Metaplastic breast carcinoma producing prominent basal lamina with neuroendocrine differentiation: A case report.

Metaplastic breast carcinoma (MBC) is a heterogeneous group of invasive breast carcinomas (IBCs) characterized by the differentiation of the neoplastic epithelium toward squamous cells and/or mesenchymal-appearing elements. The present study describes the case of a 42-year-old woman who underwent a mastectomy and sentinel lymph node biopsy for two tumors in their left breast. One of the resected tumors was diagnosed as MBC with neuroendocrine (NE) differentiation and the other was diagnosed as IBC of no special type. The MBC tumor contained a matrix composed of basal lamina with a focal area of myxoid matrix and squamoid differentiation. To the best of our knowledge, the present study is the first report of MBC producing prominent basal lamina. The patient has remained alive and well for >10 years without recurrence, and has been treated with oral and injected anticancer drugs.

Dimensional changes of buccal bone in the edentulous maxilla with telescopic-retained implant-supported fixed dental prostheses.

STATEMENT OF PROBLEM: The buccal bone in an edentulous maxilla loses thickness over time because of physiological changes. However, the dimensional changes of the buccal bone in an edentulous maxilla with an implant-supported fixed dental prosthesis are unknown. PURPOSE: The purpose of this retrospective clinical study was to evaluate cone beam computed tomography (CBCT) images of the dimensional changes of the buccal bone in edentulous maxillae with complete arch telescopic-retained implant-supported fixed dental prostheses (CTI-FDPs) after 6 years by using a professional retrieval system. MATERIAL AND METHODS: This study included 17 participants with edentulous maxillae who had been provided with CTI-FDP with 121 taper joint implants. A three-dimensional radiographic analysis by using CBCT was performed at implant insertion (0 years) and after 6 years. Vertical and horizontal bone measurement values were evaluated. During horizontal bone thickness measurement, 4 different levels, 0, 2, 4, and 6 mm apical to the implant shoulder, were evaluated as bone value (BV)0mm, BV2mm, BV4mm, and BV6mm, respectively. The BVs were compared with the Wilcoxon signed-rank test and Kruskal-Wallis test (α=.05). In addition, the Spearman rank correlation coefficient was used to identify 0yBV factors that influence the 6yBVs. A nonlinear regression analysis was used to clarify the slopes of 0yBVs and 6yBV0mm. RESULTS: Significant decreases in vertical and horizontal BVs were found between 0 years and 6 years (P<.05). However, no significant difference was observed in bone loss at 6 years at any of the vertical and horizontal measurement points (P≥.05). When 0yBVs related to 6yBV0mm were analyzed, 0yBV0mm and 0yBV2mm showed strong correlations with 6yBV0mm (|r|≥.7). In the regression analysis, a 0yBV0mm of 0.58 mm and 0yBV2mm of 0.78 mm could be critical factors associated with a 6yBV0mm of 0 mm. A 6yBV0mm of 0yBV0mm more than 0.58 mm was significantly higher than a 6yBV0mm of 0yBV0mm less than 0.58 mm (P<.001). Moreover, a 6yBV0mm of 0yBV2mm more than 0.78 mm was significantly higher than a 6yBV0mm of 0yBV2mm less than 0.78 mm (P<.001). CONCLUSIONS: The buccal bone in an edentulous maxilla with fixed implant-supported prostheses lost significant vertical and horizontal bone thicknesses after 6 years. At implant insertion, both a 0.58-mm buccal bone on the platform and a 0.78-mm buccal bone at 2 mm apical to the implant shoulder are necessary for longer term maintenance of bone on the platform of implants specifically supporting CTI-FDPs.

Implant Treatment in Patient with Periodontitis: A Case Report with 13-year Follow-up.

