanism, Regioselectivity, and Role of o-Chloranil.

The transition-metal-catalyzed C-H arylation of aromatic hydrocarbons represents a useful and ideal method for the production of biaryls and multiarylated aromatic compounds. We have previously reported the palladium-catalyzed direct C-H arylation of polycyclic aromatic hydrocarbons, such as phenanthrene, pyrene, and corannulene with various organosilicon, -borane, and -germanium compounds. In these reactions, o-chloranil proved to be an essential and unique promoter (stoichiometrically as an oxidant) and arylation occurred exclusively at the K-region. Herein, we report our mechanistic investigation of Pd/o-chloranil catalysis in C-H arylation of phenanthrene with trimethylphenylsilane by computational calculations. The results revealed that C-H arylation occurs through a sequence of transmetalation, carbometalation, and trans-ß-hydrogen elimination steps. In addition, the triple role of o-chloranil as a ligand, oxidant, and base is also elucidated.

Epigallocatechin gallate induces extracellular degradation of amyloid ß-protein by increasing neprilysin secretion from astrocytes through activation of ERK and PI3K pathways.

Amyloid-ß (Aß) production and clearance in the brain is a crucial focus of investigations into the pathogenesis of Alzheimer disease. Imbalance between production and clearance leads to accumulation of Aß. The important Aß-degrading enzymes in the brain are neprilysin (NEP) and insulin-degrading enzyme (IDE), and defective enzyme expression may facilitate Aß deposition in sporadic late-onset AD patients. It has been suggested that epigallocatechin gallate (EGCG), a member of the catechin family, might be an effective treatment for AD, because it has been shown to elevate NEP expression. Therefore, we examined whether catechins, which are functional components of common foods, could regulate the degradation of Aß by inducing NEP and IDE expression. We also investigated the role of catechins in activating intracellular signal transduction in astrocytes. Treatment of cultured rat astrocytes with EGCG significantly reduced the expression of NEP, but not IDE, in a concentration- and time-dependent manner. NEP expression in cultured astrocytes was suppressed by activation of extracellular signal-regulated kinase (ERK) and phosphoinositide 3-kinase (PI3K), and reduced NEP expression was accompanied by an increase of NEP release into the extracellular space (culture medium). Moreover, culture medium from EGCG-treated astrocytes facilitated the degradation of exogenous Aß. These results suggest that EGCG may have a beneficial effect on AD by activating ERK-and PI3K-mediated pathways in astrocytes, thus increasing astrocyte secretion of NEP and facilitating degradation of Aß.

Cyclodextrin-Isolated Alkynylpyrenes as UV-Stable and Blue-Light-Emitting Molecules Even in Condensed States.

Encapsulation of highly emissive alkynylpyrenes with permethylated α-cyclodextrin (PM-α-CD) followed by capping reaction yielded alkynylpyrene-based [3]rotaxanes. The [3]rotaxane emitted only blue light of monomeric pyrene under various circumstances such as lipophilic, hydrophilic, and even condensed states and exhibited extremely high stability for UV irradiation. These properties would result because PM-α-CD, like bulletproof glass, protected the alkynylpyrene core from the attack of another excited alkynylpyrene and singlet oxygen generated by the energy transfer from the excited alkynylpyrene.

Regulation of the unfolded protein response via S-nitrosylation of sensors of endoplasmic reticulum stress.

Protein S-nitrosylation modulates important cellular processes, including neurotransmission, vasodilation, proliferation, and apoptosis in various cell types. We have previously reported that protein disulfide isomerase (PDI) is S-nitrosylated in brains of patients with sporadic neurodegenerative diseases. This modification inhibits PDI enzymatic activity and consequently leads to the accumulation of unfolded/misfolded proteins in the endoplasmic reticulum (ER) lumen. Here, we describe S-nitrosylation of additional ER pathways that affect the unfolded protein response (UPR) in cell-based models of Parkinson's disease (PD). We demonstrate that nitric oxide (NO) can S-nitrosylate the ER stress sensors IRE1α and PERK. While S-nitrosylation of IRE1α inhibited its ribonuclease activity, S-nitrosylation of PERK activated its kinase activity and downstream phosphorylation/inactivation or eIF2α. Site-directed mutagenesis of IRE1α(Cys931) prevented S-nitrosylation and inhibition of its ribonuclease activity, indicating that Cys931 is the predominant site of S-nitrosylation. Importantly, cells overexpressing mutant IRE1α(C931S) were resistant to NO-induced damage. Our findings show that nitrosative stress leads to dysfunctional ER stress signaling, thus contributing to neuronal cell death.

