Sublingual Dermoid Cyst in Young Child.

A dermoid cyst is a benign congenital lesion of ectodermal origin that can arise in any region of the body, though occurrence is rare. A young girl aged 2 years 4 months was referred to our hospital because of a painless mass in the floor of the mouth. Intraoral examination findings revealed a painless movable elastic soft mass on the floor of the mouth measuring approximately 15 mm in diameter. Magnetic resonance imaging indicated a cystic lesion, with low signal intensity shown in T1-weighted and extremely high signal intensity in T2-weighted images. These clinical findings indicated the presence of a dermoid cyst and removal was planned. Under general anesthesia with nasal intubation, surgical removal was performed through an incision on the floor of the mouth. Blunt dissection exposed the integrity of the cyst capsule, which was weakly attached to adjacent tissue. The excised mass was 19 mm × 14 mm × 11 mm in size. Histological examination findings confirmed a diagnosis of dermoid cyst. The operation was successfully completed without any complications and the postoperative course was good. It is important to properly evaluate cysts in children and provide proper treatment with appropriate timing.

Maxillary Sinus Floor Augmentation with Two Different Inorganic Bovine Bone Grafts: an Experimental Study in Rabbits.

OBJECTIVE: To compare the sequential healing of maxillary sinuses grafted with two different xenogeneic bone substitutes processed at either a low (300°C) or high (1200°C) temperature. METHODS: A sinus augmentation procedure was performed bilaterally in 20 rabbits and two different xenogeneic bone grafts were randomly used to fill the elevated spaces. Healing was studied after 2 and 10 weeks, in 10 rabbits during each period. RESULTS: After 2 weeks of healing, very small amounts of new bone were observed in both groups, and were mainly confined to close to the sinus bone walls and osteotomy edges. After 10 weeks of healing, new bone was found in all regions, with higher percentages in those close to the bone walls and to the osteotomy. In this period of healing, the proportion of new bone in the 300°C group was 20.0% ± 4.3%, and in the 1200°C group it was 17.2% ± 4.3% (P = 0.162). In the 1200°C group, translucent, dark fog-like shadows in regions of the grafts were hiding portions of new bone (interpenetrating bone network). CONCLUSION: Both biomaterials provided conditions that allowed bone growth within the elevated space, confirming that both biomaterials are suitable to be used as a graft for sinus floor augmentation.

Bioactivation of Bovine Bone Matrix and Collagen Scaffold Using Argon Plasma: In Vitro Study.

PURPOSE: Bone graft materials and soft tissue allografts are widely used in clinical practice to counteract physiologic postextraction site tridimensional shrinkage. The aim of this study was to test if plasma of argon treatment could have a bioactivation effect on hard and soft tissue scaffolds in clinical usage. MATERIALS AND METHODS: Forty-eight bovine bone matrix and porcine collagen samples were subdivided into two groups (test and control) of 12 samples each. The test group was treated with argon plasma (10 W, 1 bar for 12 minutes), while the control group was left untreated. Immediate cell adhesion and a proliferation assay at 72 hours were performed in the perfusion chamber of a bioreactor. Additionally, micro-CT analysis was performed on the treated and untreated scaffolds, before and after soaking in cell culture medium (four samples). RESULTS: Osteoblasts seeded on plasma-treated bone matrix significantly increased the adhesion level compared with the untreated sample (43,144.3 ± 12,442.9 vs 21,736 ± 77,27.1; P = .0083). However, 3-day proliferation tests could not achieve significant differences between groups (105,715.5 ± 21,751.5 vs 107,108.6 ± 19,343.4; P = .998). No differences were measured on fibroblast adhesion on the collagen matrix in both conditions. Plasma of argon treatment and soaking in cell culture medium did not affect the bone matrix samples. The structure of collagen matrix samples was unaltered after plasma treatment, but became enlarged after soaking. CONCLUSION: Plasma of argon may be useful to biofunctionalize bone grafts, although benefits seemed to disappear after 3 days. No biologic response was detected on collagen matrix scaffolds. In vivo studies are needed to draw final clinical conclusions.

Histologic and Micro-CT Analyses at Implants Placed Immediately After Maxillary Sinus Elevation Using Large or Small Xenograft Granules: An Experimental Study in Rabbits.

