Successful pregnancy using immature oocytes retrieved from resected borderline ovarian tumor: a case report and literature review.

BACKGROUND: Despite the recent progress of fertility preservation technique, achievement of pregnancy in women with ovarian tumor is still challenging. Here, we report a case of OTO-IVM (ovarian tissue oocyte in-vitro maturation) resulting in a successful delivery. CASE PRESENTATION: The patient, a 33-year-old woman with a history of left borderline ovarian tumor (BOT) who underwent left salpingo-oophorectomy three years ago, presented with an enlarged right ovary during infertility treatment, indicating the recurrence of BOT. Because the patient disagreed with curative surgery and normal part-preservation surgery, we eventually performed OTO-IVM. A right salpingo-oophorectomy was first performed. Eight immature oocytes were immediately aspirated not only from visible follicles, but also from entire cortex for invisible follicles, of the removed ovary. In addition, IVM procedure generated six mature oocytes, and were subjected to intracytoplasmic sperm injection (ICSI). Accordingly, three embryos were obtained and cryopreserved. Three months after surgery, hormone replacement therapy was initiated, and a frozen-thawed embryo was transferred, resulting in a successful pregnancy. Although a cesarean section was performed at 36 weeks due to maternal ileus, the baby was delivered without complications. CONCLUSIONS: This report indicates this treatment to be an effective approach for fertility preservation in BOT patients, especially, the importance of collecting oocytes from the entire ovarian cortex was suggested.

Job shadowing for early undergraduate dental students: Evaluation and validation of educational effectiveness using structural equation modelling.

INTRODUCTION: This study aimed to evaluate and validate the educational effectiveness of a job shadowing class as a dental teaching programme for preclinical dental students through a questionnaire that assessed related student perceptions. MATERIALS AND METHODS: A total of 124 preclinical (second year) dental students at Tokushima University participated in job shadowing placements from 2017 to 2019. Each student observed dental practice or surgery for 1 day in the university hospital. After shadowing, the students were requested to fill out a nine-item questionnaire based on a five-point scale. The first analysis was performed to calculate the correlation for each item. Furthermore, regression analysis for the categorical data was performed to show the relationship between eight questions (Items 1-8) and one question (Item 9: comprehensive evaluation). Next, factor analysis was performed to determine students' perceptions regarding the shadowing class. RESULTS: Ninety-eight students (response rate: 79%) completed the questionnaire. There was a strong relationship amongst Items 1, 8 and 9 ("interested in dentistry as a job," "learning motivation" and "comprehensive evaluation" respectively) based on the results of the correlation and regression analysis. The factor analysis led to three student perceptions as latent factors, namely, "Interesting," "Self-awareness" and "Future Goal," which had a relatively close inter-factor correlation (0.465-0.772). CONCLUSION: The finding suggests that job shadowing may increase a students' interest in a dentistry career at an early stage of their education and learning motivation, along with generating self-awareness. This programme may present possible educational effectiveness in dental education.

Triggering factors for febrile attacks in Japanese patients with familial Mediterranean fever.

OBJECTIVES: We occasionally encounter patients with familial Mediterranean fever (FMF) whose attacks are triggered by specific factors; however, information regarding these factors is limited. Our purpose was to identify the factors that trigger febrile attacks in Japanese patients with FMF. METHODS: Our retrospective study included 372 patients (229 women, 143 men) with FMF, who were diagnosed between April 2007 and June 2018. We retrospectively investigated clinical features, genetic variants, and the factors that the patients perceived to have triggered their attacks. Patients completed a questionnaire that included the following triggering factors, anxiety, psychological stress, tiredness, excitement, environmental change, and menstruation. RESULTS: Of 372 patients, 180 (49.4%) reported some triggering factors. Psychological stress and tiredness were commonly reported factors regardless of sex; however, menstruation (39.7%, n=91) was the most commonly reported triggering factor in female patients with FMF. Menstrual-related patients had a younger age of onset and diagnosis, a higher frequency of peritonitis, and a higher rate of patients with endometriosis compared with the non-menstrual-related patients. CONCLUSIONS: Gaining an understanding of these triggering factors could help to reduce attacks and educate the patients. Clinicians may need to consider FMF for patients who have fever and serositis that occurs with every menstrual period.