Deprotonation of a dinuclear copper complex of 3,5-diamino-1,2,4-triazole for high oxygen reduction activity.

A dinuclear copper(II) complex of 3,5-diamino-1,2,4-triazole is one of the highly active copper-based catalysts for the oxygen reduction reaction (ORR) in basic solutions. Our in situ X-ray absorption near edge structure measurements revealed that deprotonation of the triazole ligand might cause coordination geometrical changes, resulting in the enhancement of the ORR activity.

One-shot K-region-selective annulative π-extension for nanographene synthesis and functionalization.

The optoelectronic nature of two-dimensional sheets of sp(2)-hydridized carbons (for example, graphenes and nanographenes) can be dramatically altered and tuned by altering the degree of π-extension, shape, width and edge topology. Among various approaches to synthesize nanographenes with atom-by-atom precision, one-shot annulative π-extension (APEX) reactions of polycyclic aromatic hydrocarbons hold significant potential not only to achieve a 'growth from template' synthesis of nanographenes, but also to fine-tune the properties of nanographenes. Here we describe one-shot APEX reactions that occur at the K-region (convex armchair edge) of polycyclic aromatic hydrocarbons by the Pd(CH3CN)4(SbF6)2/o-chloranil catalytic system with silicon-bridged aromatics as π-extending agents. Density functional theory calculations suggest that the complete K-region selectivity stems from the olefinic (decreased aromatic) character of the K-region. The protocol is applicable to multiple APEX and sequential APEX reactions, to construct various nanographene structures in a rapid and programmable manner.

Induction of hepatic Bach1 mRNA expression by carbon tetrachloride-induced acute liver injury in rats.

Hepatic oxidative stress is a major contributor to the pathogenesis of several acute liver diseases. Diagnostic markers of hepatic oxidative stress may facilitate early detection and intervention. Bach1 is an oxidative stress-responsive transcription factor that represses heme oxygenase 1 (HO-1), the rate-limiting enzyme in the catabolism of heme, a potent pro-oxidant. We previously demonstrated that carbon tetrachloride (CCl4) causes oxidative hepatic injury in rats, exacerbated by free heme, suggesting that CCl4 may affect Bach1 gene expression. In the present study, we used northern blot analysis to measure Bach1, HO-1 and δ-aminolevulinate synthase (ALAS1; a heme biosynthesis enzyme) mRNA expression levels during acute hepatic injury induced by CCl4 (at doses of 0.1, 1.0 and 2.0 ml/kg body weight). Oxidative injury was assessed by measuring serum alanine aminotransferase (ALT), hepatic malondialdehyde (MDA) and glutathione (GSH) content. Treatment with CCl4 induced a significant dose-dependent increase in Bach1 mRNA 1-3 h after administration. Bach1 mRNA peaked at 6 h after CCl4 treatment (1 ml/kg), followed by a rapid decrease and gradual return to baseline by 12 h after treatment. The timecourse of transient Bach1 mRNA induction roughly mirrored that of HO-1 mRNA, while ALAS1 mRNA was inversely downregulated. Serum ALT levels and hepatic MDA concentration were significantly increased at 24 h after CCl4 treatment, while the hepatic GSH content was significantly reduced within 3 h of treatment. Serum ALT levels were positively correlated with Bach1 mRNA levels. These findings indicate that Bach1 mRNA is transiently induced in rat liver by CCl4, possibly as a regulatory mechanism to restore HO-1 to baseline following free heme catabolism. Our findings also suggest that Bach1 mRNA expression may be a novel indicator of the extent of oxidative hepatic injury caused by free heme.

[Effectiveness of gum elastic bougie for tracheal intubation with Airtraq optical laryngoscope].

