Multidisciplinary perioperative management in dilatation and evacuation for a giant hydatidiform mole: A case report.

Gestational trophoblastic disease (GTD) is an abnormal pregnancy caused by the placenta, which can potentially metastasise. Suction evacuation is recommended for diagnosis and treatment, and dilatation and evacuation (D&E) is usually performed under intravenous anaesthesia due to the short operation time and minimal blood loss. We refer to the guidelines produced by the Japan Society of Obstetrics and Gynaecology (JSOG), and acknowledge that practices vary globally. However, to the best of our knowledge, there is no evidence on perioperative management and arrangements in D&E required for managing giant hydatidiform moles, such as preventing massive haemorrhage, respiratory dysfunction with a pathogenesis like ovarian hyperstimulation syndrome (OHSS), or intensive care needs. This case report describes perioperative considerations for managing a giant hydatidiform mole using D&E in a uterus enlarged to the third-trimester pregnancy size. A 28-year-old multiparous woman was clinically diagnosed with a hydatidiform mole after a spontaneous miscarriage due to abnormal genital bleeding, systemic oedema, and abdominal distention. Ultrasound and computed tomography showed a ballooning uterus with a third-trimester pregnancy size, a robust intrauterine mass, and ascites. Serum hCG levels were extremely high (>3,000,000 mIU/mL), confirming the clinical diagnosis of a hydatidiform mole. Emergency D&E was safely performed under multidisciplinary perioperative management, with careful preparation and support. This is a rare experience-based case report and valuable documentation detailing multidisciplinary perioperative management under general anaesthesia. To the best of our knowledge, this is the first report describing the considerations, details, and innovations required in the perioperative management of giant hydatidiform moles using D&E.

Standard Values and Concurrent Validity of a Newly Developed Occlusal Force-Measuring Device among Community-Dwelling Older Adults: The Otassha Study.

Recently, an occlusal force-measuring device with a capacitive-type pressure-mapping sensor (OFMD-CPS) was developed. We aimed to establish age- and sex-specific standard values for OFMD-CPS-measured occlusal force (OF) and to assess the concurrent validity of the OFMD against another OF measuring system with a pressure-sensitive sheet (Dental Prescale II). Using data from a population-based study, we calculated the OFMD-CPS-measured OF means and deciles in 5-year age groups for each sex. The OFMD-CPS-measured OF was validated against the Dental Prescale II-measured OF with Spearman correlation coefficients. Furthermore, we calculated the area under the receiver operating characteristic curve (AUC) against the preexisting Dental Prescale II-measured OF cutoff value of 350 N. In total, 596 individuals (236 men and 360 women) with a mean (standard deviation (SD)) age of 73.7 (6.7) years were included in the analyses. The mean (SD) OFMD-CPS-measured OFs were 581.6 (284.6) N in men and 446.9 (209.9) N in women. There was a strong positive correlation (Spearman's Rho = 0.73) between OFMD-CPS-measured and Dental Prescale II-measured OF. The diagnostic accuracy of the OFMD-CPS-measured OF for the Dental Prescale II-measured OF cutoff value was high (AUC = 0.88). In conclusion, we demonstrated standard values and concurrent validity of OFMD-CPS-measured OF in community-dwelling older adults.

Capacitive-Type Pressure-Mapping Sensor for Measuring Bite Force.

Bite force is an important indicator of masticatory performance. However, existing methods for measuring bite force are either ineffective or expensive. Hence, we developed a novel capacitive-type pressure-mapping sensor that converts mechanical forces into changes in capacitance and calculates bite force. A portable device was fabricated based on this sensor sheet, and the accuracy of the bite-force measurements provided by the device was evaluated. The sensor has a thickness of 1.6 mm and has 63 measurement points. It was inserted into a dental model, where the output value was measured and compared with that of a universal testing machine (AG-IS 100 kN). A regression equation to estimate the bite force was obtained based on the relationship between the output of the capacitive-type pressure-mapping sensor and that of the load cell of the universal testing machine. The estimated bite force from the sensor and the quadratic regression equation closely resembled the known load applied by the compression tester (R2 = 0.992). We therefore conclude that the developed sensor can measure bite force accurately and effectively. A device with a built-in capacitive-type pressure-mapping sensor can potentially be a user-friendly tool for bite-force measurements in both clinical and epidemiological settings.

