A gross anatomical study of the styloid process of the temporal bone in Japanese cadavers.

BACKGROUND: The incidence of an elongated styloid process (SP) and average length and diameter of SP have not been reported using Japanese cadavers. Data on the female-to-male ratio of an elongated SP vary. We calculated the average length and diameter of SP in Japanese cadavers and compared SP lengths between sexes. MATERIALS AND METHODS: Twenty-seven sides (right and left of bodies) in males and 51 sides in females were analysed. Measurements were obtained from the inferior external acoustic meatus to the distal tip of the SP. SP diameters at the proximal base, midpoint, and distal tip were measured. SP > 30 mm was considered elongated. We used Welch's t-test for the statistical analysis. Fisher's exact two-tailed test was also performed to analyse the female-to-male elongation ratio. A p-value < 0.05 was considered statistically significant. RESULTS: Styloid process elongation prevalence was 29.5% in our sample. The average full length was 27.04 ± 7.88 mm overall; the average diameters were 5.41 ± 1.77 mm at the proximal base and 2.21 ± 1.22 mm at the distal tip. The average SP measurement was 26.81 ± 5.92 mm in males and 27.16 ± 8.79 mm in females (p = 0.74). The female-to-male ratio of SP elongation was 1:2 (p = 0.041). Females had longer full lengths of non-elongated SPs than males (p = 0.004). Males had wider diameters at the proximal base of elongated SPs than females (p = 0.017). CONCLUSIONS: The average length of SP was 27.04 mm in the Japanese population and about 30% of the Japanese presented SP ≥ 30 mm. Male had significantly higher rate than female among the SP ≥ 30 mm, and female had significantly longer SPs than male among the SP < 30 mm. Anatomically, the SP gets narrow as distally goes. Our anatomical findings would be beneficial to creating treatment plans, diagnosis, and surgery.

Variations in the gonadal artery with a single common trunk: embryological hypotheses by observation.

BACKGROUND: A gonadal artery originates as a branch of the abdominal aorta and renal artery inferior to the level of origin of the renal arteries. Variations in multiple right testicular arteries (RTAs) arising from the abdominal aorta are common. We aimed to re-evaluate the unusual courses of gonadal arteries with a single common trunk in relation to the inferior vena cava and left renal vein and explain the developmental anatomy. MATERIALS AND METHODS: The observational cross-sectional study was performed on 54 Japanese adult cadavers (29 men and 25 women). We examined the literature and developed embryological hypotheses on the single common trunk of the gonadal artery. RESULTS: The gonadal artery, testicular artery, and ovarian artery arose from the abdominal aorta in 93.1%, 96.3%, and 89.6% of cases, respectively, and from the renal artery in 4.9%, 3.7%, and 6.3% of cases, respectively. We found two rare variations in the RTAs observed during the routine dissection of two male cadavers; in these two cases, a single common trunk of the RTAs originated from the abdominal aorta. A single common trunk was found in 3.7% of cadavers, 2.0% of sides, and 2.0% of arteries in the gonadal artery and in 6.9% of cadavers, 3.8% of sides, and 3.7% of arteries in the testicular artery. All cases of the single common trunk, including those in past reports, were observed only in men. CONCLUSIONS: Knowledge of the variations in RTAs has important clinical consequences for invasive and non-invasive arterial procedures. In addition, this variation provides a new interpretation of the embryology of the gonadal artery. Variations similar to our findings have not been previously reported. Therefore, different variations concerning the RTA should be considered during surgical and non-surgical evaluations.

Majorana quantization and half-integer thermal quantum Hall effect in a Kitaev spin liquid.