PURPOSE: To compare the osseointegration at the portion of the implant within the elevated space after sinus elevation using different sizes of xenograft. MATERIALS AND METHODS: Eighteen New Zealand rabbits were selected, antrostomies were prepared bilaterally through the nasal dorsum, and the sinus mucosa was elevated. Deproteinized bovine bone mineral with granules of either 1 to 2 mm (large sites) or 0.250 to 1.0 mm (small sites) were randomly used to fill the elevated space of the two sinuses. Subsequently, mini-implants were placed through the antrostomy, one in each sinus. The animals were euthanized 2, 4, and 8 weeks after surgery, six animals for each group. Microcomputed tomography (micro-CT) and histologic analyses were performed. RESULTS: In the elevated space, at the histologic analysis after 2 weeks of healing, new bone formed on the implant surface was found in fractions of 18.8% ± 6.8% and 15.8% ± 9.6% in the large and small sites, respectively (P = .249). After 4 weeks, the respective fractions of new bone were 20.3% ± 3.5% and 23.3% ± 5.6% (P = .249). After 8 weeks, the proportions reached 33.9% ± 9.5% and 28.5% ± 10.3% (P = .173), respectively. At the micro-CT analysis, bone-to-implant contact percentage (BIC%) was 21.0% ± 2.3% and 21.2% ± 2.4% in the large and small sites, respectively (P = 1.000). The respective proportions of BIC% at the large and small sites were 20.5% ± 3.3% and 23.4% ± 5.4% after 4 weeks (P = .463), and 23.0% ± 2.7% and 25.8% ± 4.1% after 8 weeks (P = .249). CONCLUSION: The use of xenograft granules of different dimensions resulted in similar amounts of bone-to-implant contact at implants placed simultaneously with sinus floor augmentation.

Comparison of histomorphometry and microCT after sinus augmentation using xenografts of different particle sizes in rabbits.

PURPOSE: The aim of the present experiment was to compare the data on new bone formation measured histologically and microtomographically in maxillary sinuses augmented with a xenograft with higher density and higher mineral content compared with the natural bone. The hypothesis was that histomorphometric and micro-computed tomography (microCT) analyses do not yield similar outcomes when a xenograft with higher density and mineral content compared with the natural bone is used. METHODS: In 18 rabbits, the maxillary sinus was augmented bilaterally using deproteinized bovine bone mineral (DBBM) xenograft granules of either 0.125-1 mm or 1-2 mm of dimensions. The rabbits were euthanized after 2, 4, and 8 weeks of healing. Comparisons were performed between microCT and histological analyses. RESULTS: After 2 weeks of healing, higher contents of bone were found at the histological compared with the microCT analyses in both sinuses, especially in the middle regions of the grafted sinus. Between 2 and 8 weeks of healing, new bone increased of about 21% at the histological analyses while, at the microCT, increased only about 4%. In the same period, the xenograft proportion decreased from 51.6 ± 4.9 to 45.3 ± 3.3% at the histological analyses while, at the microCT, the xenograft appeared to increase in percentages. CONCLUSION: Histological and microCT analyses yielded different outcomes when a xenograft with higher density and higher mineral content compared with the natural bone was used.

Antrostomy Preparation for Maxillary Sinus Floor Augmentation Using Drills or a Sonic Instrument: A Microcomputed Tomography and Histomorphometric Study in Rabbits.

PURPOSE: To evaluate the healing after sinus floor augmentation at antrostomies prepared with either drills or a sonic instrument. MATERIALS AND METHODS: Sinus mucosa elevation was performed bilaterally in 18 rabbits. The antrostomy was prepared with either drills or a sonic instrument. The elevated space was filled with a collagenated porcine bone, and the access antrostomy was covered by a collagen membrane. The animals were euthanized in groups of six after 2, 4, and 8 weeks of healing. Microcomputed tomorgraphy (microCT) and a histologic analysis was performed. RESULTS: After 8 weeks of healing, remaining defects occupying about 28.9% and 26.0% of the antrostomy were found at the microCT analysis. At the histologic analysis, new bone was formed from the margins of the antrostomy, reaching the central region over time. After 8 weeks of healing, 29.1% ± 18.6% and 28.4% ± 15.6% of new mineralized bone was occupying the analyzed zone in the antrostomy at the drill and sonic sites, respectively. CONCLUSION: The use of a sonic device to prepare the antrostomy resulted in similar healing outcomes in both the antrostomy and the elevated regions.

Plasma of argon enhances the adhesion of murine osteoblasts on different graft materials.