Evaluation of the measurement precision and accuracy in the dental CAD/CAM system.

The purpose of this study is to investigate the precision and trueness of the occlusal contact record obtained with a dental CAD/CAM device (ARCTICA). Sandblasted spherical steel balls with diameters of 10-20 mm were measured using ARCTICA and a three-dimensional measurement device (FN503). The radius of each steel ball was calculated from the measured value and the difference between the measured and nominal values was obtained. Upper/lower dental arch casts were measured and processed for occlusal contact image creation using both devices. The graphical images of the occlusal contacts at the intercuspal position obtained from both systems and an occlusal analysis device (BE-1) were compared with the occlusal contact area. Excellent correlation was observed between the measurement results of ARCTICA and FN503 (p<0.001, R2: 0.99). The occlusal contact areas were 186.0 mm2 (ARCTICA), 192.8 mm2 (FN503), and 196.1 mm2 (BE-1). This study showed that ARCTICA is capable of conducting highly accurate measurements and generating a graphical image of occlusal contacts with good reliability.

Association between indoor nitrous acid, outdoor nitrogen dioxide, and asthma attacks: results of a pilot study.

The association between nitrogen dioxide (NO2) and asthma has been investigated. However, conventional NO2 assays measure nitrous acid (HONO) as NO2. In this pilot epidemiological observational study, we assessed exposure to indoor HONO and some air pollutants in pediatric asthma patients and examined possible association between exposure and asthma symptoms. Indoor HONO and nitric oxide (NO), which are primarily generated by the combustion of certain substances, were significantly associated with asthma attacks in 2010. In 2010, indoor HONO was closely correlated with indoor NO than with outdoor NO2. Conversely, in 2012, indoor HONO was closely correlated with outdoor NO2 and NO than with indoor NO2 and NO. Outdoor NO2 was significantly associated with asthma attacks in 2012. Our results highlight the need for further epidemiological studies of the association between indoor HONO and asthma symptoms using multivariate analyses to examine the role of NO2 in asthma symptoms. Abbreviations: CXCL1: the chemokine (C-X-C motif) ligand 1; EP: the entire study period; FP: the first half of study period; HONO: nitrous acid; NO: nitric oxide; NO2: nitrogen dioxide; OH radical: hydroxyl radical; SP: the second half of study period; TNF-α: tumor necrosis factor-α; US EPA: United States Environmental Protection Agency; WHO: World Health Organization.

FGF2 Has Distinct Molecular Functions from GDNF in the Mouse Germline Niche.

Both glial cell line-derived neurotrophic factor (GDNF) and fibroblast growth factor 2 (FGF2) are bona fide self-renewal factors for spermatogonial stem cells, whereas retinoic acid (RA) induces spermatogonial differentiation. In this study, we investigated the functional differences between FGF2 and GDNF in the germline niche by providing these factors using a drug delivery system in vivo. Although both factors expanded the GFRA1+ subset of undifferentiated spermatogonia, the FGF2-expanded subset expressed RARG, which is indispensable for proper differentiation, 1.9-fold more frequently than the GDNF-expanded subset, demonstrating that FGF2 expands a differentiation-prone subset in the testis. Moreover, FGF2 acted on the germline niche to suppress RA metabolism and GDNF production, suggesting that FGF2 modifies germline niche functions to be more appropriate for spermatogonial differentiation. These results suggest that FGF2 contributes to induction of differentiation rather than maintenance of undifferentiated spermatogonia, indicating reconsideration of the role of FGF2 in the germline niche.

Evaluation of sperm head shape at high magnification revealed correlation of sperm DNA fragmentation with aberrant head ellipticity and angularity.