[A LONG PROSPECTIVE OBSERVATIONAL STUDY ON PREVALENCE OF ATOPIC DERMATITIS IN EARLY CHILDHOOD TO ADOLESCENCE].

BACKGROUND: There are few prospective observational studies on the prevalence of atopic dermatitis (AD) in children. We aimed to prospectively investigate the dynamics of change in the prevalence of AD from early childhood to adolescence. METHODS: We conducted a survey with a modified questionnaire to diagnose AD based on The International Study of Asthma and Allergies in Childhood questionnaire with 1230 13-year-old children who were born in the Minami ward, Yokohama City between May 2004 and June 2005 and had undergone physical examinations by dermatologists at 3 years of age. Among the 422 children who answered the questionnaire, 210 had undergone periodic physical examinations by dermatologists from 4 months to 3 years of age (Cohort 1), whereas 212 had undergone physical examinations only at 3 years of age (Cohort 2). RESULTS: The prevalence of AD was 16.9% in 422 children at 13 years of age, with 22.9%, 16.6%, 20.0% and 18.3% prevalence at 4 months, 18 months, 3 years and 13 years of age, respectively, in children who were followed up long-term. The frequency of AD occurrence per year decreased after the age of 3 years; a history of AD at this age was significantly related to AD at 13 years of age (Fisher's exact test, p<0.001). CONCLUSION: In conclusion, it was suggested that AD in 3-year-old children is one of the risk factors for the development of AD in 13-year-old children.

Nuclear receptor-mediated transcriptional regulation in Phase I, II, and III xenobiotic metabolizing systems.

Studies of the genetic regulation involved in drug metabolizing enzymes and drug transporters are of great interest to understand the molecular mechanisms of drug response and toxic events. Recent reports have revealed that hydrophobic ligands and several nuclear receptors are involved in the induction or down-regulation of various enzymes and transporters involved in Phase I, II, and III xenobiotic metabolizing systems. Nuclear receptors (NRs) form a family of ligand-activated transcription factors (TFs). These proteins modulate the regulation of target genes by contacting their promoter or enhancer sequences at specific recognition sites. These target genes include metabolizing enzymes such as cytochrome P450s (CYPs), transporters, and NRs. Thus it was now recognized that these NRs play essential role in sensing processing xenobiotic substances including drugs, environmental chemical pollutants and nutritional ingredients. From literature, we picked up target genes of each NR in xenobiotic response systems. Possible cross-talk, by which xenobiotics may exert undesirable effects, was listed. For example, the role of NRs was comprehensively drawn up in cholesterol and bile acid homeostasis in human hepatocyte. Summarizing current states of related research, especially for in silico response element search, we tried to elucidate nuclear receptor mediated xenobiotic processing loops and direct future research.

Structures of platinum(II) complexes of 2-aminomethylaziridine and S-2-aminomethylazetidine and correlation of anticancer activities of (2-aminomethylazacycloalkane)platinum(II) complexes with the geometry of the chelate rings formed with platinum(II).

The spectroscopic properties of platinum(II) complexes with 2-aminomethyl-derivatives of small-membered 1-aza-cycloalkane, i.e., =2-aminomethylaziridine=azida and S-2-aminomethylazetidine=S-azeda, and the crystal structures of their dichloro complexes demonstrate that the conformation of the fused three- (azida) or four- (S-azeda) and five-membered chelate ring formed by the coordination of S-azida and S-azeda to platinum(II) has an S(N) absolute configuration at the secondary amine site and that the two alkyl groups extend axially from the five-membered chelate ring. The chelate ring of the azida is more planar than the S-azeda or other 2-aminomethyl-1-azacycloalkanes. The anticancer activity reported for azeda and 2-aminomethylpyrrolidine appears to be related to their coordination structure, namely the presence of cis-fused successive rings.