OBJECTIVE: Plasma of argon treatment was demonstrated to increase material surface energy leading to stronger and faster interaction with cells. The aim of the present in vitro study was to test the effect of plasma treatment on different graft materials. MATERIALS AND METHODS: Synthetic hydroxyapatite (Mg-HA), biphasic calcium phosphate (BCP), cancellous and cortical xenogeneic bone matrices (CaBM, CoBM) were used representing commonly used classes of bone substitute materials. Fifty serially numbered disks with a 10mm-diameter from each graft material were randomly divided into two groups: test group (argon plasma treatment) and control group (absence of treatment). Cell morphology (using pre-osteoblastic murine cells) and protein adsorption were analyzed at all samples from both the test and control group. Differences between groups were analyzed using the Mann-Whitney test setting the level of significance at p<0.05. RESULTS: Plasma treatment significantly increased the protein adsorption at all samples. Similarly, plasma treatment significantly increased cell adhesion in all groups. CONCLUSIONS: Data confirmed that non-atmospheric plasma of argon treatment led to an increase of protein adsorption and cell adhesion in all groups of graft material to a similar extent. CLINICAL RELEVANCE: Plasma of argon is able to improve the surface conditions of graft materials.

A Soup Service for Advanced Digestive Cancer Patients with Severe Anorexia in Palliative Care.

BACKGROUND/AIMS: The palliative care team (PCT), nutrition support team (NST), and department of nutrition in our hospital developed a special soup service for patients with terminal cancer. We evaluated the usefulness of this soup service for improving the mood in patients with advanced digestive cancer with severe anorexia. MATERIAL AND METHODS: We retrospectively reviewed the clinical data of 18 patients with advanced cancer originating in digestive organs who received soup service at our institution between 2015 and 2016. Members of the PCT, NST, and a licensed cook visited the bedside of each patient and served them a cup of soup twice a week. RESULTS: Fifteen patients (83%) were able to taste the soup with no adverse events, and 11 (73%) of them enjoyed the taste of the soup. In the five patients who died in our hospital during the service, the time between their last soup intake and death ranged from two to seven days (median three days). CONCLUSION: Even terminally ill patients suffering from advanced digestive cancer with severe anorexia were able to enjoy the taste of the soup served to them. The establishment of special meal service, such as this soup service, may not only relieve their stress but also support the strength of living and help improve their spiritual quality of life.

Prognostic psychosocial factors for disabling low back pain in Japanese hospital workers.

BACKGROUND: Although the occupational health field has identified psychosocial factors as risk factors for low back pain that causes disability, the association between disabling low back pain and psychosocial factors has not been examined adequately in Japanese hospital workers. Therefore, this study examined the association between low back pain, which interfered with work, and psychosocial factors in Japanese hospital workers. METHOD: This cross-sectional study was conducted at a hospital in Japan. In total, 280 hospital workers were recruited from various occupational settings. Of these, 203 completed a self-administered questionnaire that included items concerning individual characteristics, severity of low back pain, fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), somatic symptoms (Somatic Symptom Scale-8), psychological distress (K6), workaholism, and work-related psychosocial factors (response rate: 72.5%). Logistic regression was used to explore risk factors associated with disabling low back pain. RESULTS: Of the 203 participants who completed questionnaires, 36 (17.7%) reported low back pain that interfered with their work. Multivariate analyses with individual factors and occupations adjusted for showed statistically significant associations between disabling low back pain and fear-avoidance beliefs (adjusted odds ratio [OR]: 2.619, 95% confidence interval [CI]: 1.003-6.538], somatic symptoms (OR: 4.034, 95% CI: 1.819-9.337), and interpersonal stress at work (OR: 2.619, 95% CI: 1.067-6.224). CONCLUSIONS: Psychosocial factors, such as fear-avoidance beliefs, somatic symptoms, and interpersonal relationships at work, were important risk factors in low back pain that interfered with work in Japanese hospital workers. With respect to occupational health, consideration of psychosocial factors is required to reduce disability related to low back pain.

Amoxicillin-resistant oral streptococci identified in dental plaque specimens from healthy Japanese adults.