The quantum Hall effect in two-dimensional electron gases involves the flow of topologically protected dissipationless charge currents along the edges of a sample. Integer or fractional electrical conductance is associated with edge currents of electrons or quasiparticles with fractional charges, respectively. It has been predicted that quantum Hall phenomena can also be created by edge currents with a fundamentally different origin: the fractionalization of quantum spins. However, such quantization has not yet been observed. Here we report the observation of this type of quantization of the Hall effect in an insulating two-dimensional quantum magnet1, α-RuCl3, with a dominant Kitaev interaction (a bond-dependent Ising-type interaction) on a two-dimensional honeycomb lattice2-7. We find that the application of a magnetic field parallel to the sample destroys long-range magnetic order, leading to a field-induced quantum-spin-liquid ground state with substantial entanglement of local spins8-12. In the low-temperature regime of this state, the two-dimensional thermal Hall conductance reaches a quantum plateau as a function of the applied magnetic field and has a quantization value that is exactly half of the two-dimensional thermal Hall conductance of the integer quantum Hall effect. This half-integer quantization of the thermal Hall conductance in a bulk material is a signature of topologically protected chiral edge currents of charge-neutral Majorana fermions (particles that are their own antiparticles), which have half the degrees of freedom of conventional fermions13-16. These results demonstrate the fractionalization of spins into itinerant Majorana fermions and Z2 fluxes, which is predicted to occur in Kitaev quantum spin liquids1,3. Above a critical magnetic field, the quantization disappears and the thermal Hall conductance goes to zero rapidly, indicating a topological quantum phase transition between the states with and without chiral Majorana edge modes. Emergent Majorana fermions in a quantum magnet are expected to have a great impact on strongly correlated quantum matter, opening up the possibility of topological quantum computing at relatively high temperatures.

Variations of the cephalic vein anterior to the clavicle in humans.

BACKGROUND: Clinicians should understand that jugulocephalic vein (JCV) variants may be occasionally found. This study aims to classify JCV variants and obtain their frequency. MATERIALS AND METHODS: We investigated anatomical variants of the cephalic vein in 55 human cadavers during a gross anatomy course at our medical school. RESULTS: The percentage of JCVs that pass through the anterior part of the clavicle and anastomose to the jugular vein as per previous studies and our study was 2-5%. Five cases with anastomosis between the cephalic and external jugular veins that pass through the anterior part of the clavicle were found. The courses were classified into 1A, 1B, 2A, and 2B. Type 1 extends beyond the clavicle and anastomoses with the external jugular vein. Type 2 follows the same course as type 1, but anastomoses with the subclavian vein. Subtype A does not have a branch that anastomoses with the axillary vein, whereas subtype B does. We encountered two cases of type 1A and three of type 1B. CONCLUSIONS: Four anatomical variants of the cephalic vein around the clavicle were identified. Clinicians' knowledge of these variants is expected to decrease possible complications if venous access via the cephalic vein is needed.

Three-dimensional analysis of the uniqueness of the anterior dentition in orthodontically treated patients and twins.

Dental uniqueness can be proven if no perfect match in pair-wise morphological comparisons of human dentitions is detected. Establishing these comparisons in a worldwide random population is practically unfeasible due to the need for a large and representative sample size. Sample stratification is an option to reduce sample size. The present study investigated the uniqueness of the human dentition in randomly selected subjects (Group 1), orthodontically treated patients (Group 2), twins (Group 3), and orthodontically treated twins (Group 4) in comparison with a threshold control sample of identical dentitions (Group 5). The samples consisted of digital cast files (DCF) obtained through extraoral 3D scanning. A total of 2.013 pair-wise morphological comparisons were performed (Group 1 n=110, Group 2 n=1.711, Group 3 n=172, Group 4 n=10, Group 5 n=10) with Geomagic Studio® (3D Systems®, Rock Hill, SC, USA) software package. Comparisons within groups were performed quantifying the morphological differences between DCF in Euclidean distances. Comparisons between groups were established applying One-way ANOVA. To ensure fair comparisons a post-hoc Power Analysis was performed. ROC analysis was applied to distinguish unique from non-unique dentures. Identical DCF were not detected within the experimental groups (from 1 to 4). The most similar DCF had Euclidian distance of 5.19mm in Group 1, 2.06mm in Group 2, 2.03mm in Group 3, and 1.88mm in Group 4. Groups 2 and 3 were statistically different from Group 5 (p<0.05). Statistically significant difference between Group 4 and 5 revealed to be possible including more pair-wise comparisons in both groups. The ROC analysis revealed sensitivity rate of 80% and specificity between 66.7% and 81.6%. Evidence to sustain the uniqueness of the human dentition in random and stratified populations was observed in the present study. Further studies testing the influence of the quantity of tooth material on morphological difference between dentitions and its impact on uniqueness remain necessary.