BACKGROUND: Although Airtraq (ATQ) is well accepted as a useful device for tracheal intubation especially in cases of difficult airway management, we sometimes encounter difficulty in insertion of a tracheal tube along the blade of ATQ across the vocal cord in spite of ATQ assistance. Gum Elastic Bougie (GEB) is well known as a practical device for intubation assistance with Macintosh laryngoscope. We studied the efficacy of GEB for intubation with ATQ. METHODS: One-hundred-forty one patients scheduled for general anesthesia, ASA physical status 1 or 2, were allocated into two groups randomly; patients intubated with ATQ without GEB (n = 70), and those with ATQ with GEB (n = 71). Twenty anesthegiologists were assinged to them evenly according to their experience. We measured the time they needed for intubation. RESULTS: The combinational advantage of ATQ and GEB was not significantly proved among board certified anesthesiologist. However, among non-board-certified anesthesiologist group, the time needed for successful intubation was significantly shorter with combined use of ATQ and GEB. CONCLUSIONS: For the people with less experience of intubation, GEB is useful assistance for intubation with ATQ. It was concluded that the combined use of ATQ and GEB is a simple and effective process for ordinary doctors or paramedics.

Control of dry weight and tube feeding improved the general condition of a hemodialysis patient: report of a case.

Patients on long-term hemodialysis are at risk of developing malnutrition,and poor nutrient intake is an important factor in this. In the present case, we encountered a 55-year-old Japanese woman with end-stage renal failure and a past history of schizophrenia. Severe systemic edema was observed. Hemodialysis was started, but after one year she suddenly became unable to consume food orally, despite provision of a dietary plan by the nutrition support team (NST). Tube feeding was eventually implemented. Because the systemic edema did not improve, we decided to remove body fluid by intense hemodialysis. Hypotension was often observed during this hemodialysis, requiring dopamine. Over approximately 2 months, the patient's dry weight fell from 73 kg to 62 kg, the patient's activity improved and she became able to eat orally again, allowing tube feeding to be stopped. Although the reason for the sudden anorexia has not been clarified, tube feeding and dry weight control was successful in the treatment of this malnourished hemodialysis patient.

In vivo anti-inflammatory and antioxidant properties of ellagitannin metabolite urolithin A.

Urolithin A is a major metabolite produced by rats and humans after consumption of pomegranate juice or pure ellagitannin geraniin. In this study, we investigated the anti-inflammatory effect of urolithin A on carrageenan-induced paw edema in mice. The volume of paw edema was reduced at 1h after oral administration of urolithin A. In addition, plasma in treated mice exhibited significant oxygen radical antioxidant capacity (ORAC) scores with high plasma levels of the unconjugated form at 1h after oral administration of urolithin A. These results indicate strong associations among plasma urolithin A levels, the plasma ORAC scores, and anti-inflammatory effects and may help explain a mechanism by which ellagitannins confer protection against inflammatory diseases.

Reevaluation of laboratory methods for diagnosis of measles.

The purpose of this study is to reevaluate the sensitivities of different methods used in the diagnosis of measles including virus isolation, RT-PCR, and measurement of IgM. Sixty-three throat swabs, 84 peripheral blood mononuclear cell (PBMC) samples, and 85 plasma samples were collected from 85 cases of suspected measles. The sensitivity of virus isolation using throat swabs and PBMC in comparison with RT-PCR was 58.1 and 93.5%, respectively. We defined laboratory-confirmed cases as those in which at least one of the methods was positive. The percentage of positive results by the different methods was compared among 49 laboratory-confirmed cases. The percentage of positive results from PBMC by RT-PCR and virus isolation was 100 and 91.7%, respectively. The percentage of positive results from throat swabs by RT-PCR and virus isolation was 91.2 and 52.8%, respectively. The percentage of IgM positive (79.6%) was significantly lower than that of PBMC by RT-PCR. Ten of 27 plasma samples collected within 5 days of the onset of fever were IgM negative. In contrast, all of the 21 plasma samples collected 6 days after the onset of fever were IgM positive. In conclusion, the detection of measles virus RNA in PBMC by RT-PCR was the most effective method for diagnosis of measles.

Factitious purpura in a 10-year-old girl.

We describe a 10-year-old girl who presented with bizarre purpura. Both congenital and autoimmune hemorrhagic disorders were excluded based on her past medical history and physical and laboratory findings. Child abuse was also ruled out as purpura continued to develop after child-family separation. Histologic examination of the skin lesions revealed disruption of collagen fiber bundles. This finding indicated application of external force, leading to a definitive diagnosis of factitious purpura. Although it is very rare in school-age children, the diagnosis of factitious purpura should be included in the differential diagnosis of purpura in children. Histologic analysis of skin biopsies may aid in establishing the diagnosis.