This report describes long-term implant treatment in a patient with chronic periodontitis. The patient was a 59-year-old man who attended our facility requesting a dental implant. An initial examination revealed generalized gingival inflammation and subgingival calculus. Clinical examination revealed 55.3% of sites with a probing depth (PD) of >4 mm and 41.3% of sites with bleeding on probing. Radiographic examination revealed vertical bone resorption in #23, #33, #33, #35, and #47. Initial periodontal therapy consisting of plaque control, scaling and root planing, and tooth extraction was subsequently performed based on a clinical diagnosis of severe chronic periodontitis. Open flap debridement was performed for teeth with a PD >5 mm (#21, #22, #23, 333, #34, #35 and #47). After confirming the stability of the periodontal tissue, 3 implants were first placed in the maxilla (#25, #26, and #27). Final prostheses comprising a screw retaining-type implant superstructure were then placed (#25, #26, and 327). Following reevaluation, the patient was placed on supportive periodontal therapy. At 15 years after the first visit, the periodontal and implant conditions have remained stable. These results indicate that periodontal treatment before implantation and subsequent maintenance yield a clinically favorable and long-lasting outcome.

Clinical evaluation of periodontal pathogen levels by real-time polymerase chain reaction in peri-implantitis patients.

OBJECTIVE: The mechanisms underlying the onset and progression of peri-implantitis are similar to those of periodontitis, and the causative bacteria are believed to similar. Previous studies support an association between peri-implantitis and periodontal pathogen. Thus, we investigated the bacterial flora of peri-implantitis patients in comparison to those of healthy implant and periodontitis patients. MATERIALS AND METHODS: In total, 70 patients visiting Tokyo Dental College Chiba Hospital were divided into four groups: healthy, periodontitis, healthy implant, and peri-implantitis. For each group, the following five periodontal pathogens were detected using real-time polymerase chain reaction: Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Treponema denticola, and Prevotella intermedia. RESULTS: The average copy number of total bacteria was significantly higher in the periodontitis group than in the other groups. P. gingivalis was detected in the periodontitis and peri-implantitis groups at levels as high as 18.92% and 12.29%, respectively, and P. intermedia was found in the peri-implantitis group at a rate of 2.06%. Nevertheless, periodontal pathogens were generally detected at lower levels in the peri-implantitis group than in the periodontitis group. CONCLUSION: We found lower bacterial counts in the peri-implantitis group relative to the periodontitis group. Our results suggest that the peri-implant tissue is less resistant to bacteria, so even a small number of bacteria can be a risk factor for peri-implantitis and the causative agent of peri-implantitis can be bacteria other than periodontal pathogen.

Suppression of Tumor Growth in a Rabbit Hepatic Cancer Model by Boron Neutron Capture Therapy With Liposomal Boron Delivery Systems.

BACKGROUND/AIM: Tumor cell destruction by boron neutron capture therapy (BNCT) is attributed to the nuclear reaction between 10B and thermal neutrons. The accumulation of 10B atoms in tumor cells without affecting adjacent healthy cells is crucial for effective BNCT. We previously reported that several types of liposomal boron delivery systems (BDS) delivered effective numbers of boron atoms to cancer tissues, and showed tumor-growth suppression after thermal neutron irradiation. In the present study, we examined the effects of BNCT after intra-arterial infusion of 10B-borono-dodecaborate (10BSH) by liposomal BDS in rabbit hepatic cancer models. MATERIALS AND METHODS: We prepared 10BSH-entrapped transferrin-conjugated polyethylene glycol liposomes constructed with distearoyl-boron lipid (TF-PEG-DSBL), and performed thermal neutron irradiation at the Kyoto University Institute for Integrated Radiation and Nuclear Science after intra-arterial infusion into rabbit VX-2 hepatic tumors. RESULTS: Concentrations of 10B in VX-2 tumors on delivery with TF-PEG-DSBL liposomes reached 25 ppm on day 3 after the injection. Tumor growth was suppressed by thermal neutron irradiation after intra-arterial injection of this 10BSH-containing liposomal BDS, without damage to normal cells. CONCLUSION: The present results demonstrate the applicability of 10B-containing TF-PEG-DSBL liposomes as a novel intra-arterial boron carrier in BNCT for cancer.

Implant Body Displacement into Medullary Cavity of Mandible: A Case Report.

