Preoperative and postoperative examination of occlusal and maxillofacial changes after osteochondroma extirpation.

A patient came with left-side temporomandibular arthralgia, limited mandibular opening, frontal facial asymmetry, and a significant anterolateral open bite. Severe alterations in the occlusal and maxillofacial anatomy resulted from an osteochondroma associated with the mandibular condyle. We describe the changes associated with extirpation of the mandibular condylar osteochondroma and subsequent orthodontic treatment. These clinical changes resulted in improved facial symmetry and a satisfactory functional occlusion.

Feasibility, reliability, and validity of the Japanese version of the Postoperative Quality of Recovery Scale: a first pilot study.

The Postoperative Quality of Recovery Scale (PQRS) is a multi-domain tracking scale to assess recovery after surgery. The PQRS is used in seven countries and five languages; however, the Japanese version of the PQRS (PQRSj) has not been established. We therefore translated the PQRS into Japanese, and examined the feasibility, reliability and validity of the PQRSj. The time taken to complete the test was measured to assess feasibility. Cronbach's alpha was calculated to assess reliability. The Mini Mental State Examination (MMSE) and the Japanese version of the Quality of Recovery Scale 40 (QoR-40 J) were performed for comparison with the PQRSj (validity). Fifty-one patients were enrolled in the study. The mean completion time was 3.9 min for baseline (feasibility). Cronbach's alpha was between 0.40 and 0.94 in each domain (reliability). A relationship was shown between cognitive domain and MMSE at baseline (r = 0.65, P < 0.01); however, no relationship was found between the other domains and the MMSE and QoR-40 J. Ceiling effects were observed in 78% of the questions. These results indicate that the PQRSj can be used to assess recovery after surgery, although it may be better to revise some of the questions to improve the validity of the PQRSj.

Costimulatory signals mediated by the ITAM motif cooperate with RANKL for bone homeostasis.

Costimulatory signals are required for activation of immune cells, but it is not known whether they contribute to other biological systems. The development and homeostasis of the skeletal system depend on the balance between bone formation and resorption. Receptor activator of NF-kappaB ligand (RANKL) regulates the differentiation of bone-resorbing cells, osteoclasts, in the presence of macrophage-colony stimulating factor (M-CSF). But it remains unclear how RANKL activates the calcium signals that lead to induction of nuclear factor of activated T cells c1, a key transcription factor for osteoclastogenesis. Here we show that mice lacking immunoreceptor tyrosine-based activation motif (ITAM)-harbouring adaptors, Fc receptor common gamma subunit (FcRgamma) and DNAX-activating protein (DAP)12, exhibit severe osteopetrosis owing to impaired osteoclast differentiation. In osteoclast precursor cells, FcRgamma and DAP12 associate with multiple immunoreceptors and activate calcium signalling through phospholipase Cgamma. Thus, ITAM-dependent costimulatory signals activated by multiple immunoreceptors are essential for the maintenance of bone homeostasis. These results reveal that RANKL and M-CSF are not sufficient to activate the signals required for osteoclastogenesis.

[Spinal epidural hematoma after spinal anesthesia using a 27-gauge spinal needle in a patient with normal coagulation profile].

A 76-year-old man underwent transurethral resection of bladder tumor under spinal anesthesia. Preoperative laboratory date showed normal platelet count (188,000 x microl(-1)) and normal coagulation profile (PT 11.4 sec, APTT 35.1 sec). Lumbar puncture was successfully performed at the L3-4 intervertebral space using a 27-gauge spinal needle with some technical difficulties. Nine hours after the operation, patient suddenly complained of pain from the buttocks to the thighs. Neither motor weakness nor sensory disturbance was found. Therefore conservative therapy was chosen with a diagnosis of transient neurologic symptoms (TNS). However, the subjective symptoms did improve. On the 6th postoperative day, magnetic resonance image (MRI) showed a large epidural hematoma from L1 to L4. On the 13th postoperative day, the subjective symptoms disappeared and MRI on the 17th postoperative day revealed the absence of the hematoma. We should keep in mind that epidural hematoma as well as TNS can occur after spinal anesthesia even with a very fine needle.

Mechanical properties of orthodontic wires covered with a polyether ether ketone tube.

