Topical application of glycyrrhetinic acid in the gingival sulcus inhibits attachment loss in lipopolysaccharide-induced experimental periodontitis in rats.

BACKGROUND AND OBJECTIVE: Attachment loss of the junctional epithelium and alveolar bone destruction are signs of periodontitis, which is mainly caused by an inflammatory response to dental plaque. Glycyrrhetinic acid (GA), a component of the licorice herb, has been shown to have important anti-inflammatory activities; however, there are no previous reports on the ability of its inhibitory effects to prevent periodontal diseases. Hence, in this study, using our experimental periodontitis model, we attempted to evaluate whether GA had an effect on the prevention of attachment loss and alveolar bone loss. MATERIAL AND METHODS: Rats were intraperitoneally immunized with Escherichia coli lipopolysaccharide (LPS). The LPS group (n = 5) received 3 topical applications of 50 µg/µL of LPS followed by one application of the vehicle (propylene glycol:ethyl alcohol:phosphate-buffered saline [PBS] = 8:1:1) into the gingival sulcus. This protocol was repeated twice per day for 10 days. The low (n = 5) and high (n = 5) groups received topical application of LPS and 0.03% or 0.3% GA, respectively. The control group received topical application of PBS and vehicle. The rats were killed on the 10th day. Attachment loss, alveolar bone level and inflammatory cell infiltration were investigated histometrically. The formation of immune complexes and infiltration of LPS were evaluated immunohistologically. RESULTS: Attachment loss, formation of immune complexes and infiltration of inflammatory cells were increased in the LPS group compared with the control group, and were completely inhibited in the low and high groups compared with the LPS group. The LPS group showed greater alveolar bone destruction compared with the control group and GA-treated groups. In addition, invasion of LPS was detected in the LPS group, was absent in the control group and was weaker in the GA-treated groups than in the LPS group. CONCLUSION: In the present study, we showed that GA inhibits periodontal destruction in the rat experimental periodontitis model.

[Surgical strategy for critical aoritc stenosis with small aortic annulus in the elderly patients].

BACKGROUND: There are an increasing number of elderly patients with critical aortic stenosis. This study was performed to evaluate the surgical outcome of aortic valve surgery for elderly patients with aortic stenosis. METHODS: Eleven patients aged over 75 years old (mean 79.7 +/- 4.4) underwent aortic valve replacement with stented bioprosthesis from May 2001 to August 2004. All of the patients had a history of congestive heart failure, syncope, or angina pectoris with multiple medical problems including renal dysfunction, diabetes mellitus, cerebral infarction, or coronary artery disease. The New York Heart Association (NYHA) classification ranged II to IV (mean 2.8 +/- 0.7). Their logistic Euro score ranged from 2.56 to 41.61 (mean 8.6 +/- 10.9). The concomitant procedures were annular enlargement in 2 and coronary artery bypass grafting (CABG) in 3 patients. RESULTS: All patients tolerated these procedures well and were discharged except 1 patient who died from arrhythmia on the postoperative day 14. Postoperative echocardiogram after 3 months showed satisfactory decrease in peak left ventricular-aortic pressure gradient as well as left ventricular mass regression. All surviving patients are in NYHA class I. CONCLUSIONS: Aortic valve replacement provided satisfactory results for elderly patients. Surgical treatment should be considered even for the elderly patients with critical aortic stenosis under meticulous perioperative management.

[The effect and role of the intraaortic balloon pumping in off-pump coronary artery bypass].

Eighty consecutive patients who underwent off-pump coronary artery bypass (OPCAB) were studied. They were divided into group I (n = 10) which received preoperative intraaortic balloon pumping (IABP), and group II (n = 70) which did not receive IABP. The indications for preoperative IABP were severe left main coronary artery disease in 7 patients, severe 3 vessel disease in 3 patients, unstable angina in 5 patients, acute myocardial infarction in 3 patients. There was no operative mortality in both groups. The average number of distal anastomosis 2.7/patients in group I and 3.3/patients in group II. There was no differences in ventilator support time, length of stay in the intensive care unit and morbidity between 2 groups. The average postoperative IABP support time was 5.4 hours. There was no IABP-related complication in group I. IABP was very effective to perform OPCAB surgery safety. Preoperative IABP may be effective modality to support OPCAB surgery not only in emergent case but also in elective case.