BACKGROUND: Infective endocarditis (IE) is known to be a life-threatening disease and invasive dental procedures are considered to be important factors. Oral amoxicillin (AMPC) is widely used for prophylaxis in patients with heart disorders who are at risk for IE. However, there is only limited information regarding the inhibition of oral bacteria by AMPC. METHODS AND RESULTS: Dental plaque specimens were obtained from 120 healthy Japanese adult subjects, then diluted and streaked onto selective medium for oral streptococci. The minimum inhibitory concentration (MIC) of AMPC was evaluated using a macro-dilution method by Clinical Laboratory Standard Institute (2006). Seven strains with an MIC of AMPC of 16µg/mL or more were isolated from 5 subjects. The bacterial species were confirmed by sequence analysis of 16S rRNA from each strain, which demonstrated that most were Streptococcus sanguinis, followed by Streptococcus oralis. Dental plaque specimens collected from these 5 subjects again after an interval of 2-3 months possessed no strains with an MIC of AMPC of 16µg/mL or more. CONCLUSIONS: These findings suggest that strains with a high MIC of AMPC are present in the oral cavities of Japanese adults, though they may be transient rather than inhabitants.

The collagen-binding protein of Streptococcus mutans is involved in haemorrhagic stroke.

Although several risk factors for stroke have been identified, one-third remain unexplained. Here we show that infection with Streptococcus mutans expressing collagen-binding protein (CBP) is a potential risk factor for haemorrhagic stroke. Infection with serotype k S. mutans, but not a standard strain, aggravates cerebral haemorrhage in mice. Serotype k S. mutans accumulates in the damaged, but not the contralateral hemisphere, indicating an interaction of bacteria with injured blood vessels. The most important factor for high-virulence is expression of CBP, which is a common property of most serotype k strains. The detection frequency of CBP-expressing S. mutans in haemorrhagic stroke patients is significantly higher than in control subjects. Strains isolated from haemorrhagic stroke patients aggravate haemorrhage in a mouse model, indicating that they are haemorrhagic stroke-associated. Administration of recombinant CBP causes aggravation of haemorrhage. Our data suggest that CBP of S. mutans is directly involved in haemorrhagic stroke.

Distribution of oral streptococci highly resistant to amoxicillin in dental plaque specimens from Japanese children and adolescents.

Oral streptococci are major pathogens of infective endocarditis. Prophylactic antibiotics are commonly given to subjects with certain kinds of heart disorders when invasive dental treatments are performed, with amoxicillin (AMPC) being widely used for this purpose. However, there is little information regarding AMPC-resistant oral streptococci. Here, a total of 344 dental plaque specimens collected from 253 healthy Japanese children, adolescents and young adults (aged 2-22 years) were diluted and streaked onto culture medium containing high-dose AMPC. The MICs for the isolated strains were evaluated using a macrodilution broth method described by the Clinical and Laboratory Standards Institute. Bacterial DNA was extracted from each strain and the entire sequences of the 16S rRNA gene were compared with those in GenBank to identify the species. The results showed that strains with AMPC MICs >16 µg ml(-1) were isolated from 18 specimens from 14 patients. Analyses of the 16S rRNA gene sequences of these strains identified them as major oral streptococcal species, including Streptococcus oralis and Streptococcus mitis. These findings indicate that oral streptococci with elevated MICs for AMPC exist in certain small populations of healthy children, and highlight the need for further studies to determine risk factors that lead to the appearance of such strains.

Potential of synchrotron X-ray powder diffractometry for detection and quantification of small amounts of crystalline drug substances in pharmaceutical tablets.

The purpose of this study was to develop a sensitive system for detection of crystalline drug substances in intact pharmaceutical tablets by X-ray powder diffractometry (XRPD), using synchrotron X-rays. Fenoprofen calcium dihydrate was used as a model compound. The wavelength and path length of X-rays from synchrotron radiation were optimized in order to maximize the potential of the synchrotron radiation. The optimum wavelength and path length for the measurement of fenoprofen calcium dihydrate were found to be 0.69817 Å and 6.0 mm, respectively, based on theoretical calculations. Under the optimized conditions, a limit of quantification of 0.05% (RSD=9.4%, n=3) and a limit of detection of 0.02% (RSD=17.3%, n=3), results which are approximately 10² times as sensitive as those obtained using conventional XRPD instruments, were achieved. The technique was also applied to fenoprofen calcium dihydrate detection in intact film-coated tablets, which contained Ti in the coating film, and a limit of detection of 0.02% was again attained.

Study of the pseudo-crystalline transformation from form i to form II of thiamine hydrochloride (vitamin B(1)).