OBJECTIVES: To evaluate the esthetics and frictional force of an orthodontic wire passed through a newly designed tube made of a polyether ether ketone (PEEK) resin. MATERIALS AND METHODS: Two types of standard PEEK tubes were prepared at 0.5 × 0.6ф and 0.8 × 0.9ф, and different archwires were passed through the tubes. Color values were determined according to brightness and hues. Friction was assessed with different bracket-wire combinations, and surface roughness was determined by stereomicroscopy before and after the application of friction. RESULTS: The PEEK tube showed a color difference that was almost identical to that of coated wires conventionally used in clinical practice, indicating a sufficient esthetic property. The result of the friction test showed that the frictional force was greatly reduced by passing the archwire through the PEEK tube in almost all of the archwires tested. CONCLUSIONS: Use of the new PEEK tube demonstrated a good combination of esthetic and functional properties for use in orthodontic appliances.

Mechanical and frictional properties of aesthetic orthodontic wires obtained by hard chrome carbide plating.

BACKGROUND/PURPOSE: Although aesthetic wire coating has been increasing in demand, it has problems that changes in mechanical properties and increase in frictional force. The aim of this study was to evaluate the coating of the wire, as characterized by aesthetics, in terms of low and constant friction and mechanical properties. MATERIALS AND METHODS: Hard chrome carbide-plated (HCCP) wires (HCCP group), commercially available polymer-coated wires (P group), rhodium-coated wires (R group), and uncoated wires (control group) were used. For all wire types, a stainless steel wire of dimensions 0.017 inch × 0.025 inch was used. They were evaluated by three-point bending, friction testing, surface observation, and colorimetric testing. RESULTS: The HCCP group was not significantly different from the control group in terms of flexural strength (σ) and flexural modulus (E) (σ: p = 0.90, E: p = 0.35). However, it was significantly inferior compared to the three other groups in terms of the maximum static and kinetic frictional forces under both dry and wet conditions (p < 0.05). In the surface observation, scratches were observed on the wire after the friction test. In the colorimetric test, no significant difference was observed between the HCCP group and the R group (p > 0.05). CONCLUSION: The mechanical properties of the HCCP wire were not significantly different compared to the control group. The frictional force of the HCCP wire was significantly lower than the other group. Therefore, the HCCP wire was suggested to increase the efficiency of tooth movement in clinics.

[Effect of patient's choice of type of anesthesia or postoperative pain management].

BACKGROUND: Recently, informed consent is important for anesthesia. However, type of anesthesia or of postoperative pain management has been rarely selected by the patient in Japan. We performed a questionnaire survey about the choice of each procedure. METHODS: We studied 104 patients who were to undergo elective surgery between September and December 2005. After the date of the surgery had been scheduled, we informed the patient about each method and offered a choice of method in the anesthetic consultation clinic. On the day before the operation, we obtained the patient's consent. The questionnaire survey was done in post-anesthetic clinic several days after the operation. RESULTS: With regard to anesthesia choice, 36 (70.6%) of the 51 patients chose general anesthesia. Forty-eight patients (94.1%) replied that the anesthesia method choice satisfied them. Forty-eight patients (94.1%) were satisfied with anesthesia. With regard to postoperative pain management choice, 38 (71.7%) of the 53 patients chose epidural anesthesia. Forty-nine patients (92.5%) replied that anesthesia method choice satisfied them. Forty-eight patients (90.6%) were satisfied with anesthesia. CONCLUSIONS: Offering choice of each method led to the patient's understanding and increased the rating of satisfaction with anesthesia. Increase in opportunity for having the anesthetic consultation was effective to obtain better patients understanding about the choice of each procedure.

Adhesion of human periodontal ligament cells by three-dimensional culture to the sterilized root surface of extracted human teeth.

Residual periodontal ligament (PDL) and cement mass on the roots of extracted teeth are factors that considerably affect tooth transplantation. Therefore, when normal extracted teeth are used for autologous transplantation, it is necessary to regenerate the PDL of the root surface. Here we describe a method to examine human PDL cell adhesion on sterilized root surfaces. Sample teeth were extracted during orthodontic treatment. PDL cells were obtained from healthy periodontal tissue explants from teeth extracted for orthodontic reasons. We developed a method for adhering PDL cells to sterile root surfaces using three-dimensional culture for 3 weeks. We evaluated the adhesion of human PDL cells to the sterilized root surfaces biochemically and histologically. The adherent PDL cells presented new projections on the sterile root surfaces. Therefore, PDL cells can adhere to sterile root surfaces.