[Routine application of trans-sternal off-pump coronary artery bypass grafting using innovative technique].

OBJECTIVE: With specific apparatus and surgical techniques, we have extended the use of off-pump coronary artery bypass grafting (CABG) [OPCAB] through sternotomy approach to all of the patients with multiple coronary vessel lesions necessitating CABG. The objective of this study is to assess the safety and efficacy of our technique. METHODS: All of the consecutive 100 patients with multiple coronary vessel lesions necessitating CABG underwent trans-sternal OPCAB using our innovative technique between September 2000 and December 2002. Our new technique included left pericardial traction with sternal spreader, right pericardial compression with pericardial retractor and routine use of our original coronary shunt tube. RESULTS: The total number of distal anastomoses was 322 and the individual grafts were to left anterior descending coronary artery branch (LAD) 127, circumflex (CX) 101 and right coronary artery (RCA) 94. The mean number of the grafts was 3.22 +/- 0.97. The conduits included left internal thoracic artery (LITA) 103, right internal thoracic artery (RITA) 29, radial artery (RA) 82, gastro-epiploic artery (GEA) 43 and saphena magna vein graft (SVG) 65. Predischarge graft angiogram showed over all patency of 99.1% (arterial graft 100% and vein graft 95.4%). Postoperative course was uneventful in all cases with no other organ failures. There was no operative or hospital death. CONCLUSIONS: OPCAB of our technique is effective and safe. The early clinical outcome and excellent patency rates suggests its more widespread use in CABG cases.

Relationship between the reduction of tetrazolium salt XTT and DNA strand breakage with aminosugars.

Dihydropyrazine derivatives formed by the self-condensation reaction of D-glucosamine have the DNA breaking activity. To establish the monitoring method of the biological active dihydropyrazines, we investigated the relationship between the XTT (3'-[1-[(phenylamino)-carbonyl]-3, 4-tetrazolium]bis(4-methoxy-6-nitro)benzensulfonic acid hydrate) reducibility and the DNA breaking activity of aminosugars. Aminosugar in 50 mM sodium phosphate buffer (pH 7.4) was incubated at 37 degrees C. At a given time, the XTT reducibility and the DNA breaking activity of the incubated aminosugar were measured. Both XTT reducibility and DNA breaking activity showed a maximum value within 1-4 h after the incubation and then gradually decreased with the incubation time. Superoxide anion was suggested to involve in both of the DNA breaking activity and the XTT reducibility by the addition of the radical scavengers into those assay mixtures. The quantity of remaining covalently closed circular DNA and the XTT reducibility of all aminosugars showed a good correlation (r = 0.825, n = 26). This means that the XTT assay is applicable for the monitoring of those biologically active products derived from aminosugars when the participation of superoxide anion in DNA scission is recognized.

Concentration of mRNA for the natriuretic peptide receptor-C in hypertrophic chondrocytes of the fetal mouse tibia.

The roles of natriuretic peptides in cardiovascular homeostasis have been well characterized. A recent study revealed that mice lacking natriuretic peptide receptor-C (NPR-C) exhibit skeletal-overgrowth. We therefore, performed in situ hybridization with riboprobes to determine the localization of mRNAs for receptors for natriuretic peptides in the growth plate of the fetal mouse tibia The amount of mRNA for NPR-A was below the detectable level in the growth plate. The mRNA for NPR-B was detected predominantly in proliferating chondrocytes. By contrast, high levels of mRNA for NPR-C were found in hypertrophic chondrocytes. In other regions of the growth plate, the levels of mRNA for NPR-C were very low. The patterns of expression of mRNAs for NPR-B and NPR-C, namely, subtype switching during differentiation from proliferating chondrocytes to hypertrophic chondrocytes, suggest that these receptors might be involved in the growth and differentiation of the growth plate during fetal development in the mouse.

