A Case Report on Unstable Angina Pectoris Manifesting as Orofacial Pain.

Cardiac ischemia, such as angina pectoris or myocardial infarction, is associated with pain in the oral cavity, lower jaw, head, or neck, or spanning from the left upper arm to the shoulder. When presenting to a dentist, however, appropriate treatment for such patients is often delayed, as dental problems are usually the first to be suspected when the chief complaint is orofacial pain. This report describes a case of a 70-year-old woman who was aware of pain and a burning sensation in the oral cavity upon exertion for a year prior to presenting at our clinic. She had been examined by her family physician, an otolaryngologist, and another dentist, none of whom found any abnormalities other than suspected periodontal disease and caries, for which she was treated. An examination at our clinic revealed no abnormal dental findings that would have been consistent with the mandibular pain, however. Although no chest symptoms were reported, pain was elicited on exertion, suggesting cardiogenic toothache. An immediate referral to a cardiologist was therefore made on the same day. The patient visited the cardiology department of the University Hospital of Tokyo Dental College 6 days later. The increased frequency of symptoms on exertion suggested unstable angina, and the patient was admitted to the emergency department on the same day. Emergency coronary angiography showed that right coronary artery #1 was 99% stenosed proximally (highly calcified plaque). The diagnosis was unstable angina pectoris, with the right coronary artery #1 as the responsible lesion, and percutaneous coronary angioplasty was performed on the same day. Subsequently, all the orofacial pain disappeared, confirming unstable angina as the cause. The pain characteristics in this case were consistent with pain associated with cardiac ischemia, which led to the immediate referral to the cardiology department. In cases of toothache associated with cardia ischemia, it is essential to seek cardiological care as soon as possible.

A Secondary Metabolic Enzyme Functioned as an Evolutionary Seed of a Primary Metabolic Enzyme.

The antibiotic alaremycin has a structure that resembles that of 5-aminolevulinic acid (ALA), a universal precursor of porphyrins, and inhibits porphyrin biosynthesis. Genome sequencing of the alaremycin-producing bacterial strain and enzymatic analysis revealed that the first step of alaremcyin biosynthesis is catalysed by the enzyme, AlmA, which exhibits a high degree of similarity to 5-aminolevulinate synthase (ALAS) expressed by animals, protozoa, fungi, and α-proteobacteria. Site-directed mutagenesis of AlmA revealed that the substitution of two amino acids residues around the substrate binding pocket transformed its substrate specificity from that of alaremycin precursor synthesis to ALA synthesis. To estimate the evolutionary trajectory of AlmA and ALAS, we performed an ancestral sequence reconstitution analysis based on a phylogenetic tree of AlmA and ALAS. The reconstructed common ancestral enzyme of AlmA and ALAS exhibited alaremycin precursor synthetic activity, rather than ALA synthetic activity. These results suggest that ALAS evolved from an AlmA-like enzyme. We propose a new evolutionary hypothesis in which a non-essential secondary metabolic enzyme acts as an 'evolutionary seed' to generate an essential primary metabolic enzyme.

Response inhibition deficits are positively associated with trait rumination, but attentional inhibition deficits are not: aggressive behaviors and interpersonal stressors as mediators.

Previous findings on relationships between inhibition that is a core executive function, and trait rumination have been inconsistent. This inconsistency could be overcome by investigating the association between rumination and the two subcomponents of inhibition: response inhibition and attentional inhibition. This study examined whether and how response inhibition and attentional inhibition were related to rumination as well as worry. University students in Japan (N = 213) conducted the Go/No-Go Task and the Modified Stroop Task. They also completed self-report measures of depression, trait rumination, trait worry, stressors, and aggressive behaviors. Results indicated that response inhibition deficits were positively associated with trait rumination, and this association was mediated by increases in aggressive behaviors and interpersonal stressors. The associations between these variables remained significant even after controlling for depression level. There were no significant direct or indirect associations between attentional inhibition deficits and rumination. These results suggest that response inhibition deficits, among the subcomponents of inhibition, have an indirect positive association with rumination through interpersonal processes. Results also showed nonsignificant differences between rumination and worry in the magnitude of correlation coefficients with the two subcomponents of inhibition. Therefore, it remains unclear whether the positive association with response inhibition is unique to rumination.

Do shorter inter-stimulus intervals in the go/no-go task enable better assessment of response inhibition?