One serious complication in implant surgery is displacement of the implant body into the surrounding tissue. This occurs only rarely in the mandible, however. This report describes a case of an implant body displacing into the medullary cavity of the mandible and discusses this in reference to the literature. The patient was a 72-year-old woman who was referred to our department at Tokyo Dental College Chiba Hospital (now Chiba Dental Center) by her regular dentist after an implant inserted in the left mandible in 2010 showed loosening in October 2016. Panoramic X-rays obtained at the initial examination revealed that 2 implants had been inserted into the left mandible, one on top of the other. Removal of both was recommended to prevent infection at the implant site and any potential effects on the alveolar nerve. In the absence of subjective symptoms other than implant loosening, however, the patient did not consent to this proposal. Therefore, only the broken abutment was removed. The patient was instructed to contact us immediately should infection or any other symptoms appear once the mucosa had healed, and the dental clinic that had referred her to us was requested to make her a set of dentures. To our knowledge, only 11 reports have been published to date describing displacement of an implant body into the mandible, and these address a total of just 20 cases. The possibility that an implant body in the mandible may become displaced must be kept in mind during treatment.

Effects of 2% sodium fluoride solution on the prevention of streptococcal adhesion to titanium and zirconia surfaces.

Streptococci are associated with dental plaque formation as the early-colonizing bacteria that adhere to titanium (CpTi) and zirconia (TZP) implant abutment surfaces. Effective prevention of peri-implantitis may be possible by removing streptococci as target. This study aimed to evaluate the effects of 2% NaF on the prevention of streptococcal adhesion to CpTi and TZP. After immersion in 2% NaF for 90 min, surface characterization of mirror-polished CpTi and TZP disks were assesed using XPS, EPMA, and SEM. S. sanguinis, S. gordonii, and S. oralis were used as the streptococcal bacterial strains. After 24 h culture, bacterial adhesion was evaluated using an ATP-bioluminescent assay and SEM. In XPS, EPMA, and SEM analyses, fluoride was detected on the CpTi and TZP surfaces after 2% NaF immersion with no signs of localization, and no corrosion on the CpTi disks. Based on the adhesion assay, the adherences of S. sanguinis, S. gordonii, and S. oralis were significantly lower with NaF than without NaF in CpTi (p = 0.005, 0.001, and 0.001, respectively) and TZP (p = 0.003, 0.002, and 0.001). This was also confirmed by SEM. In conclusion, 2% NaF reduced the adhesion of streptococci to the CpTi and TZP surfaces.

Tumor Growth Suppression With Novel Intra-arterial Chemotherapy Using Epirubicin-entrapped Water-in-oil-in-water Emulsion In Vivo.

BACKGROUND/AIM: A mixture of anticancer agents and iodized poppy seed oil (IPSO) has been widely used for intra-arterial chemotherapy of hepatocellular carcinoma. However, the anticancer agents can easily separate from IPSO, so the therapeutic potential is limited. We developed epirubicin-entrapped water-in-oil-in-water emulsion (WOW-Epi) using a double-membrane emulsification technique. MATERIALS AND METHODS: We delivered WOW-Epi through a hepatic arterial injection to VX2 hepatic tumor rabbit model (1.2 mg/kg). RESULTS: VX2 tumor growth was selectively suppressed in the WOW-Epi-treated group compared with the control treated groups. The accumulation of WOW in nearby cancer cells was confirmed via electron-microscopy. Endocytosis seemed to be the mechanism underlying the uptake of WOW. CONCLUSION: WOW-Epi led to tumour growth suppression in vivo. WOW does not cause toxicity to arterial vessels. WOW-Epi will be hopefully used for repeated intra-arterial chemotherapy to HCC patients in the near future.

Influence of eccentric cyclic loading on implant components: Comparison between titanium and zirconia abutments.

The objective of this study was to investigate the effects of eccentric cyclic loading on implant components using the internal joint system with titanium and zirconia abutments. Abutments were made of either pure titanium (Ti group) or zirconia (TZP group). Cyclic loading test was conducted according to the specifications of ISO 14801. Loading condition was at 2 points assuming axial load and eccentric load. The reverse torque value reduced after the eccentric load and reduced more in the TZP group than the Ti group. Marginal gap changed after eccentric loading, and was greater in the TZP group. In the TZP group, changes in configuration were observed in the implant body, and Ti was detected on the abutment surface. From the above, the eccentric load may have worse effects than axial loads. It was suggested that the TZP group was clinically disadvantageous compared to the Ti group.

Effects of unloading by tail suspension on biological apatite crystallite alignment in mouse femur.