Common and separate origins of the left and right inferior phrenic artery with a review of the literature.

In a 94-year-old male cadaver, upon which routine dissection was being conducted, a rare variation was found in the gastrophrenic trunk (GPT), the common trunk of the left gastric artery (LGA), right inferior phrenic artery (RIPA), and left inferior phrenic artery (LIPA); the GPT arises from the abdominal aorta. A hepatosplenic trunk accompanied the variation. In this variation, the RIPA first branched from the GPT and then to the LIPA and LGA. Variations in the common trunk of the LIPA and RIPA in the GPT are common, but to our knowledge, a variation (separate inferior phrenic artery in the GPT) similar to our findings has not been previously reported. We discuss the incidence and developmental and clinical significance of this variation with a detailed review of the literature. Knowledge of such a case has important clinical significance for invasive and non-invasive arterial procedures. Therefore, different variations concerning the LGA and inferior phrenic artery should be considered during surgical and non-surgical evaluations.

The effect of potassium diclofenac and dexamethasone on MMP-1 gene transcript levels during experimental tooth movement in rats.

OBJECTIVES: The aim of this study was to analyze MMP-1 transcript levels in periodontal tissues of rats that underwent orthodontic treatment using potassium diclofenac and dexamethasone at different stages of tooth movement. SETTING AND SAMPLE POPULATION: The sample comprised of ninety male Wistar rats. MATERIAL AND METHODS: A closed nickel-titanium coil spring was used to apply a force of 50 cN to move the maxillary right first molars mesially. One group received daily doses of 0.9% saline solution, the second group received daily doses of 5 mg/kg potassium diclofenac, and the third group received daily doses of 0.5 mg/kg dexamethasone. Tooth movement was observed on days 0, 1, 3, 7, and 14. MMP-1 transcript levels were evaluated by real-time polymerase chain reaction and the results were compared between groups by three-way ANOVA, with a significance level of 0.05. RESULTS: Transcript levels increased in groups that received the coil spring treatment on all days of the experiment. MMP-1 expression was found to be decreased in groups treated with potassium diclofenac and dexamethasone compared to that in the control group, on days 1, 3, 5, and 7. CONCLUSIONS: The application of orthodontic forces significantly increased MMP-1 transcript levels. The use of anti-inflammatory drugs may have an inhibitory effect on MMP-1 expression.

Effect of organic solvents and ultrasound on the removal of orthodontic brackets.

OBJECTIVE: To evaluate the effect of organic gel solvents (70% acetone and 90% ethanol) and ultrasound in the removal of metallic brackets. MATERIALS AND METHODS: Metallic brackets were bonded with light-cured orthodontic composite (Transbond XT) in 120 human bicuspids and divided into 6 groups for the enamel etch-and-rinse adhesive system (XT) and 6 groups to self-etching system (SEPT) according to pretreatment to removal test: control, 70% acetone, 90% ethanol, ultrasound, 70% acetone+ultrasound, and 90% ethanol+ultrasound. The brackets were subjected to removal by shear testing and Adhesive Remnant Index (ARI) evaluation. Some specimens were prepared and its adhesive interface and etching ability observed by scanning electron microscopy (SEM). RESULTS: Only the factor 'ultrasound' and its interaction with 'adhesive' were detected as a source of variance, with the SEPT/ultrasound showing the lowest shear strength than the other groups. Regardless the factor 'ultrasound', XT showed a higher ARI than SEPT; however, when the solvents were used, no differences were detected between XT and SEPT. CONCLUSION: The organic solvents were not effective in reducing shear bond strength. The etch-and-rinse adhesive system showed a higher and more favorable ARI score than the self-etching primer. The behavior of the organic solvents on ARI showed to be better when associated with the self-etching primer. The ultrasound was effective in reducing the shear bond strength of the self-etching adhesive system but not in affecting the ARI of the adhesive systems.

Anomalous connection of the left posterior renal vein with the left ascending lumbar vein in a Japanese cadaver.

A rare variation was found in one of the two left renal veins in a 94-year-old male cadaver undergoing routine dissection. The characteristic findings in the cadaver included, in addition to the primary left renal vein, the presence of a posterior left renal vein draining to the left ascending lumbar vein without communicating with the inferior vena cava and other renal veins. Variations in the number and arrangement of the vessels terminating in the renal veins are common, but to our knowledge, variation similar to our findings has not been previously reported. This variation may represent an immature form of the complicated development of the renal vessels.