Young, Sutherland, and McCoy indicated that a Go/No-Go Task (GNG) becomes more difficult as the inter-stimulus intervals (ISIs) becomes shorter. However, is the number of commission errors under extremely short ISIs a useful metric for assessing response inhibition? This study challenges the assumption that a shorter ISI in the GNG enables better assessment of response inhibition. University students (N = 213) completed the GNG, the Conners Continuous Performance Test 3rd Edition (CCPT), and the Modified Stroop Task. The GNG comprised four blocks of 400, 600, 800, and 1000 ms ISIs, whereas the stimulus presentation was fixed at 250 ms. Consistent with Young et al., shorter ISIs in the GNG resulted in more commission errors. In the block with the shortest ISI, participants also failed more frequently in responses in go trials than in the other blocks, which appears to increase in error variance of commission errors. Consistent with this interpretation, the association between the number of commission errors in the block with 400 ms ISI and CCPT performance was weaker than those between the number of commission errors in other blocks and CCPT performance. It is concluded that using the number of commission errors in the condition with extremely short ISIs in the GNG might be inappropriate for assessing response inhibition.

Patent ductus arteriosus closure and somatic regional oxyhemoglobin saturation.

The authors report a case of a 14-day-old infant patient with patent ductus arteriosus (PDA) with pulmonary hypertension. Accidental clipping of the left pulmonary artery (LPA) during intended PDA closure was revealed, and subsequent urgent PDA closure and releasing a clip of the LPA were conducted. During surgeries we measured somatic regional oxyhemoglobin saturation (rSO2) values and change in those might be a key for early diagnosis of accidental clipping of the LPA. These findings suggest that we should understand the risk of accidental closure of the LPA during PDA surgery and somatic rSO2 values will provide information for early diagnosis of critical complication.

Preoperative cerebral and renal oxygen saturation and clinical outcomes in pediatric patients with congenital heart disease.

We examined the predictability of preoperative cerebral and renal rSO2 values for outcomes in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass (CPB). Patients who underwent pediatric cardiac surgery under CPB between September 2015 and September 2017 were enrolled in this study. Patients monitored with both cerebral and renal rSO2 at the beginning of surgery were included. The primary outcome was the prediction of outcomes after pediatric cardiac surgery. Outcome was defined as any of: (1) death within 30 days after surgery, or the need for (2) renal replacement therapy or (3) extracorporeal membrane oxygenation, (4) shorten mechanical ventilator-free day,(5) shorten ICU-free survival day. We included 59 patients: cyanotic n = 31; non-cyanotic n = 28. Among all patients, 15 (25%) had poor outcomes, including three deaths. The cerebral and renal rSO2 values were significantly lower in the cyanotic patients with poor outcomes compared to those without poor outcomes (cerebral: 59 ± 11 vs. 50 ± 5, p = 0.021; renal: 59 ± 15 vs. 51 ± 14, p = 0.015) but only the renal rSO2 value was significantly lower in the non-cyanotic patients (77 ± 10 vs. 61 ± 14, p = 0.011). The cut-off value (51%) of cerebral rSO2 were associated with risk of mechanical ventilator-free day and ICU-free survival day [ORs of 22.8 (95% CI 2.21-235.0, p = 0.0087) and 15.8 (95% CI 1.53-164.0, p = 0.0204), respectively] in the cyanotic patients. The cut-off value (66%) of cerebral rSO2 value was associated with risk of mechanical ventilator-free day [OR of 11.3 (95% CI 1.05-25.3, p = 0.0456)] and the cut-off value (66%) of renal rSO2 value was associated with risk of ICU-free survival day [ORs of 33.0 (95% CI 2.25-484.0, p = 0.0107)] in the noncyanotic patients. The preoperative low rSO2 values were associated with outcomes including 30-day mortality and might be reflective of the severity of cardiopulmonary function. Further studies are needed to confirm our results.

[Development of the Japanese version of the Thought Control Ability Questionnaire and evaluation of its reliability and validity].

Intrusive thoughts and difficulty in controlling thoughts are common, not only for people with psychological disorders, but also for healthy people. Individual differences in thought control ability may underlie such problems. The Thought Control Ability Questionnaire (TCAQ), which consists of 25 items, was developed by Luciano et al. (2005) in order to measure individual differences in the perceived ability to control unwanted intrusive thoughts. The purpose of the present study was to develop the Japanese version of the TCAQ and evaluate its reliability and validity. We translated the English version of the TCAQ into Japanese. We also conducted confirmatory factor analysis with a one factor solution, similar to the previous study. Based on the analysis, we excluded items whose factor loadings were lower than .30, resulting in 22 items for the Japanese version of the TCAQ. The model exhibited acceptable goodness-of-fit. The Japanese version of the TCAQ also demonstrated good reliability as well as evidence of construct validity. Thus, the development of the Japanese version of the TCAQ was successful.