The aim of this study was clarify the effects of reducing various functional pressures essential for the maintenance of bone homeostasis. Femoral bone mineral density (BMD) and biological apatite (BAp) crystallite alignment were measured in conventionally reared and hindlimb-unloaded mice. The femur was divided into 10 equal segments perpendicular to the longitudinal axis of the bone and measurements were performed on the cortical bone in the five segments closest to the midpoint of the femur. Significantly lower BMD and BAp alignment in the longitudinal (Z-axis) direction were observed in the hindlimb-unloaded group. The present findings suggest that unloading by tail suspension significantly decreases not only mouse femoral bone mass but also BAp crystallite alignment, although minimal uniaxial preferential alignment is retained.

Full-Arch Implant-Supported Fixed Dental Prosthesis Retained by a Combination of Galvano-Telescopic Copings and Screws: A Clinical Report.

Full-arch screw-retained implant-supported fixed dental prostheses have a high long-term success rate and are considered the gold standard by many clinicians. However, accurate fabrication of a passive fit long-span prosthesis can be challenging. A novel intraoral adhesion method using galvano-telescopic copings was proposed as a way of improving prosthetic fit for edentulous patients. This report describes the treatment of a 74-year-old female with a full-arch implant-supported dental prosthesis, supported by a combination of galvano-telescopic copings and screws to prevent retention loss. Four years have passed since this superstructure was placed, during this time she exhibited a good clinical course with no inflammation noted in surrounding tissues. Treatment with an implant-supported fixed dental prosthesis, retained by a combination of galvano-telescopic copings and screws, can be a useful alternative treatment for edentulous patients.

Role of Dental Implant Superstructure in Patients with Severe Periodontal Disease.

Many studies have investigated the relationship between periodontal disease and the onset of peri-implantitis. It is important to devise practical measures for preventing the development of peri-implantitis in patients with periodontal disease if the success of implant treatment is to be secured. Here, we report the role of the superstructure in two cases of implant treatment in patients with severe periodontal disease. Both patients had severe periodontitis and underwent implant treatment after improving the state of the disease, thereby ensuring that the implant superstructure could be maintained. Both cases remained stable after implant treatment. The results indicate that proper periodontal treatment prior to implant treatment leads to long-term success. In addition, it is necessary to use an implant superstructure that reduces plaque accumulation in preventing peri-implantitis.

Pencil Lead as a Material for Microfluidic 3D-Electrode Assemblies.

We present an electrochemical, microfluidic system with a working electrode based on an ordered 3D array of pencil leads. The electrode array was integrated into a plexiglass/PDMS channel. We tested the setup using a simple redox probe and compared the results with computer simulations. As a proof of concept application of the device we showed that the setup can be used for determination of dopamine concentration in physiological pH and ultrasensitive, although only qualitative, detection of p-nitrophenol with a limit of detection below 1 nmol L-1. The observed limit of detection for p-nitrophenol is not only much lower than achieved with similar methods but also sufficient for evaluation of exposure to pesticides such as methyl parathion through urinalysis. This low cost setup can be fabricated without the need for clean room facilities and in the future, due to the ordered structure of the electrode could be used to better understand the process of electroanalysis and electrode functionalization. To the best of our knowledge it is the first application of pencil leads as 3D electrochemical sensor in a microfluidic channel.

Implant Treatment after Sagittal Splitting Ramus Osteotomy and Alveolar Ridge Augmentation in Patient with Mandibular Prognathism and Multiple Missing Maxillary Teeth.