Dose response study of conjugated fatty acid derived from safflower oil on mammary and colon carcinogenesis pretreated with 7,12-dimethylbenz[a]anthracene (DMBA) and 1,2-dimethylhydrazine (DMH) in female Sprague-Dawley rats.

To clarify the chemopreventive effects of conjugated fatty acid derived from safflower oil (CFA-S), rich in conjugated linoleic acid (CLA), on mammary and colon carcinogenesis, 6 week old female Sprague-Dawley (SD) rats received diet containing 0.01, 0.05, 0.1, 1, or 2% CFA-S subsequent to five times subcutaneous injections of 1,2-dimethyl-hydrazine (DMH) at a dose of 40 mg/kg b.w. and a single 50 mg/kg b.w. intragastric application of 7,12-dimethylbenz[a]anthracene (DMBA) during the first 11 days. The experiment was terminated at week 36. Numbers of mammary tumors, colon aberrant crypt foci (ACF), and proliferative indices of mammary tumors, and colon epithelium were analyzed. The 1% dose was found to be optimal for suppression of carcinogenesis in both target organs, a good correlation being noted with between data for cell proliferation. These results suggest that a diet containing appropriate levels of CFA-S may be useful for prevention of mammary and colon cancer.

Lack of significant inhibitory effects of a plant lignan tracheloside on 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP)-induced mammary carcinogenesis in female Sprague-Dawley rats.

Tracheloside, one of the plant lignans which can be extracted from the debris after safflower oil is produced from the seeds of Carthamus tinctorious, is an analogue of another plant lignan, arctiin, the side-chain C-2 of the five-membered ring being changed from a hydrogen to a hydroxyl group. We have already demonstrated that arctiin has chemopreventive effect on mammary carcinogenesis. Therefore, chemopreventive effects of tracheloside on the initiation or post-initiation period of 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP)-induced mammary carcinogenesis in female rats were examined. For initiation, female Sprague-Dawley (SD) rats at the 6 weeks of age were given intragastric administrations of 100 mg/kg body weight of PhIP once a week for 8 weeks. The animals were treated with 0.2 or 0.02% tracheloside during or after this carcinogen exposure. Control rats were fed basal diet with PhIP initiation or 0.2% tracheloside or basal diet alone without initiation throughout the experimental period. All surviving animals were necropsied at the week 52 of administration. There were no clear treatment-related changes with statistical significance in all parameters for mammary carcinomas measured in this experiment. These results indicate that tracheloside may not exert significant effects on PhIP-induced mammary carcinogenesis at least under the present experiment condition.

Inhibition of conjugated fatty acids derived from safflower or perilla oil of induction and development of mammary tumors in rats induced by 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP).

Chemopreventive effects of conjugated fatty acids derived from safflower oil (CFA-S), which contains large amounts of conjugated linoleic acid, and from perilla oil (CFA-P) with abundant conjugated alpha-linolenic acid were examined in a 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP)-induced rat mammary carcinogenesis model. Groups of 20-22 6-week-old female Sprague-Dawley (SD) rats were given eight intragastric injections of PhIP at a dose of 100 mg/kg b.w. during the initial 8 week period. Powdered basal diets containing 0.1% CFA-S or CFA-P were applied during or after PhIP treatment until week 40. In the rats receiving CFA-S or CFA-P together with PhIP treatment, retardation of mammary tumor emergence was observed until week 27. The groups given CFA-S or CFA-P after PhIP treatment, in contrast, demonstrated significant decrease in the final incidences of mammary adenocarcinomas. The indices of proliferating cell nuclear antigen positive cells in mammary adenocarcinomas were significantly reduced with both CFA-S and CFA-P in the post-initiation phase. Formation of aberrant crypt foci in the colon and basophilic foci of the pancreas due to the PhIP treatment group were not affected by CFA-S or CFA-P. In a second short-term experiment, female SD rats were maintained on powdered basal diet containing 0.03% PhIP alone or together with 0.1% CFA-S or CFA-P for 4 weeks. Immunohistochemically, CFA-S and CFA-P were revealed to suppress PhIP-DNA adduct formation in the epithelial cells of mammary gland (duct and alveolar cells), colon and pancreas. These results indicated that CFA-P and CFA-S may retard development of PhIP-induced mammary tumors with inhibition of PhIP-DNA adduct formation, and decreased mammary carcinogenesis in the post-initiation period with inhibition of cell proliferation.