OBJECTIVE: To test for an association between DNA fragmentation and head shape at high magnification in fresh motile spermatozoa. DESIGN: Observational study. SETTING: Academic tertiary care center. PATIENT(S): A total of 60 men in our assisted reproductive program. INTERVENTION(S): Quantifying sperm head shape using elliptic Fourier analysis, and detecting DNA fragmentation by use of a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. MAIN OUTCOME MEASURE(S): Correlation between percentage of spermatozoa with abnormal head shape and percentage of DNA fragmentation. RESULT(S): Elliptic Fourier analysis decomposed sperm head shapes into four quantitative parameters: ellipticity, anteroposterior (AP) symmetry, lateral symmetry, and angularity. The DNA fragmentation was statistically significantly correlated with abnormal angularity, and moderately with abnormal ellipticity but not with abnormal AP symmetry or lateral symmetry. Forward stepwise multiple logistic regression analysis revealed a statistically significantly higher percentage of DNA fragmentation in spermatozoa with abnormal ellipticity and abnormal angularity than in spermatozoa with normal-shaped head (6.1% and 5.4% vs. 2.8%). Spermatozoa with large nuclear vacuoles also correlated with sperm DNA fragmentation, and had a statistically significantly higher percentage of DNA fragmentation (4.7%). CONCLUSION(S): Among the morphologic features of the sperm head, abnormal ellipticity, angularity, and large nuclear vacuoles are associated with DNA fragmentation.

Patterns of tooth agenesis in Japanese subjects with bilateral agenesis of mandibular second premolars.

The aim of this study was to explore the patterns of tooth agenesis in Japanese orthodontic patients with bilateral agenesis of mandibular second premolars. A total of 80 Japanese orthodontic patients with 2 congenitally missing mandibular second premolars were selected as the subjects of this study (experimental group). Another 80 individuals without bilateral agenesis of mandibular second premolars were collected for comparison (control group). The 2 groups were matched with regard to sex. Radiographs, dental casts and records of medical and/or dental treatment were used to identify tooth agenesis. The Chi-square test, odds ratio, and test for equality were used to make statistical comparisons. The prevalence rates of other types of tooth agenesis were significantly higher in the experimental group than in the control group. The occurrence of agenesis of maxillary and mandibular lateral incisors and third molars, and maxillary second premolars was also significantly higher in the experimental group than in the control group. Significantly increased prevalence rates of symmetrical tooth agenesis, with third molars included, and oligodontia were observed in the experimental group. Japanese subjects with bilateral agenesis of mandibular second premolars are at significantly high risk of agenesis of other types of permanent teeth, symmetrical tooth agenesis and oligodontia.

Stable transformation and cloning mediated by piggyBac vector and RNA interference knockdown of Drosophila ovarian cell line.

An in vitro study is a powerful method for elucidating gene functions in cellular and developmental events. However, until date, no reliable in vitro transformation, cloning, or knockdown system has been reported for Drosophila cells, with the exception of S2 and Kc cells. In this study, we demonstrated that the piggyBac vector stably integrates donor DNA into ovarian somatic sheets derived from follicle stem cells. The transformed ovarian somatic sheet cells were easily cloned with a new piggyBac selection vector carrying enhanced green fluorescent protein and dihydrofolate reductase genes, egfp, and dhfr, respectively, in culture media containing methotrexate, an inhibitor of DNA synthesis. Donor egfp continued to be expressed at a high level in long-term culture. Furthermore, the translation of donor egfp was inhibited by treatment with double-stranded RNA derived from the target gene. The transfection and cloning methods mediated by the piggyBac vector would thus be useful for future analyses of gene functions in OSS cells and possibly be applicable to other Drosophila cell lines.

Carbon dioxide laser application enhances the effect of silane primer on the shear bond strength between porcelain and composite resin.