Absolute-length determination of a long-baseline Fabry-Perot cavity by means of resonating modulation sidebands.

A new method has been demonstrated for absolute-length measurements of a long-baseline Fabry-Perot cavity by use of phase-modulated light. This method is based on determination of a free spectral range (FSR) of the cavity from the frequency difference between a carrier and phase-modulation sidebands, both of which resonate in the cavity. Sensitive response of the Fabry-Perot cavity near resonant frequencies ensures accurate determination of the FSR and thus of the absolute length of the cavity. This method was applied to a 300-m Fabry-Perot cavity of the TAMA gravitational wave detector that is being developed at the National Astronomical Observatory, Tokyo. With a modulation frequency of approximately 12 MHz, we successfully determined the absolute cavity length with resolution of 1 microm (3 x 10(-9) in strain) and observed local ground strain variations of 6 x 10(-8).

Intrapocket chemotherapy in adult periodontitis using a new controlled-release insert containing ofloxacin (PT-01).

PT-01 is a newly developed water-soluble controlled-release insert containing ofloxacin (OFLX) as an antibacterial agent. The effect of PT-01 was evaluated by split-mouth application after oral hygiene instruction. No mechanical debridement was carried out during the experiment. PT-01 was applied once a week for 4 weeks in the periodontal pockets of 46 patients with adult periodontitis. The control insert without any antibacterial agent was applied in a selected pocket in a different quadrant for each patient. Clinical findings plaque index, PI; gingival index, GI; bleeding on probing, BOP; pus discharge, pus; and probing depth, PD at both PT-01 and control sites were measured at every visit for 4 weeks. Clinical findings were improved at both PT-01 and control sites, but the improvements were much more significant at PT-01 sites, in particular BOP and PD, than at control sites. PI was also significantly reduced at PT-01 sites. These results suggest that weekly application of PT-01 in the periodontal pocket has a significant effect on the resolution of periodontal inflammation and has an inhibitory effect on supragingival plaque deposition.

The effect of ofloxacin on experimental periodontitis in hamsters infected with Actinomyces viscosus ATCC 15987.

Syrian hamsters were infected with Actinomyces viscosus ATCC 15987 by inoculation into the oral cavity to induce experimental periodontitis. The effect of an antibiotic, ofloxacin (OFLX), on the experimental periodontitis was examined. In Group A, OFLX gel was applied daily to the gingival mucosa, 2 weeks after bacterial inoculation. Groups B and C were an infected control and a noninfected control, respectively. The hamsters in these three groups were fed a powdered high-sucrose diet. The hamsters in Group D, also a noninfected group, were fed an ordinary solid diet. Salivary occult blood test, evaluation of gingival and plaque index, measurement of alveolar bone loss, bacterial examination, and histological observation were performed 11 weeks after infection. Group B exhibited significantly higher levels of gingival index, plaque index, and alveolar bone loss than the noninfected controls. Severe inflammation of the gingivae, formation of gingival pockets, migration of many inflammatory cells, and obvious bone loss were also observed in Group B. However, these inflammatory changes were milder in Group A, which was treated with OFLX.

[Topical chemotherapy of chronic periodontitis using controlled-release insert containing ofloxacin (PT-01) without root planing].

Topical chemotherapy of periodontal disease using several drug delivery systems (DDS) is currently being attempted. PT-01 is a DDS which consists of fast- and sustained- release parts containing ofloxacin as an antibacterial agent. Since PT-01 was found to sustain the antibacterial effect for 7 days in a periodontal pocket, it was used tor periodontal patients without root planing or scaling in this study. PT-01 and a placebo were applied to two separate and opposite pockets of 46 patients, once a week from the first visit (week 0) to week 3. The clinical parameters (plaque index, gingival index, tooth mobility, bleeding on probing, pus discharge, and probing depth) were evaluated from weeks 0 to 4. At the end of the test (week 4), global improvement at the two sites was assessed. The clinical parameters and the global improvement of the PT-01 and placebo-treated sites were compared statistically. All parameters at the PT-01 sites except for tooth mobility showed much greater improvement than at the placebo sites. The global improvement of PT-01 sites was also significantly greater than that of the placebo sites. No side effects could be seen in patients treated with PT-01. These results indicate that topical chemotherapy using PT-01 could be effective and safe for periodontal therapy.