Modulation of body fat and serum leptin levels by dietary conjugated linoleic acid in Sprague-Dawley rats fed various fat-level diets.

OBJECTIVES: In this study, we examined the effect of dietary conjugated linoleic acid (CLA) on body fat levels in Sprague-Dawley rats. METHODS: Rats were fed AIN-93G type diets containing 4%, 7%, and 10% fats with or without 1.5% CLA. RESULTS: Three weeks after the onset of the experimental period, the weights of perirenal white adipose tissue were lower in CLA-fed rats. The weights of epididymal white adipose tissue also were lower in CLA-fed rats than in control rats, but this effect disappeared with increased dietary fat level. Serum leptin levels tended to be lower in the CLA group, especially the low-fat diet group, than in the control group. There were significant positive correlations between serum leptin level and weights of perirenal and epididymal white adipose tissues in control groups, but these correlations were weaker in the CLA groups. Serum tumor necrosis factor-alpha levels also tended to be lower in CLA-fed rats, and this tendency was most remarkable in the rats fed 7% fat diets. CONCLUSION: In conclusion, dietary CLA, especially the low-fat diet, reduced body fat without hepatic injury to Sprague-Dawley rats.

Phytoestrogen-low diet for endocrine disruptor studies.

Hormonally active chemicals (HACs) that are capable of inducing adverse effects on wildlife as well as human beings are featured as "endocrine disruptors". Various animal studies conducted to clarify the characteristics of HACs, including the uterotrophic assay, are sufficiently sensitive to detect the effect of 17-beta-estradiol in micrograms per kilogram of body weight or lower. In such systems, a trace amount of HACs in the dietary pellets may interfere with the test results and thus can be a serious problem for the low-dose issue, which is now a major topic in the field of endocrine disruptor research. Here, the significance of the hormonal effects of phytoestrogen components in the NIH-07 diet is confirmed and a NIH-07-based open formula "phytoestrogen-low diet" (PLD) is proposed, which effectively reduces uterine weight as well as the uterine luminal epithelial labeling index in ovariectomized rats.

Evaluation of estrogenic activity in diets for experimental animals using in vitro assay.

We used a modified yeast-based human estrogen receptor alpha (ER alpha) bioassay to determine the estrogenic activity in 22 kinds of diets for experimental animals. The estrogenic activity of each diet was reevaluated by comparison with a calibration curve of 17 beta-estradiol. Almost all of the diets had estrogenic activity. The diets for rabbits and guinea pigs had the highest estrogenic activity compared to any other diets, including those for rats and mice. Estrogenic activity was found in dried skim milk, fishmeal, soybean meal, and alfalfa meal. In the NIH-07 diet opened for the ingredients, estrogenic activity was nearly all derived from the alfalfa meal. Multiple assays were performed to evaluate potential seasonal variations in the estrogenic potency in the raw materials of the rat and mouse diets. We found that the estrogenic activity in these raw materials changed throughout the year.

Physiological difference between free and triglyceride-type conjugated linoleic acid on the immune function of C57BL/6N mice.