The purpose of this study was to evaluate the effect of carbon dioxide laser irradiation on the performance of silane coupling agent as an adhesion promoter. The carbon dioxide laser used in this study was Opelaser 03S II, which irradiated the silane coupling agent applied on the adhesive surface of porcelain. Before and after thermal cycling, shear bond strength was measured using a universal testing machine. Without primer treatment, most of the specimens failed adhesively before reaching the end of the thermal cycling period. For the specimens irradiated with carbon dioxide laser after primer treatment, their shear bond strengths before and after thermal cycling were higher than those treated with primer only -with a significantly pronounced difference between these two groups especially after thermal cycling. Therefore, a combined surface treatment which involved silane application followed by laser treatment was feasible and efficacious for chairside porcelain repair.

Effects of nitrous acid exposure on pulmonary tissues in guinea pigs.

Many epidemiological studies on the effects of nitrogen dioxide (NO(2)) on respiratory function may have included nitrous acid (HONO) exposures in their measures, because conventional NO(2) assays detect HONO as NO(2). A few epidemiological studies and human HONO inhalation experiments have associated HONO with decrements in lung functions. However, there have been few HONO exposure experiments in animals. This study aims to develop a HONO generation system for the animal exposure experiments, and to assess the association of HONO exposure with histopathologic alterations in the respiratory tract of guinea pigs. We exposed the guinea pigs to 3.6 ppm HONO with secondary products of 0.3 ppm NO(2) and 1.6 ppm nitric oxide (NO) for 4 weeks (24 h/day). We conducted histopathologic analyses and measured specific airway resistance (sRaw) from 7 h 40 min to 8 h 30 min after the end of HONO exposure. We found pulmonary emphysema-like alterations in the alveolar duct centriacinar regions, distortion of the centriacinar regions of alveolar ducts with extension of the bronchial epithelial cells and smooth muscle cells, and expansion of bronchial epithelial cells, in the HONO exposure. These histopathologic results suggest that a high concentration of HONO with some NO(2) and NO may associate with decrements in lung functions and some respiratory symptoms. Although the increased tendency of the sRaw value was observed in the HONO exposure group, no statistically significant difference was found between the sRaw values from the HONO exposure group and the filtered air group (p = 0.06, student's t-test).

Brief communication: Three-dimensional motion analysis of hindlimb during brachiation in a white-handed gibbon (Hylobates lar).

In brachiating gibbons, it is thought that there is little movement in the hindlimb joints and that lateral body movement is quite limited. These hypotheses are based on naked-eye observations, and no quantitative motion analyses of the hindlimbs have been reported. This study quantitatively describes the three-dimensional movements of the lower trunk and distal thigh during continuous-contact brachiation in a white-handed gibbon (Hylobates lar) to evaluate the roles of the trunk and hindlimb. The results revealed that the lower trunk moved both laterally and vertically. The lateral movement of the lower trunk resulted from the lateral inclination of the trunk by gravity. The vertical movement of the trunk was converted into forward velocity, indicating an exchange between potential and kinetic energy. We also observed flexion and extension of the hip, although the excursion was within a small range. In addition, the lateral movement of the hindlimb in thedirection opposite to that of trunk movement helped to reduce the lateral sway of the body. These results suggest that during continuous-contact brachiation a gibbon uses hip flexion and extension motions to increase the kinetic energy in the swing. In addition, fine motions of the hip may restrict the lateral sway of the center of body mass.

Preliminary survey of taxonomical problems, pharmacognostical characteristics, and chloroplast DNA polymorphisms of the folk medicinal herb Artemisia campestris from the Ryukyu Islands, Japan.