A finite element analysis of the maxillary first molar PDL with maxillary protraction in a mixed dentition Class III malocclusion.

OBJECTIVES: To analyze the stress distribution on the PDL of the maxillary first molar in a mixed dentition Class III malocclusion, using a Hyrax-type appliance and maxillary protraction. SETTING AND SAMPLE POPULATION: A Class III malocclusion in the mixed dentition was reconstructed based on CBCT images. MATERIAL AND METHODS: The 3D FEM comprised the maxilla, alveolar bone, right first permanent molar teeth, and PDL and consisted of 1 133 497 nodes and 573 726 elements. Maxillary protraction force was applied to a hook positioned close to the deciduous canines with 600 g and at 15°, 30°, and 45° downward angles to the maxillary occlusal plane. RESULTS: Analysis was carried out from the top and buccal view of the sagittal plane. The magnitude of the stresses at 15°, 30°, and 45° of protraction angulation resulted in the highest stress magnitude being in the region between the distobuccal and palatal roots, as well as on the distal surface of the mesial root. The vector direction in this area showed traction and mesial movement. With 30° and 45° protraction angulations, the stress was located only between the distobuccal and palatal roots, and the vector direction was more extrusive at 15°. CONCLUSIONS: The suggested orthodontic movement is in the mesial direction with a small amount of extrusion with 15° angulation and greater extrusion with 30° and 45°.

Comparison of fully automated and semi-automated biopsy needles for lung biopsy under CT fluoroscopic guidance.

OBJECTIVE: The aim of this study was to compare two different automated biopsy needles, a fully automated biopsy needle (Monopty; Bard, Covington, GA) and a semi-automated biopsy needle (Temno; Bauer Medical, Clearwater, FL), for lung biopsy. METHODS: 50 consecutive percutaneous lung biopsies using the Monopty needle between June 2006 and January 2007 and 66 consecutive lung biopsies for 1 nodule in each session using the Temno needle between February 2007 and August 2008 were performed under CT fluoroscopic guidance followed by histopathological evaluation. RESULTS: In 42/50 lung biopsies performed with the Monopty needle and 54/66 lung biopsies performed with the Temno needle, the final diagnosis was confirmed by independent surgical pathological findings or clinical follow-up. Sufficient samples for histopathological evaluation were obtained in all 50 (100%) biopsies using the Monopty needle and in 55 (83.3%) of the 66 biopsies using the Temno needle (p<0.01). Accurate diagnosis was achieved in 41 (97.6%) of 42 biopsies using the Monopty needle and in 45 (83.3%) of 54 biopsies using the Temno needle (p=0.04). Biopsy-induced complications were pneumothorax, haemoptysis and haemothorax in 44.0%, 10.0% and 6.0% of biopsies, respectively, using the Monopty needle and in 48.3%, 8.3% and 3.3%, respectively, using the Temno needle. CONCLUSION: There is a possibility that a fully automated biopsy needle such as the Monopty is more useful for CT scan-guided lung biopsy than semi-automated biopsy needles.

Hepatic artery-targeting guidewire technique during transjugular intrahepatic portosystemic shunt.

OBJECTIVE: This study evaluated the feasibility and safety of the transjugular intrahepatic portosystemic shunt (TIPS) procedure using the hepatic artery-targeting guidewire technique for the puncture step. METHODS: We retrospectively reviewed 11 consecutive patients (5 men and 6 women, aged 46-76 years (mean 64 years)) with portal hypertension in whom the TIPS procedure was performed. As the first step in the TIPS procedure in all cases, a micro-guidewire was inserted into the hepatic arterial branch accompanying the portal venous branch through a microcatheter coaxially advanced from a 5-French catheter positioned in the coeliac or common hepatic artery. At the puncture step, the tip of the metallic cannula was aimed 1 cm posterior to the distal part of this micro-guidewire, after which the TIPS procedure was performed. Success rate, number of punctures and complications were evaluated. RESULTS: The TIPS procedure was successfully performed in all 11 patients. The mean number of punctures until success in entering the targeted portal venous branch was 5 (range 1-14). In 3 patients (27%), the right portal venous branch was entered at the first puncture attempt. The hepatic artery was punctured once in one patient and the bile duct was punctured once in another patient. No serious procedure-induced complications occurred. CONCLUSION: The TIPS procedure can be accomplished safely, precisely and relatively easily using the hepatic artery-targeting guidewire technique.