Space environment of an asteroid preserved on micrograins returned by the Hayabusa spacecraft.

Records of micrometeorite collisions at down to submicron scales were discovered on dust grains recovered from near-Earth asteroid 25143 (Itokawa). Because the grains were sampled from very near the surface of the asteroid, by the Hayabusa spacecraft, their surfaces reflect the low-gravity space environment influencing the physical nature of the asteroid exterior. The space environment was examined by description of grain surfaces and asteroidal scenes were reconstructed. Chemical and O isotope compositions of five lithic grains, with diameters near 50 µm, indicate that the uppermost layer of the rubble-pile-textured Itokawa is largely composed of equilibrated LL-ordinary-chondrite-like material with superimposed effects of collisions. The surfaces of the grains are dominated by fractures, and the fracture planes contain not only sub-µm-sized craters but also a large number of sub-µm- to several-µm-sized adhered particles, some of the latter composed of glass. The size distribution and chemical compositions of the adhered particles, together with the occurrences of the sub-µm-sized craters, suggest formation by hypervelocity collisions of micrometeorites at down to nm scales, a process expected in the physically hostile environment at an asteroid's surface. We describe impact-related phenomena, ranging in scale from 10(-9) to 10(4) meters, demonstrating the central role played by impact processes in the long-term evolution of planetary bodies. Impact appears to be an important process shaping the exteriors of not only large planetary bodies, such as the moon, but also low-gravity bodies such as asteroids.

[Remembering past events activates temporal concepts of future].

The cognitive function to project oneself into the specific past or future is labeled mental time travel (MTT). MTT to the past is considered "episodic memory" and the future is termed "episodic future thinking". Remembering the past and imaging the future during MTT both draw on information stored in episodic memory: a process that enables integration of episodic information into a coherent event representation. Recent studies suggested that episodic information in past/future event representations varies with temporal distance from the present to the event. However, it is unclear whether the influence on temporal distance is actually caused by the function of episodic memory retrieval. The present study investigated the relationship between episodic memory and temporal concepts with a lexical decision task. The results indicate that remembering the past activated temporal concepts of the near future more than that of the far future. This finding suggests that the rich information derived from episodic memory modulates the subjective sense of time in episodic future thinking.

Visual long-term memory and change blindness: Different effects of pre- and post-change information on one-shot change detection using meaningless geometric objects.

To clarify the relationship between visual long-term memory (VLTM) and online visual processing, we investigated whether and how VLTM involuntarily affects the performance of a one-shot change detection task using images consisting of six meaningless geometric objects. In the study phase, participants observed pre-change (Experiment 1), post-change (Experiment 2), or both pre- and post-change (Experiment 3) images appearing in the subsequent change detection phase. In the change detection phase, one object always changed between pre- and post-change images and participants reported which object was changed. Results showed that VLTM of pre-change images enhanced the performance of change detection, while that of post-change images decreased accuracy. Prior exposure to both pre- and post-change images did not influence performance. These results indicate that pre-change information plays an important role in change detection, and that information in VLTM related to the current task does not always have a positive effect on performance.

Depressive rumination and past depression in Japanese university students: comparison of brooding and reflection.

The Ruminative Responses Scale, a measure of depressive rumination, contains two subscales: Brooding and Reflection. Treynor, Gonzalez, and Nolen-Hoeksema (2003) proposed that Brooding is maladaptive and Reflection is adaptive. This article examined the relationships among Brooding, Reflection, and previous depression in two samples of Japanese undergraduates, who were non-depressed at the time of their participation. Based on answers to a self-report measure, participants were divided into a formerly depressed group, who had experienced an episode that met the criteria for major depression, and a never-depressed group. Logistic regression analyses were conducted with Brooding, Reflection, and current depression as the independent variables and past depression as the dependent variable. Brooding had consistent positive associations with past depression. The relationship between Reflection and past depression was not significant for one sample, but was statistically significant and positive in the second sample. In the second sample, Brooding and Reflection both were related with past depression after controlling for worry.

Longitudinal predictions of the Brooding and Reflection subscales of the Japanese Ruminative Responses Scale for depression.