Artemisia campestris L. (Compositae) occurs naturally along the coastline of the Ryukyu Islands and has been traditionally used as a folk medicine for the treatment of liver and kidney disorders. The authors obtained specimens from the Ishigaki and Kume Islands of the Ryukyu Islands, Japan, and from the USA. A survey of the literature revealed that the Japanese name for A. campestris is Niitaka-yomogi or Riukiu-yomogi. Two distinct overall plant-form phenotypes were identified: an erect phenotype with long, upright, and straight main axis and assurgent branches; and a prostrate phenotype, having branches that are longer than the main axis and which grow along the ground. Except for the number of ray flowers, most of the flower head characters in the erect phenotypes were significantly larger than those in the prostrate phenotypes. In this experiment, the flower heads contained only small amounts of either capillarisin (<0.01-0.11 of the dry weight, % DW) and 6,7-dimethylesculetin (<0.01-0.30% DW), or none at all. DNA polymorphisms at two sites of the rpl16-rpl14 spacer region (nucleotide position 181-189 and 291-300 from the 5' end) revealed the existence of four different haplotypes. The number of adenines at nucleotide positions 291-300 appeared to be polymorphic within A. campestris from the Ryukyu Islands. Conversely, geographic differences between specimens from the Ryukyu Islands and USA manifested as a nine-base deletion at nucleotide positions 181-189. From a pharmacognostical context, the use of A. campestris flower heads as a substitute for Artemisiae capillaris Flos is not effective.

Cold-induced sweating syndrome with neonatal features of Crisponi syndrome: longitudinal observation of a patient homozygous for a CRLF1 mutation.

Cold-induced sweating syndrome (CISS) is a rare autosomal recessive disorder caused by mutations in CRLF1 (cytokine receptor-like factor 1), characterized by profuse sweating in cold environmental temperature and craniofacial and skeletal features. Mutations in CRLF1 also cause Crisponi syndrome (CS), characterized by neonatal-onset paroxysmal muscular contractions as well as craniofacial and skeletal manifestations and abnormal functions of the autonomic nerve system. To date, it is an unresolved problem whether the two conditions are distinct clinical entities or a single clinical entity with variable expressions or with different presentations depending on the patients' age at diagnosis. We report on a 30-year-old Japanese woman with CISS and homozygous out-of-frame 23-base deletion of CRLF1. In infancy, she did not show paroxysmal muscular contractions, but showed feeding difficulty, hyperthermia, and facial characteristics including thick and arched eyebrows, a short nose with anteverted nostrils, full cheeks, an inverted upper lip, and a small mouth, resembling those observed in CS. Profuse sweating was noticed at 3 years of age. Cold-induced sweating was recognized in her elementary school days. In adolescence to adulthood, she showed a Marfanoid habitus with progressive kyphoscoliosis and craniofacial characteristics including dolichocephaly, a slender face with poor expression, a distinctive nose with hypoplastic nares, malar hypoplasia, prognathism, and a small mouth. This is the first report of detailed longitudinal observation of a patient with CRLF1 abnormalities, compatible with the notion that CISS and CS may be a single clinical entity.

Immunohistochemical detection of steroid receptor cofactors in ovarian endometriosis: involvement of down-regulated SRC-1 expression in the limited growth activity of the endometriotic epithelium.

To study the steroid hormone-induced growth mechanisms of endometriosis, the immunohistochemical expression of steroid hormone receptor cofactors was investigated in 37 cases of endometriotic epithelia and was compared with that of eutopic endometria of identical patients. The expression of steroid receptor coactivators (p300/CBP and SRC-1) and corepressors (NCoR and SMRT) was examined in relation to the estrogen receptor (ER), the progesterone receptor (PR), and Ki-67. Results of immunostaining were indicated as a "positivity index" (PI, full score; 100). The expression of ER and PR in endometriotic epithelia largely resembled that in eutopic endometria, however, the expression of Ki-67 in the proliferative phase (PI 13.8 +/- 2.4, mean +/- SD) was significantly lower than that in eutopic endometria (32.6 +/- 10.6). The expression of SRC-1 in eutopic endometria was increased in the proliferative phase (56.5 +/- 16.8) and decreased in the secretory phase (14.8 +/- 6.9). In endometriosis, however, the PI for SRC-1 did not show apparent cyclic changes during the menstrual cycle. Moreover, the expression of SRC-1 in endometriotic epithelia in the proliferative phase was significantly lower than that in eutopic endometria. These findings suggested the reduced proliferative activity in endometriotic epithelia to be related to the reduced expression of SRC-1.

