Pelvic arterial embolisation with cyanoacrylate during caesarean hysterectomy for placenta accreta.

PURPOSE: To compare n-butyl cyanoacrylate (NBCA) and gelatine sponge (GS) as embolic materials for prophylactic pelvic arterial embolisation during caesarean hysterectomy for placenta accreta spectrum (PAS). MATERIAL AND METHODS: This retrospective study comprised 12 women (age range, 23-42 years; mean, 34.1 years) who underwent caesarean hysterectomy for PAS. Following caesarean delivery, bilateral uterine and non-uterine parasitic arteries were embolized with GS in the first four cases (GS group) and primarily with NBCA mixed with iodized oil in the subsequent eight cases (NBCA group). Procedure time for embolisation and hysterectomy and total blood loss were compared between the two groups using Welch's t-test. RESULTS: Although procedure time for embolisation tended to be longer in the NBCA group than in the GS group (111 ± 47 min versus 71 ± 32 min, p=.11), that for hysterectomy was significantly reduced in the NBCA group when compared to the GS group (158 ± 42 min versus 236 ± 39 min, p=.02). Total blood loss was significantly lower in the NBCA group than in the GS group (1375 ± 565 mL versus 2668 ± 587 mL, p=.01). CONCLUSION: Procedure time for hysterectomy and total blood loss during caesarean hysterectomy can be reduced by using NBCA instead of GS in prophylactic pelvic arterial embolisation for PAS.

Angiogenesis and new bone formation in novel unidirectional porous beta-tricalcium phosphate: a histological study.

Affinos® (Kuraray Co., Ltd., Tokyo, Japan) is a beta-tricalcium phosphate (TCP) artificial bone comprising a novel unidirectional porous structure with 57% porosity. This study examined angiogenesis and bone formation over time with unidirectional porous beta-TCP (UDPTCP). Ten Japanese White rabbits were used in this study. A 5 × 8-mm rectangular area of periosteum was resected, followed by preparation of a cortical bone defect using a high-speed bur. UDPTCP was embedded in the defect in the direction of the pores, parallel to the axis of the tibia. Tissue samples were harvested at 2 weeks (n = 3) and 6 weeks (n = 7) after implantation. Just before euthanasia, the vasculature of the lower limb was perfused with saline from the femoral artery and filled with MICROFIL® (Flow Tech, Inc., Carver, MA) to create a vascular cast. The tibia was cut longitudinally at the center of the material. Decalcified sagittal sections treated with hematoxylin and eosin staining, undecalcified sagittal sections treated with Villanueva-Goldner staining, and axial unstained sections were used for histological evaluation. The lengths of the largest vessels and newly formed bone at the material border were measured in a sagittal section. Both lengths were significantly larger at 6 weeks than at 2 weeks. In the axial sections at 2 weeks, newly formed vessels filled with blue dye grew along the pores of the UDPTCP. Mature bone tissue with a lamellar structure was observed at 6 weeks. Our histological findings demonstrated that angiogenesis and bone formation occur over time in UDPTCP.

Saliva amylase as a measure of sympathetic change elicited by autogenic training in patients with functional somatic syndromes.

The aim of this study was to discuss the effect of autogenic training (AT) on patients with functional somatic syndrome (FSS) using salivary amylase, the skin temperature of the finger, subjective severity of symptoms, and psychological characteristics as measures. We assessed 20 patients with FSS and 23 healthy controls before and after AT. Baseline levels of salivary amylase prior to an AT session were significantly higher in the FSS group than in the control group. However, this difference was not significant after AT. The skin temperature of the finger increased after AT in both the FSS and control groups. AT contributed to the improvement of somatic symptoms in patients with FSS. Our results regarding psychological characteristics suggest that mood disturbances are deeply involved in the pathology of FSS. Individuals with FSS exhibited elevated levels of sympathetic activity compared with healthy controls. Our data indicates that AT eased dysregulation of the autonomic nervous system in patients with FSS. Thus, salivary amylase may be a useful index of change induced by AT in patients with FSS.

Causes of persistent joint pain after arthrocentesis of temporomandibular joint.