The Ruminative Responses Scale (RRS) is a measure of depressive rumination which has two subscales: Brooding and Reflection. This article examines the longitudinal predictions for depression and the test-retest reliability of the Brooding and Reflection of the Japanese RRS. Japanese university students (N = 378) completed the RRS, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Inventory to Diagnose Depression, Lifetime Version (IDDL) which was modified to assess symptoms experienced in the 8-wk. follow-up period. The standardized betas of the initial Brooding and Reflection subscales for the IDDL scores were significant and positive after controlling for baseline CES-D scores, but those for the CES-D scores at Time 2 were not significant. Longitudinal predictions of Brooding were partially consistent with those of other language versions (significant in almost all studies); however, longitudinal predictions of Reflection were not consistent with those of other language versions (negative in previous studies). The test-retest correlations of both subscales were similar to those obtained in Western countries.

Neuroanatomical substrates involved in true and false memories for face.

We often mistake an unknown person for a familiar person because of the similarities in facial features. This phenomenon, known as false memory, has been investigated mainly using words, pictures, and shapes. Previous neuroimaging studies on false memory have shown that both true and false memories trigger a similar activation in the medial temporal lobe, suggesting that it plays a common role in both. However, no study to date has investigated neural substrates of false memories for faces. In the present fMRI study, we applied a modified version of the standard false memory paradigm, using morphed pictures of faces, to induce false memory in an MRI environment. We found that activity in the amygdala and orbital cortices was associated with the degree of familiarity of items. In particular, false responses to "lure" items evoked a level of activity in the amygdala between that evoked for correct or incorrect responses to "true" items. This indicates a possible role of the amygdala in false memory. A specific region in the anterior cingulate cortex was involved in false recognition; the activity being correlated to reaction times for the response types. These results suggest that the amygdala is involved in determining the relevance of items; therefore, ambiguousness of lure items in terms of familiarity and novelty may be related to decreased activity in the amygdala. The anterior cingulate activity in false memory may be caused not only by increased effort and motor demand but also by higher mnemonic processing of lure items.

Ketamine Does Not Change Natural Killer Cell Cytotoxicity in Patients Undergoing Cancer Surgery: Basic Experiment and Clinical Trial.

Background: The natural killer cell cytotoxicity (NKCC) suppressed by nociceptive stimuli, systemic inflammation, and drugs used during cancer surgery may be associated with poor outcomes. We investigated the potential modulation of ketamine on NKCC in vitro and in a clinical setting during cancer surgery. Subjects and Methods. The NK cell line KHYG1 was cultured for the in vitro experiments. The NK cells were treated with 3 and 10 µM ketamine (the ketamine groups) or without ketamine (the control) for 4, 24, and 48 h. The posttreatment NKCC was measured with a lactate dehydrogenase assay and compared among the treatment groups. For the clinical study, lung cancer patients (n = 38) and prostate cancer patients (n = 60) who underwent radical cancer surgeries at a teaching hospital were recruited. The patients received propofol and remifentanil superposed with or without ketamine (ketamine group, n = 47; control group, n = 51). The primary outcome was the difference in NKCC between these groups. Results: In the in vitro experiment, the cytotoxicity of NK cells was similar with or without ketamine at all of the incubation periods. The patients' NKCC was also not significantly different between the patients who received ketamine and those who did not, at the baseline (36.6 ± 16.7% vs. 38.5 ± 15.4%, p = 0.56) and at 24 h (25.6 ± 12.9% vs. 27.7 ± 13.5%, respectively, p = 0.49). Conclusion: Ketamine does not change NKCC in vitro or in the clinical setting of patients who undergo cancer surgery. This trial is registered with UMIN000021231.

Repeated retrieval of generalized memories can impair specific autobiographical recall: A retrieval induced forgetting account.

Overgeneral autobiographical memory (OGM) refers to the tendency toward increased general memory and reduced specific memory recall, observed in various psychiatric disorders. Previous studies have suggested that inhibitory processes involved in resolving competition between competing memories may reduce memory specificity via retrieval-induced forgetting (RIF). However, it remains unclear whether the repeated retrieval of general memories can induce forgetting of specific memories. We adapted the RIF paradigm to address this question across three experiments. Participants first generated specific memories in response to positively and negatively valenced cue words. They then generated and repeatedly retrieved general memories for half of the cue words. Recall for all of the original specific memories was later tested. Experiment 1 showed that the retrieval practice of general memories reduced the recall of associated specific memories, regardless of cue valence. Experiment 2 demonstrated that this forgetting effect was cue independent, occurring even when novel retrieval cues were used on the final test. Experiment 3 suggested that this effect was competition dependent, finding a greater RIF effect following practice of general memories (high competition) than following a cue-color association task (low competition). These results suggest that repeated retrieval of general memories suppressed specific memory representations through RIF. These findings are discussed in relation to hierarchical models of autobiographical memory, mechanisms that maintain overgeneral memory tendencies, and the role of retrieval in shaping autobiographical memory. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Negative item memory and associative memory: Influences of working memory capacity, anxiety sensitivity, and looming cognition.