Previous studies have shown the physiological significance of dietary conjugated linoleic acid (CLA) in various experimental animals and in human beings. One of the important problems to better elucidate is the difference between triglyceride (TG) and free (FFA) dietary CLA. Here, using splenocytes, this study assesses how TG- and FFA-CLA modulate immunoglobulin and various cytokine productions. In this study, C57BL/6N mice were fed an experimental diet containing 0% CLA, 0.1 or 1% FFA-CLA, or 0.1 or 1% TG-CLA for 3 weeks. The production of immunoglobulin tended to be up-regulated by 1% FFA-CLA. As a result of protein array analysis using the supernatant from splenocytes cultured with no CLA, 1% FFA-CLA, and TG-CLA, some cytokine production was shown to be remarkably regulated by dietary FFA- and TG-CLA. A total of 32 cytokines were examined, and 11-14 produced cytokines that were 2-fold up-regulated as compared with control for FFA- or TG-CLA, respectively. Especially, the production of IL-9 and MCP-5 and other cytokines was remarkably up-regulated by both FFA- and TG-CLA. In addition, seven cytokines were 2-fold down-regulated by TG-CLA. These data show that there is a slight but significant difference between the functionalities of FFA- and TG-CLA.

Oxidation rate of conjugated linoleic acid and conjugated linolenic acid is slowed by triacylglycerol esterification and alpha-tocopherol.

We have recently shown that alpha-eleostearic acid (alpha-ESA), a conjugated linolenic acid, has a stronger antitumor effect than conjugated linoleic acid (CLA), both in vitro and in vivo. In this study, the oxidative stability of alpha-ESA was examined compared with linoleic acid (LA), alpha-linolenic acid (LnA), and CLA. Thin layers of the FA (LA, 9Z,11 E-CLA, 10E,12Z-CLA, LnA, and alpha-ESA) were auto-oxidized at 37 degrees C, and the FA remaining, the absorbed oxygen volume, the lipid hydroperoxide content, and the TBARS content were determined. The oxidation rate of alpha-ESA was faster than that of the unconjugated FA and CLA (9Z, 11 E-CLA and 10E, 12Z-CLA). However, the lipid hydroperoxide and TBARS contents following alpha-ESA oxidation were low, suggesting production of only small amounts of rapid-reacting secondary oxidation products. Furthermore, the oxidative stability of conjugated FA (CLA and CLnA) in which the carboxylic acid group was esterified with triacylglycerol was greater than that of the FFA. Addition of an antioxidant (alpha-tocopherol) also increased the stability of the conjugated FA to a level similar to that of the unconjugated FA.

Dietary protein modulates the effect of CLA on lipid metabolism in rats.

The effect of the interaction of CLA and type of dietary protein on lipid metabolism was studied in male rats by feeding diets containing casein (CAS) or soy protein (SOY) as dietary protein and either linoleic acid (LA, a control FA) or graded levels of CLA at 0, 0.1, 0.5, and 1.0% for 28 d. CLA reduced the weight of perirenal adipose tissue in a dose-dependent manner, but the magnitude of the reduction was greater when rats were fed SOY. Feeding SOY resulted in a significant reduction of the concentrations of serum total and HDL cholesterol, TG, glucose, and insulin irrespective of dietary CLA. The concentration of serum leptin tended to be lower on the SOY diet free of CLA than in the corresponding CAS diet, but it fell with an increasing dietary level of CLA in the CAS groups. In contrast, serum leptin tended to increase when CLA was added to SOY diets. The concentration of serum adiponectin was higher in the CAS than in the SOY groups, and it tended to increase in response to dietary CLA levels in the CAS-fed rats, whereas CLA showed no effect in SOY-fed rats. The activity of liver mitochondrial carnitine palmitoyltransferase was higher in the SOY than in the CAS groups, but it tended to increase with an increasing dietary level of CLA in both protein groups. Although the body fat-reducing activity of CLA was more effective when the protein source was SOY, rats fed CAS appeared to be more susceptible to CLA than in those fed SOY with respect to cytokines examined. These results suggest that the type of dietary protein may modify the antiobesity activity of CLA.

Dietary conjugated linolenic acid in relation to CLA differently modifies body fat mass and serum and liver lipid levels in rats.