Cephalometric evaluation of maxillary sinus sizes in different malocclusion classes.

We found few studies on the association between maxillary sinus size and malocclusion in an electronic search using PubMed. The purpose of this study was to investigate maxillary sinus size in different malocclusion groups and the association between maxillary sinus size and dentofacial morphology by the use of lateral cephalometric radiographs. A total of 120 lateral cephalograms were used. These radiographs were derived from subjects with skeletal Class I, Class II, and Class III malocclusions, classified on the basis of the A-N-B angle. Each malocclusion group consisted of 20 boys and 20 girls ranging in age from 12 to 16 years. Two linear measurements and three area measurements were made to evaluate maxillary sinus size, and four angular and eight linear measurements were made to evaluate dentofacial morphology. Analysis of variance and Pearson's correlation analysis were performed for statistical comparison. The maxillary sinuses showed no significant differences in size between the different classes of skeletal malocclusion or between sexes. However, the maxillary sinus measurements were significantly correlated with several dentofacial morphological measurements. When formulating an orthodontic treatment plan, orthodontists should take into consideration the fact that the patients 12 to 16 years old with large cranial bases and nasomaxillary complexes tend to have larger maxillary sinuses, but there is no significant association between maxillary sinus size and the A-N-B angle denoting the sagittal skeletal jaw relationship.

Tooth size discrepancies among different malocclusions in a Japanese orthodontic population.

OBJECTIVE: To identify the possible sex differences in anterior and overall tooth size ratios and to evaluate whether any differences exist in tooth size ratios and distributions of subjects with clinically significant tooth size discrepancies among Angle Class I, Class II, and Class III malocclusion groups with the corresponding skeletal characteristics in a Japanese population. MATERIALS AND METHODS: Each malocclusion group comprised 60 subjects (30 males and 30 females). The mesiodistal width from first molar to first molar was measured on each pretreatment cast to the nearest 0.01 mm using digital calipers, and the anterior and overall ratios were calculated. Student's t-test, Welch t-test, analysis of variance, and chi2-test were performed for statistical analysis. RESULTS: No statistically significant sex differences were found in anterior or overall ratio in any group. No significant differences in anterior or overall ratios were found among the malocclusion groups. No significant differences were found between the distributions of subjects with clinically significant tooth size discrepancies, categorized by the Bolton standard deviation definition and by the actual amount of change calculated for tooth size correction in millimeters, among the malocclusion groups except for the mandibular correction for the overall ratio between Class I and Class III subjects. CONCLUSION: Bolton's values can be used with confidence for the typical Japanese orthodontic population. The use of the actual millimeters of correction for the tooth size ratios could help orthodontists avoid underestimating the prevalence of clinically significant tooth size discrepancies.

[Fetal death following high-dose systemic steroid therapy in a pregnant patient with Vogt-Koyanagi-Harada disease].

BACKGROUND: In previous reports, all pregnant women with VKH were successfully treated in the second or third trimester with high-dose systemic corticosterioids without any severe complications. We present a case of fetal death during systemic steroid treatment of a VKH disease patient. RESULTS: A 28-year-old woman in the 30th week of pregnancy was diagnosed with VKH disease. Because of the progression to high bullous retinal detachment in spite of topical corticosteroid therapy, systemic intravenous prednisolone (PSL, 200 mg/day) was begun. On day 18 (PSL, 55 mg/day), sudden intrauterine fetal death occurred. Maternal conditions were normal and there was no apparent abnormality in the umbilical cord, placenta, or fetus; no autopsy was allowed. With gradual tapering of the PSL, the patient's vision was preserved, without recurrence of the VKH disease. CONCLUSIONS: We present a case of fetal death in a 28-year-old pregnant woman being treated with intravenous prednisolone for VKH disease. The cause of the fetal death was not clear. It was reported as an adverse event.