BACKGROUND AND OBJECTIVES: Traumatic or negative stimuli facilitate item memory but impair associated context memory. Vulnerability factors related to the maintenance and onset of posttraumatic stress disorder (PTSD), such as anxiety sensitivity, looming cognitive style, dissociation, and low working memory capacity, have been identified. However, little is known about how these factors influence negative item or associative memory. METHODS: Eighty-five undergraduates completed self-report questionnaires, the operation span with words (OSPAN) task, and an item and associative memory task in which incidental encoding of negative and neutral items and context information (Day 1) was followed by an unexpected retrieval test (Day 2). RESULTS: The results showed greater Hit rates and False Alarms on item memory and lower accuracy on context memory with negative stimuli than with neutral stimuli, replicating previous findings. Low working memory capacity and high dissociation were correlated with low negative item memory. Under low working memory capacity, high levels of anxiety sensitivity and looming cognitive style predicted high dissociation levels and low accuracy for negative item memory. There were no individual differences involving associative memory. LIMITATIONS: A nonclinical sample was used, which limits the generalizability of our results to clinical samples. CONCLUSIONS: Dissociation could be a coping strategy for reducing negative item memory. Anxiety sensitivity and looming cognitive style facilitate dissociative coping; however, working memory capacity buffers against these vulnerabilities.

Successful respiratory management of a Marshall-Smith syndrome patient with a tracheo-innominate artery fistula.

BACKGROUND: Tracheo-innominate artery fistula (TIF) is a life-threatening complication of tracheostomy. We describe perioperative management for innominate artery transection in a case with TIF. CASE PRESENTATION: A 4-year-old Japanese female with Marshal-Smith syndrome presented for management of TIF. She underwent tracheostomy at the age of 3 months and an uncuffed tracheostomy tube was inserted. One month before admission to our hospital, intermittent tracheal bleeding, suggesting TIF, occurred. Although we considered to change to a cuffed endotracheal tube, craniofacial abnormality suggested difficult oral intubation, and there was a possibility of rebleeding. Finally, innominate artery transection was performed under total intravenous anesthesia without changing the tracheostomy tube. Surgery completed uneventfully and she received mechanical ventilation under sedation for a day, followed by weaning without complications. CONCLUSIONS: A cuffed tracheostomy tube should have been inserted before surgery for effective hemostasis against sudden bleeding from TIF even though conversion to oral intubation was difficult.

Immunomodulation by ketamine as an adjunct to total intravenous anesthesia in patients undergoing minimally invasive radical prostatectomy: A randomized pilot trial.

Post-surgery immunomodulation, including reduced natural killer cell cytotoxicity (NKCC), is recognized as a predictor of poor outcomes in patients following cancer surgery. The present study investigated direct immunomodulation via ketamine as an anesthetic adjuvant in patients undergoing cancer surgery. The present non-double blinded randomized trial was conducted at Hirosaki University Hospital with 60 patients who underwent minimally invasive robotic radical prostatectomy to minimize the immunomodulation due to surgical stress. Patients received total intravenous anesthesia using propofol and remifentanil, with ketamine as an anesthetic adjuvant (the ketamine group) or without ketamine (the control group). The primary outcome was the difference in NKCC between these groups. The secondary outcomes were the differences in neutrophil-lymphocyte ratio (NLR) and levels of interleukin (IL)-6, IL-1ß, IL-10 and tumor necrosis factor-alpha (TNF-α). NKCC and cytokines were measured before anesthesia (baseline) and at 6 and 24 h after baseline measurements were recorded. NLR was determined on the last day before admission and at 48 h post-baseline. NKCC values were similar in each group at 6 h when compared with respective baseline results (baseline control, 36.9±15.6%; 6 h control, 38.3±13.4%; baseline ketamine, 36.1±17.0%; 6 h ketamine, 36.6±16.4%) but significantly decreased at 24 h (control, 26.5±12.2%; ketamine, 24.1±12.7%; P<0.001). There were no significant differences in NKCC between the ketamine and control groups (P=0.64) at any of the assessed time points. NLR, IL-1ß, IL-10 and TNF-α levels were also similar between two groups. In contrast, IL-6 at 24 h was significantly lower in the ketamine group compared with the control group (mean difference, -7.3 pg ml-1; 95% confidence interval, -14.4 to -0.2; P=0.04). Ketamine as an anesthetic adjuvant did not provide direct immunomodulation in patients who underwent cancer surgery.