PURPOSE: The present study was undertaken to elucidate the factors responsible for the failure of arthrocentesis to cure persistent joint pain in patients with nonreducing articular disc displacement in the temporomandibular joint (TMJ). PATIENTS AND METHODS: Thirty-six patients with internal derangement of the TMJ were selected. Magnetic resonance imaging was used to examine the configuration and position of the articular discs, cortical changes, and bone marrow abnormalities in the condyle and the presence of joint effusion. Arthrocentesis was then performed, and the patients were followed for 6 weeks. The results were then classified as poor or improved. RESULTS: The effects of arthrocentesis did not depend on the configuration of the disc, disc position and motion, or bone marrow abnormalities. Joints with no or minimal amounts of joint effusion achieved a good response to arthrocentesis. Joints with erosive cortical changes of the condyle were less responsive to arthrocentesis. CONCLUSION: Persistent joint pain after arthrocentesis is generally associated with extensive amounts of joint effusion or erosive cortical changes of the condyle.

Unidirectional porous ß-tricalcium phosphate induces bony fusion in lateral lumbar interbody fusion.

Lateral lumbar interbody fusion (LLIF) often requires the use of allograft or artificial bone. We used ß-tricalcium phosphate artificial bone with a porosity of 57% consisting of a novel unidirectional porous structure (Affinos®) in patients (5 male and 9 female) who underwent LLIF from August 2015 as a substitute for autologous bone. We evaluated 60 graft windows in the cages at 30 intervertebral levels. To evaluate interbody bony fusion, CT multi-planar reconstruction coronal and sagittal images obtained 1 year after surgery were assessed. Intra-cage bony fusion was observed in 39 of 60 graft windows and so total bony fusion rate was 65%. Intra-cage bony fusion was confirmed in 17 of 29 (58.6%) graft windows with autologous bone and 22 of 31 (70.9%) graft windows with Affinos®. There was no significant difference in the rate of bony fusion between autologous bone and Affinos® (p = 0.418). In conclusion, the rate of bony fusion using Affinos® in LLIF cages was not inferior to that using autologous bone graft. Affinos® is a candidate for graft material in LLIF surgery and further exploration is warranted.

Bone bonding, displacement, and absorption in cases of double-door laminoplasty with unidirectional porous hydroxyapatite spacers.

We used a newly developed, high-porosity unidirectional porous hydroxyapatite spacer (Regenos spacer, not approved by the FDA). To assess the short-term bone bonding capacity of Regenos spacer used in a double-door laminoplasty, including displacement, deformation, and absorption after implantation. Fifty patients underwent a double-door laminoplasty using Regenos spacers, with computed tomography (CT) images obtained at 2-4 weeks and 6-12 months, post-surgery, in 30 patients. Bone bonding rate, amount of displacement, and the incidence of deformation and absorption were evaluated from the early and late postoperative CT images. Bone bonding rate for Regenos spacers, using our modified classification, was 48.9% at 6 months, post- surgery, and 67.0% at 12 months. The change in anterior-posterior diameter of the spinal canal (ΔH) was significantly greater for Regenos spacers than for autologous bone spacers (p < 0.05). There was no difference in the change in angle between the vertebral arch and the posterior wall of the vertebral body (ΔR) between the Regenos and autologous bone spacers. Deformation was identified in 21.3% (10/47). Though, no evidence of breakage along their long axis was identified among these 10 cases on axial CT images with passable clinical results. Regenos spacers lowered the risk of early dislocation after implantation and facilitated bone bonding due to infiltration of surrounding tissue. However, the deformation and absorption was observed at high rates because of their insufficient mechanical strength, we need to require a longer term follow-up to more clearly evaluate their adverse impact in clinically.

Efficacy of a new jet nozzle for removal of carious dentin with an air abrasion system.

A new version of an air abrasion device, which expelled abrasive sodium bicarbonate powder, was fabricated to remove carious tissue. This device had a motor-driven mechanism to control the amount of powder expelled. The purpose of this study was to estimate the abrading efficacy of this device, in particular the new jet nozzle, for removal of carious dentin. Powder was supplied to the handpiece by a rotary gear attached to the powder control motor. Two types of jet nozzles, a cylinder-type and a bugle-type, were fabricated and evaluated. The duct of bugle-type nozzle had an isthmus to increase the air pressure on the powder and to spread it out in a cone-shaped flow. Results obtained showed that the bugle-type jet nozzle exhibited a more prominent abrasive capability. Compared to the cylinder-type nozzle, it was thus more effective in removing the carious dentin which remained in the undercut region of the cavities.

Dietary inflammatory index and risk of upper aerodigestive tract cancer in Japanese adults.