The purpose of the current study was to evaluate the rate of the pseudo-crystalline transformation of thiamine hydrochloride form I to form II depending on the temperature and humidity. Changes in the appearance and weight of form I crystals were observed under humidified conditions using a water vapor sorption system equipped with a CCD camera. The form I crystals and tablets were stored under various temperature and humidity conditions (the saturation salt desiccator method), and the pseudo-crystalline transformation was observed using X-ray powder diffractometry with our laboratory equipment for drug substances and using synchrotron X-ray powder diffractometry for tablets. It was confirmed that the activation energy in the pseudo-crystalline transformation rate from form I to form II was dependent on humidity, and the calculated values were 121-155 kJ/mol at 70-90% relative humidity. Moreover, when thiamine hydrochloride was formulated as tablets, it was confirmed that the transformation rate was slower compared with the drug substances alone. The pseudo-crystalline transformation rate therefore declined after formulation in tablet form, perhaps due to the shielding effects of thiamine hydrochloride crystal from contact with water molecules by excipients, compaction, etc.

Successful application of atelocollagen for treatment of perforated teeth.

OBJECTIVE: Cervical or furcal root perforation is a serious clinical problem and one of its treatment modalities is perforation repair with composite resin. However, many cases still progress in inevitable extraction. When primary teeth are affected, early tooth loss can cause problems related to the eruption space for the permanent successors. The aim of the present study was to evaluate a novel clinical treatment method for perforated teeth. STUDY DESIGN: Atelocollagen was applied to perforated furcal and cervical areas of 13 primary teeth in 13 children aged 4-9 years and 8 permanent teeth in 8 adults aged 35-69 years after debridement with an electric knife. Thereafter the final restorations were performed after confirming good tooth conditions. Clinical evaluations were performed at follow-up examinations at approximately 3-month intervals. RESULTS: None of the treated primary teeth showed any clinical problems throughout the observation period, with eruption of the permanent successors noted in 7 cases. In the permanent teeth, no clinical problems were identified in any of the cases during follow-up periods of 10-60 months. CONCLUSION: This novel method may enable preservation of perforated primary teeth for a longer duration.

Solid-state 13C NMR study of indomethacin polymorphism.

The purpose of this study was to analyze the difference in the molecular conformation packed in the crystal lattice between the meta-stable alpha-form and stable gamma-form of indomethacin on the basis of solid-state (13)C NMR spectral patterns. The chemical shifts of each resonance of the alpha-form were distinctly different from the gamma-form. Each carbon nucleus of the gamma-form showed a single signal with no splitting. In contrast, carbon nuclei of the alpha-form showed a complicated set of resonances for each carbon. For some carbons of the alpha-form, four signals assigned to one carbon were observed at 203 K. Two of these four signals were merged between the temperature range from 203 to 343 K without a transformation in the crystal structure. It was found that solid-state (13)C NMR can be a powerful tool to estimate the number of molecular conformations as well as configurational differences in the packing of molecules in a unit cell.

Comparison of molecular mobility in the glassy state between amorphous indomethacin and salicin based on spin-lattice relaxation times.

PURPOSE: The purpose of the current study was to evaluate the molecular mobility of amorphous indomethacin and salicin in the relaxed glassy state based on spin-lattice relaxation times (T(1c)) and to clarify the effects of molecular mobility on their physical stability. METHODS: Pulverized glassy amorphous indomethacin and salicin samples were completely relaxed, and the T(1c) values were investigated using solid-state (13)C-nuclear magnetic resonance (NMR) at temperatures below the glass transition temperature (T(g)). All NMR spectra were obtained using the T(1c) measurement method combined with variable-amplitude cross-polarization, the Torchia method, and total sideband suppression method. RESULTS: The T(1c) value of amorphous indomethacin indicated that 73% of carbons were in a state of monodispersive relaxation, suggesting that the amorphous state was relatively homogeneous and restricted, particularly in backbone carbons. On the other hand, 92% of carbons of amorphous salicin exhibited both fast and slow biphasic relaxation. Individual structures of the salicin molecules behaved heterogeneously, and thus the entire molecule showed relatively fast local as well as slow mobility. CONCLUSIONS: At temperatures below T(g), amorphous salicin had relatively greater molecular mobility than amorphous indomethacin. This difference in the molecular mobility of the two compounds is correlated with their crystallization behavior. Solid-state (13)C NMR provides valuable information on the physical stability of amorphous pharmaceuticals.