Effect of chlorhexidine mouth rinse on Streptococci counts of tooth-tissue-borne palatal expander biofilm.

OBJECTIVES: To assess total Streptococci (TS) counts and biofilm mass over tooth-tissue-borne palatal expander (TTBPE), as well as the effect of chlorhexidine (CHX) mouth rinse on these variables. DESIGN: A cross-sectional study design employed clinical procedures and laboratorial techniques. SETTING AND SAMPLE POPULATION: Patients who had TTBPE removal indicated were divided into two groups: a CHX group (n = 26) in which three times a day of 0.2% CHX digluconate mouth rinses were prescribed 7 days before TTBPE removal; and a control (CON) group (n = 25) in which no antimicrobial treatment was applied. EXPERIMENTAL VARIABLE: 'Gender', 'Age', and 'TTBPE wear time' were recorded. After TTBPE removal, biofilm mass was determined by the difference between (TTBPE + biofilm) and (TTBPE only) masses. TS counts were determined by biofilm suspension followed by progressive dilutions and culture on Mitis Salivarius agar with incubation at 37 degrees C for 72 h. OUTCOME MEASURE: Biofilm mass (mg) and Colony Forming Units of TS / mg of biofilm (CFU-TS / mg) were calculated. Results - Total Streptococci mean values in CHX (6.77 x 10(6)CFU-TS / mg) were statistically lower (p < 0.01) than those in CON (3.82 x 10(7)CFU-TS / mg), but there was no statistical difference (p > 0.05) between CHX (168.88 mg) and CON (182.04 mg) masses nor statistical correlation (p > 0.05) between biofilm mass and CFU-TS / mg in the two groups. CONCLUSION: Chlorhexidine reduces the TS counts in TTBPE, but has no effect on biofilm mass.

Should balloon-occluded retrograde transvenous obliteration be the first-line interventional radiologic treatment for bleeding duodenal varices? A case report and review of the literature.

We report a 78-year-old woman who presented with repeated tarry stools, and having lower duodenal variceal bleeding caused by portal hypertension. Endoscopic therapy had been attempted, but was impossible because the endoscope could not be inserted into the lower duodenum. Thus, the lower duodenal variceal bleeding was treated with balloon-occluded retrograde transvenous obliteration in combination with embolization using microcoils. Complete hemostasis was achieved without complications, and neither the recurrence of varices nor rebleeding has occurred for the last 3 years. A review of the English-language literature reveals only 11 such cases. The world literature is reviewed.

Expression of ATP sensitive K+ channel subunit Kir6.1 in rat kidney.

ATP-sensitive K+ (K(ATP)) channels in kidney are considered to play roles in regulating membrane potential during the change in intracellular ATP concentration. They are composed of channel subunits (Kir6.1, Kir6.2), which are members of the inwardly rectifying K+ channel family, and sulphonylurea receptors (SUR1, SUR2A and SUR2B), which belong to the ATP-binding cassette superfamily. In the present study, we have investigated the expression and localization of Kir6.1 in rat kidney with Western blot analysis, immunohistochemistry, in situ hybridization histochemistry, and immunoelectron microscopy. Western blot analysis showed that Kir6.1 was expressed in the mitochondria and microsome fractions of rat kidney and very weakly in the membrane fractions. Immunohistochemistry revealed that Kir6.1 was widely distributed in renal tubular epithelial cells, glomerular mesangial cells, and smooth muscles of blood vessels. In immunoelectron microscopy, Kir6.1 is mainly localized in the mitochondria, endoplasmic reticulum (ER), and very weakly in cell membranes. Thus, Kir6.1 is contained in the kidney and may be a candidate of mitochondrial K(ATP) channels.

Spontaneous healing of chyle leakage after lymphangiography.

