Tumour necrosis factor inhibitor-associated sinusitis.

AIM: To describe the features of chronic sinusitis associated with the use of tumour necrosis factor (TNF) inhibitors. METHODOLOGY: A retrospective review of the medical records between 2003 and 2011 revealed that five patients had developed chronic sinusitis after the start of TNF inhibitor administration and required rhinological evaluation and treatment. RESULTS: The incidence of refractory sinusitis associated with TNF inhibitors was approximately 2%. Of the five patients identified, four patients were medicated with etanercept and one with infliximab. The maxillary sinus was most commonly involved and cultures of the sinus discharge revealed Pseudomonas aeruginosa in three cases. Two patients showed improvement of sinusitis with antibiotic medication, despite the continuous use of TNF inhibitor, while in two other patients, sinusitis was resistant to antibiotic medication. Another patient who had developed recurrence of sinusitis after complete remission of previous chronic sinusitis by endoscopic sinus surgery showed remission only after cessation of TNF inhibitor. CONCLUSION: Chronic sinusitis associated with TNF inhibitors is considered to be a new disease entity, and it will become more common due to the increasing use of TNF inhibitors.

Perforation of the temporomandibular joint disc: cadaveric anatomical study.

The aim of this human cadaveric study was to investigate the relationship between temporomandibular joint disc perforation and bony changes of the mandibular condyle. Overall, 135 cadaveric mandibles were used (69 male, 66 female; all White). Mean age at death was 78.7 years. Perforation of the disc was investigated. Differences in the area of the perforation according to the different types of bony change (erosion, flattening, osteophyte) were evaluated. Perforation of the disc was observed in 34.8% of all mandibles, occurring unilaterally in 53.2% of cases and bilaterally in 46.8%. The prevalence of perforation was 16.4% in cadavers <80 years old (67 heads) and 52.9% in those ≥80 years old (68 heads) (P < 0.001). Osteophyte formation was always identified along with other bony changes (21.7%) and never in isolation. The area of the perforation was significantly larger in the groups with bony changes (one, two, or three changes) than in the 'no bony change' group. The group with osteophyte formation showed a significantly larger perforated area than the group without osteophyte formation; likewise, the group with flattening showed a significantly larger perforated area than the group without flattening. Osteophytes and flattening are probably secondary bony changes that occur following disc perforation. Based on this study, disc perforation should be suspected when these findings are identified on imaging.

Huge ameloblastic carcinoma of the mandible with metastases treated in several different ways.

Ameloblastic carcinoma is an extremely rare, aggressive, malignant tumour that is most common in the mandible. Because of its rarity there is no general approach to treatment. We present a rare case of an ameloblastic carcinoma with multiple metastases in a 63-year-old Japanese man that was treated in several different ways, including chemoradiotherapy and immunotherapy.

Intraoral vertico-sagittal ramus osteotomy: modification of the L-shaped osteotomy.

The sagittal split ramus osteotomy and intraoral vertical ramus osteotomy carry the potential risk of postoperative nerve paralysis, bleeding, and fracture and dislocation of the condyle. In 1992, Choung first described the intraoral vertico-sagittal ramus osteotomy for the purpose of avoiding postoperative dislocation of the condyle. However, there is still potential for damaging the inferior alveolar nerve and maxillary artery with this technique. The authors have developed a modified technique to minimize these risks. An evaluation of surgical experience and patient outcomes with the use of this technique is presented herein. One hundred twenty-two sides in 97 Japanese patients diagnosed with a jaw deformity were analyzed. This technique includes a horizontal osteotomy that is performed at a higher position than in the original Choung procedure. Intraoperatively, there was no unexpected bleeding from the operative site. Proximal segment dislocation from the glenoid fossa was observed on one side (0.82%). Non-union of the osteotomy was not observed in any patient. Intraoperative fracture of the coronoid process occurred in 2.46%, but none necessitated treatment of the fracture. Nerve dysfunction was found in 2.46% at the 12-month postoperative follow-up. The modified technique presented herein was developed to reduce postoperative nerve dysfunction and intraoperative hemorrhage.

Clinically managing disruptive behavior on the ward.

1. The inability to manage disruptive yelling has lead to the overuse of physical restraints, inappropriate use of psychotropic medications, and provoked feelings of powerlessness, helplessness, and frustration among caregivers that could detract from the overall quality of care. 2. Behavioral analysis provides a framework for caregivers to identify, modify, and develop practical means to alleviate and to monitor a problem. 3. Noisy behavior can become more manageable by combining the effects of improved environment, continuous monitoring and simplification of medication, individualized nursing care, and a sense of creativity. 4. Caregivers need to examine their own feelings and behavior and to understand that they have a responsibility to create an environment in which their clients can respond positively.