The auditory pathology of brain death as revealed by auditory evoked potentials.

A case of brain death is reported in which the auditory brainstem response, middle latency component, and slow vertex response were recorded before and after the cessation of cortical activity, and in which histological examination of the temporal bone and central auditory pathways was performed post mortem. Brain death of at least 48 hours' duration was demonstrated by neurological examination, flat electroencephalographic recording, and persistent absence of auditory evoked responses. The postmortem examination was performed 3 hours after death. The pathological studies of the whole length of the auditory pathway revealed total autolysis of the organ of Corti, marked cell loss in the dorsal cochlear nucleus, and moderate cell loss in other nuclei of the central auditory pathway. It should be considered that total autolysis of the organ of Corti and severe cell loss of the cochlear nucleus may occur if the auditory brainstem response becomes absent in comatose patients.

Auditory short, middle, and long latency responses in acutely comatose patients.

For assessing comatose patients, the combination of auditory short, middle, and long latency evoked potentials (auditory brain stem response [ABR], middle latency component [MLC], and slow vertex response [SVR] ) is more comprehensive than auditory brain stem response (ABR) only or ABR with slow vertex response (SVR). Fifty-four acutely comatose patients were studied. Thirty-four of the patients had severe head injury and others had coma of varied etiology. Within two months after admission, 25 patients survived, while 29 patients died. Auditory evoked response measurements were conducted usually within 48 to 72 hours after admission. For patients with normal SVR, MLC, and ABR, there was 100% survival; with absent SVR but normal MLC and ABR, survival was 91%; with absent SVR and MLC and normal ABR, it was 60%; with abnormal ABR, it was 10%; no patient survived whose ABR was absent. It is emphasized that a normal MLC is clearly a predictor of survival of comatose patients, but a normal ABR is not always a reliable indicator of survival.

[A case of hysterical deafness].

A forty years old woman with hysterical deafness is reported. Chief complaints were bilateral hearing loss. Nothing particular was found in her past and family history. In 1977, on the 11th day of May, she was admitted to A city hospital because of headache and paresis of right limb. As angiography revealed an aneurysms of her anterior communicating artery, she was undertaken the surgery of clipping and coating of the aneurysms. Post-operatively, left hemiparalysis appeared and paresis of right limb developed because of spasm of right middle cerebral artery. On the 14th day of August, ventricular-peritoneal shunt's operation was performed. As soon as she recovered from postoperative coma, she complained of bilateral hearing loss. Because pure tone audiometry demonstrated complete loss of her hearing, she was referred to ENT department of Teikyo University Hospital. Findings were as follows: 1) She had a queer way of hearing because she could understand to hear limited persons' speech (her doctor and husband). 2) Pure tone audiometry showed complete loss of her hearing but the thresholds of auditory brain stem responses were 15 dB and those of slow vertex responses were 45 dB. These results suggested no lesion in cochlea and brain stem. 3) Rorschach test and sentence complete test were performed. The results of these tests suggested hysterical state or neurotic state. 4) Total intelligent quotients by WAIS were 69 which indicated borderline level. However, this value appeared to be incorrect because she was uncooperative. 5) CT scan revealed low density areas at right temporo-parietal lobes and left temporal lobe which were localized and small. Our findings suggested hysterical deafness but not auditory agnosia. During three years, she was referred to several hospitals for rehabilitation but didn't become well at all. On the third year of the onset, her husband became sick and admitted to her room of the same hospital. During that period, suddenly, she talked her hearing to improve and the pure tone audiometry demonstrated decrease in threshold. In conclusion, this event could give a final diagnosis of hysterical deafness but not auditory agnosia.