We report a 34-year-old man with the complication of chylous ascites after retroperitoneal lymphadenectomy that was refractory to various conservative therapies. Because surgical treatment for chylous ascites was considered, lymphangiography was performed to identify the area of leakage of chyle, after which the chylous ascites spontaneously healed.

Intrahepatic portosystemic venous shunt passing through the left inferior phrenic vein and draining into the left renal vein.

We report a case of an intrahepatic portosystemic venous shunt (IPSVS) passing through the left inferior phrenic vein and draining into the left renal vein and then to the inferior vena cava. We incidentally detected the IPSVS while performing a transcatheter arterial embolisation for the treatment of hepatocellular carcinoma. IPSVS with the left inferior phrenic vein as the draining vein is very rare. The complete pathway of this IPSVS could be clearly demonstrated by multidetector row CT during arterial portography.

Retrievable vena cava filter placement during treatment for deep venous thrombosis.

The purpose of our study is to evaluate the safety of insertion and removal of the retrievable vena cava filter and the efficacy of this filter in preventing pulmonary embolism during treatment of stenosis or obstruction of the lower extremity due to deep venous thrombosis. We retrospectively evaluated placement of 10 filters in 6 patients with lower extremity deep venous thrombosis who had undergone various treatments, including those utilizing techniques of interventional radiology. Worsening of or the new formation of pulmonary embolism was prevented in all patients. All attempts at both implantation and retrieval of the filter were safely accomplished. No complication related to filter placement occurred. Filters were left in the vena cava for permanent use when deep venous thrombosis was refractory to treatment. These results demonstrate that both placement and removal of the retrievable vena cava filter can be accomplished safely and that this type of filter is useful to prevent pulmonary embolism during treatment of deep venous thrombosis of the lower extremity. Further, the use of a retrievable vena cava filter might be preferred over that of a temporary vena cava filter, especially if further implantation of a filter becomes necessary since replacement with a permanent filter would not be required when using a retrievable vena cava filter.

Brain infarction after percutaneous implantation of port-catheter system via the left subclavian artery.

The aim of this study was to evaluate the incidence of brain infarction after percutaneous implantation of a port-catheter system via the left subclavian artery for hepatic arterial infusion chemotherapy. In 90 patients with inoperable liver cancer, a port-catheter system was implanted via the left subclavian artery. In 5 patients (5.6%) brain infarction occurred after port-catheter implantation. In one patient (1.1%) thrombi formed around the catheter, as confirmed by autopsy. The risk of brain infarction should be taken into consideration when a trans-left subclavian arterial access route is used for the percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy.

Identification of a component that induces flowering of Lemna among the reaction products of alpha-ketol linolenic acid (FIF) and norepinephrine.

A stress-induced fatty acid [FIF; 9-hydroxy-10-oxo-12(Z),15(Z)-octadecadienoic acid] incubated with (-)-norepinephrine (NE) strongly induces flower formation in Lemna paucicostata [Yokoyama et al. (2000), Plant Cell Physiol. 41: 110). The increase of flower-inducing activity was well correlated with the decrease in FIF in the incubation mixture, and the reaction proceeded rapidly at higher pH. We detected small amounts of many active components in the mixture after incubation by HPLC analysis. In this study, two major components, named FN1 and FN2, of the reaction mixture were isolated, and their absolute stereostructures were determined. FN1 showed a strong flower-inducing activity and was identified as a tricyclic alpha-ketol fatty acid, 9(R)-11-[(2'R,8'R,10'S,11'S)-2',8'-dihydroxy-7'-oxo-11'-[(Z)-2-pentenyl]-9'-oxa-4'-azatricyclo[6.3.1.0(1.5)]dodec- 5'en-10'-yl]-9-hydroxy-10-oxoundecanoic acid [corrected]. FN2, the C-9 epimer of FN1, showed no flower-inducing activity. The absolute stereostructure of FIF was also determined by a modification of Mosher's method. The 9-hydroxyl group was found to be predominantly 9R, with an enantiomeric excess of 40% (70% 9R and 30% 9S). FN1 was derived from 9R-type FIF and FN2 from 9S-type FIF. Various catecholamines and related substances were investigated for the ability to develop flower-inducing activity upon incubation with FIF. The essential structures were catechol and ethylamine groups (dopamine).