Evidence for Air-Seeding: Watching the Formation of Embolism in Conifer Xylem.

Water transport in plants is based on a metastable system as the xylem "works" at negative water potentials (ψ). At critically low ψ, water columns can break and cause embolism. According to the air-seeding hypothesis, this occurs by air entry via the pits. We studied the formation of embolism in dehydrating xylem sections of Juniperus virginiana (Cupressaceae), which were monitored microscopically and via ultrasonic emission analyses. After replacement of water by air in outer tracheid layers, a complex movement of air-water menisci into tracheids was found. With decreasing ψ, pits started to aspirate and the speed of menisci movements increased. In one experiment, an airseeding event could be detected at a pit. The onset of ultrasonic activity was observed when pits started to close, and ultrasonic emission ceased at intense dehydration. Experiments clearly indicated that predictions of the air-seeding hypothesis are correct: At low ψ, pit mechanisms to prevent air entry failed and air spread into tracheids. ψ fluctuations caused complex movements of air-water menisci and pits, and at low ψ, air-seeding caused ultrasonic emissions. Main insights are presented in a video.

Graphical evaluation and partitioning of turgor responses to drought in leaves of durum wheat.

The relationship between relative water content (R) and turgor potential (Ψp) may be derived from pressure-volume (PV) curves and analyzed in various ways. Fifty PV curves were measured with the pressure chamber on leaves of durum wheat (Triticum durum L.). The plots of Ψp versus R were highly variable and could not be adequately described by a single mathematical function. The area below the curve was therefore determined by means of an area meter. This procedure gave the integral of turgor from full saturation to the turgor-loss point. Responses to drought treatment could thus be quantified and partitioned into effects of osmotic adjustment and elastic adjustment. These two adjustment responses, which are probably of different metabolic origin, together improve turgor maintenance in durum wheat considerably.

Growth and Production of Steroid Saponin in Solanum aculeatissimum During One Vegetation Period.

SOLANUM ACULEATISSIMUM (Solanaceae) plants, which were cultivated in the open field, were harvested once a month from June 1985 to January 1986. The growth matter and content of steroid saponins, aculeatiside A and B which are precursors of steroid hormones in root, were then measured in order to examine their seasonal variations during one vegetation period. The aerial parts of the plants died of chill and frost in January. In November the dry weight of root reached the maximum, and the content of steroid saponins was more than 10% and showed a maximum. The yield of steroid saponins per plant was greatest in November. These results suggest that November is the appropriate time for harvest, and that S. ACULEATISSIMUM can be more useful than the DIOSCOREA species which is now used as a source plant of steroid hormones.

X-ray diffraction with a Bragg angle near pi/2 and its applications.

X-ray dynamical diffraction phenomena at a Bragg angle near pi/2 are studied. The X-ray transmissivity as well as the reflectivity from the (991) lattice plane of a silicon thin plate is observed. It agrees fairly well with the diffraction pattern calculated on the basis of the Darwin approach. The possibility is discussed whether a set of two crystal plates arranged face to face, in which the diffraction condition with a Bragg angle near pi/2 is satisfied, may be used as a very high resolution monochromator.

X-ray characterization of alpha-Fe(2)O(3) single crystals containing 2.2% and 95% (57)Fe.

alpha-Fe(2)O(3) single crystals containing 2.2% and 95% (57)Fe isotopes were characterized by means of X-ray topography, the diffraction rocking curve and the integrated intensity. These crystals were revealed to be nearly perfect and suitable for a further nuclear-resonant Bragg-scattering study.

X-ray parametric scattering by a diamond crystal.

Spontaneous X-ray parametric scattering from a diamond single crystal has been observed at the Photon Factory. The high perfection of the diamond single crystal and the small angular divergence of synchrotron radiation has enabled down-converted X-ray photon pairs to scatter into two small solid angles which satisfy the phase-matching condition. High-efficiency noise reduction was performed using avalanche photodiode detectors with good time resolution.

Two-photon correlations in X-rays from a synchrotron radiation source.

The intensity correlation experiment using visible light performed by Hanbury Brown & Twiss [Nature (London) (1956), 177, 27-29] is extended to X-ray wavelengths. Correlations of 14.4 keV X-ray photons from a synchrotron radiation source are observed by the coincidence counting technique. The high brilliance of synchrotron radiation available in the Tristan main ring enables the observation of two-photon correlations with a reasonable measurement time.