The present study compared the effect of dietary conjugated linolenic acid (CLNA) on body fat and serum and liver lipid levels with that of CLA in rats. FFA rich in linoleic acid, a-linolenic acid, CLA, or CLNA were used as experimental fats. Male Sprague-Dawley rats (4 wk old) were fed purified diets containing 1% of one of these experimental fats. After 4 wk of feeding, adipose tissue weights, serum and liver lipid concentrations, serum tumor necrosis factor (TNF)-alpha and leptin levels, and hepatic beta-oxidation activities were measured. Compared with linoleic acid, CLA and, more potently, CLNA were found to reduce perirenal adipose tissue weight. The same trend was observed in the weight of epididymal adipose tissue. CLNA, but not CLA, was found to significantly increase serum and liver TG concentrations. Serum FFA concentration was also increased in the CLNA group more than in the other groups. The activity of beta-oxidation in liver mitochondria and peroxisomes was significantly higher in the CLNA group than in the other groups. Thus, the amount of liver TG exceeded the ability of hepatic beta-oxidation. Significant positive correlation was found between the adipose tissue weights and serum leptin levels in all animals (vs. perirenal: r = 0.557, P < 0.001; vs. epididymal: r = 0.405, P < 0.05). A less significant correlation was found between adipose tissue weights and serum TNF-alpha level (vs. perirenal: r = 0.069, P > 0.1; vs. epididymal: r = 0.382, P < 0.05). Although the mechanism for the specific effect of CLNA is not clear at present, these findings indicate that in rats CLNA modulated the body fat and TG metabolism differently from CLA.

Combined effects of dietary conjugated linoleic acid and sesamin triacylglycerol and ketone body production in rat liver.

The effects of a combination of dietary conjugated linoleic acid (CLA) supplemented with sesamin on hepatic ketogenesis and triacylglycerol secretion were compared using the livers of rats fed diets containing 1% CLA or linoleic acid (LA) in combination with 0.2% sesamin for 14 d, respectively. The feeding of CLA, as compared to LA, caused a significant reduction in the weight of perirenal adipose tissue but not that of epididymal adipose tissue, and affected neither growth parameters nor hepatic lipid concentration. Hepatic production of ketone bodies was consistently higher in rats fed CLA than in those fed LA, while triacylglycerol secretion was reversed. No significant difference was noted in the hepatic secretion of cholesterol among the groups. Although there was no effect of the dietary combination of CLA with sesamin on adipose tissue weight, hepatic lipid parameters and ketone body production were observed: i.e., triacylglycerol secretion tended to be reduced. These results suggest that the dietary combination of CLA with sesamin may be an effective approach for lowering serum triacylglycerol levels. The decreased hepatic secretion of triacylglycerol is, in part, due to enhanced fatty acid oxidation in the liver.

Feasibility of Early and Repeated Low-dose Interscalene Brachial Plexus Block for Residual Pain in Acute Cervical Radiculopathy Treated with NSAIDS.

BACKGROUND: To improve residual pain management in acute cervical radiculopathy treated with NSAIDs, the feasibility of early and repeated low-dose interscalene brachial plexus block (IS-BPB) needs to be assessed. METHODS: This was a prospective study on patients receiving NSAIDs (loxoprofen) for cervical radiculopathy of ≤ 2-week onset. Pain was assessed using the visual analogue scale (VAS). A low-dose ultrasonography (USG)-guided IS-BPB (dexamethasone [1.65 mg; 0.5 ml] and mepivacaine [1%; 3.0 ml]) was performed at baseline and weekly thereafter for 4 weeks in an outpatient setting for the intervention group. All patients were evaluated using a visual satisfaction score (VSS) at week 4. Patients with baseline VAS scores < 70 (mild to moderate pain; MM group) and ≥ 70 (severe pain; SE group) were compared to the controls receiving NSAIDs. RESULTS: A total of 316 IS-BPBs were performed in the intervention group. There was a significant difference in the decline in the VAS from week 0 to week 3 in the MM and SE groups (P < 0.05); however, from week 3 to week 4, the therapeutic effect exhibited no significant difference. Thirteen patients at week 2 (15.5%; MM: 27.7%; SE: 0%), 43 at week 3 (51.2%; MM: 83.0%; SE: 10.8%), and 47 at week 4 (56.0%; MM: 85.1%; SE: 18.9%) achieved a VAS score of ≤ 20. Patient satisfaction was high, and the decrease in VAS scores in both groups was significant (P < 0.05) compared to the controls. CONCLUSIONS: Weekly, low-dose, USG-guided IS-BPB can be implemented for early pain relief in acute cervical radiculopathy, with high patient satisfaction.