BACKGROUND: The inflammatory potential of diet that has been shown to be associated with cancer risk. We examined the association between dietary inflammatory potential as measured by the dietary inflammatory index (DII®) and risk of upper aerodigestive tract cancers in a Japanese case-control study. RESULTS: A positive association was observed between increasing DII scores and overall upper aerodigestive tract cancers, and across anatomic subsites. For upper aerodigestive tract cancers, the ORQ4vsQ1 = 1.73 (95% CI: 1.37-2.20); head and neck cancer, the ORQ4vsQ1 was 1.92 (95% CI: 1.42-2.59); and for esophageal cancer, the ORQ4vsQ1 was1.71 (95% CI: 1.54-1.90). Risks for hypopharyngeal and nasopharyngeal cancers were greatly elevated: (ORQ4vsQ1 = 4.05 (95% CI: 1.24-13.25) for hypopharyngeal cancer and ORQ4vsQ1 = 4.99 (95% CI: 1.14-21.79) for nasopharyngeal cancer. CONCLUSION: A more pro-inflammatory diet was associated with an elevated risk of upper aerodigestive tract cancers after accounting for important confounders. All anatomic subsites, except larynx, showed the consistently elevated risk with increasing DII score. Those subsites with known etiological associations with persistent infection showed the largest elevation in risk. These results warrant further evaluation in future studies. MATERIALS AND METHODS: This is a case-control study of 1,028 cases and 3,081 age- and sex-matched non-cancer controls recruited at Aichi Cancer Center. DII scores were computed based on estimates of macro- and micro-nutrients from a self-administered food frequency questionnaire. Scores were further categorized into quartiles (based on the distribution in controls). Conditional logistic regression models were fit to estimate odds ratio (OR) and 95% confidence intervals (CIs) adjusted for smoking, ethanol consumption, alcohol flushing, number of teeth, and occupation group.

Establishment of an Animal Model of Bisphosphonate-Related Osteonecrosis of the Jaws in Spontaneously Diabetic Torii Rats.

BACKGROUND: We evaluated the side effects of bisphosphonate (BP) on tooth extraction socket healing in spontaneously diabetic Torii (SDT) rats, an established model of non-obese type 2 diabetes mellitus, to develop an animal model of BP-related osteonecrosis of the jaws (BRONJ). MATERIALS AND METHODS: Male Sprague-Dawley (SD) rats and SDT rats were randomly assigned to the zoledronic acid (ZOL)-treated groups (SD/ZOL or SDT/ZOL) or to the control groups (SD/control or SDT/control). Rats in the SD/ZOL or SDT/ZOL groups received an intravenous bolus injection of ZOL (35 µg/kg) every 2 weeks. Each group consisted of 6 rats each. Twenty-one weeks after ZOL treatment began, the left maxillary molars were extracted. The rats were euthanized at 2, 4, or 8 weeks after tooth extraction, and the total maxillae were harvested for histological and histochemical studies. RESULTS: In the oral cavity, bone exposure persisted at the tooth extraction site in all rats of the SDT/ZOL group until 8 weeks after tooth extraction. In contrast, there was no bone exposure in SD/control or SDT/control groups, and only 1 of 6 rats in the SD/ZOL group showed bone exposure. Histologically, necrotic bone areas with empty lacunae, microbial colonies, and less invasion by inflammatory cells were observed. The number of tartrate-resistant acid phosphatase-positive osteoclasts was lower in the SDT/ZOL group than in the SD/control group. The mineral apposition rate was significantly lower in the SDT/ZOL group compared with the SD/control group. CONCLUSIONS: This study demonstrated the development of BRONJ-like lesions in rats and suggested that low bone turnover with less inflammatory cell infiltration plays an important role in the development of BRONJ.

Theophylline attenuates hippocampal blood flow responses induced by tooth pulp stimulation in rats.

In this study, we performed tests to determine whether tooth pulp stimulation (TPS) increases hippocampal blood flow (HBF), and if so, to investigate whether the increase in HBF is mediated via the activation of adenosine receptors. We measured HBF in urethane-anesthetized rats using laser Doppler flowmetry (LDF) and examined the effect of theophylline, a nonselective adenosine receptor antagonist, on TPS-induced HBF responses. TPS increased HBF, and its response was significantly attenuated by the intraperitoneal administration of theophylline (20 mg/kg). These results suggest that the HBF response induced by TPS may be, at least in part, produced through adenosine receptors.