An abnormal maxillomandibular ridge relationship frequently hinders oral implant treatment in patients with jaw deformities. Here, we describe a patient who was experiencing difficulty using dentures due to multiple maxillary tooth loss and mandibular prognathism. Treatment comprising sagittal splitting ramus osteotomy and alveolar ridge augmentation using bone grafts harvested from the mandibular ramus followed by implant treatment yielded good outcomes. The patient was a 47-year-old woman presenting with an unstable upper partial denture. Although prior prosthetic treatment for mandibular prognathism had resulted in normal overbite, she had since lost an increasing number of teeth due to advanced periodontal disease, impairing support for the denture. She was referred to the Department of Oral Implantology at the Tokyo Dental College Chiba Hospital in October 2008. Subsequent treatment comprised implant treatment following maxillary alveolar ridge augmentation and sagittal splitting ramus osteotomy to correct the maxillary-mandibular relationship. In January 2010, sagittal splitting ramus osteotomy and alveolar bone augmentation using a bone graft from the mandibular ramus were performed under general anesthesia. In July and August 2010, a total of 7 implants were placed in the maxilla and implant superstructure preparation started after 3 months. Taking both the patient's wishes and ease of maintenance into account, retrievable superstructures made of Auro Galvano Crown were fitted in April 2011. The jaw-to-jaw alveolar ridge relationship was improved by sagittal splitting ramus osteotomy, rendering subsequent treatment, from implant placement to superstructure preparation, feasible by conventional methods. The use of surplus bone generated during sagittal splitting ramus osteotomy for bone augmentation avoided the need to harvest bone from another area.

Bone marrow stromal cells from low-turnover osteoporotic mouse model are less sensitive to the osteogenic effects of fluvastatin.

This study aimed to investigate the effects of fluvastatin on the differentiation of bone marrow stromal cells (BMSCs) into osteoblasts in senescence-accelerated mouse prone 6 (SAMP6) compared with that in the normal senescence-accelerated-resistant mouse (SAMR1) model. SAMP strains arose spontaneously from the AKR/J background and display shortened life span and an array of signs of accelerated aging, compared with control SAMR strains. The dose effects of fluvastatin were also evaluated. BMSCs were cultured with/without fluvastatin (0 µM, 0.1 µM, 0.5 µM, and 1.0 µM). WST-1-based colorimetry was performed to evaluate cell proliferation. To evaluate cell differentiation, gene expression levels of bmp2 and runx2 were determined by quantitative reverse transcription polymerase chain reaction (qRT-PCR), and protein expression levels were determined using enzyme-linked immunosorbent assay (BMP2) and immunofluorescence staining (BMP2 and Runx2). Alkaline phosphatase (ALP) activity assay and histochemical detection were determined; the effect of noggin, a BMP-specific antagonist, was examined using ALP histochemical detection. To assess for mature osteogenic marker, gene expression levels of bglap2 were determined by qRT-PCR and mineralization was determined by alizarin red staining. RhoA activity was also examined by Western blotting. In SAMP6, BMP2, Runx2 and Bglap2 mRNA and protein expressions were significantly increased by fluvastatin, and ALP activity was increased by BMP2 action. RhoA activity was also inhibited by fluvastatin. The concentration of fluvastatin sufficient to increase BMP2 and Runx2 expression and ALP activity was 0.5 µM in SAMP6 and 0.1 µM in SAMR1. In conclusion, the present study revealed that fluvastatin promoted BMSC differentiation into osteoblasts by RhoA-BMP2 pathway in SAMP6. BMSCs of SAMP6 are less sensitive to the osteogenic effects of fluvastatin than SAMR1.

Release properties of atelocollagen-gelatin complexes as carriers for local administration of fluvastatin.

The aim of this study was to investigate properties of atelocollagen/gelatin complexes (AC/Gel) and their characteristics of sustained statin release, to assess the utility of AC/Gel. AC/Gel were prepared by changing the mixing ratio of AC (0 to 40% of AC). Analysis of spectra of fluvastatin (Flu), gelatin (Gel), and Flu with Gel complex using a Fourier transform-infrared spectrometer indicates that Flu was bound to Gel through a bond involving the carboxyl and amino groups. Evaluation of characteristics of sustained release of Flu from the AC/Gel using an ultraviolet-visible spectrophotometer showed that the release rate of Flu decreased with increasing the AC content. The histological evaluation using of Sprague-Dawley rats suggest that, unlike the pure Gel sponge, the AC/Gel was not absorbed in an early stage. Therefore, the present study showed that sustained Flu release can be controlled by using an AC/Gel, suggesting the utility of this composite material.

Influence of eccentric cyclic loading on implant components: Comparison between external joint system and internal joint system.

The purpose of this in vitro study was to investigate the influence of eccentric loading on implant components by measuring screw loosening and observing these components under several load positions and magnitudes. The external and internal joint system implants with butt joint connection were subjected to cyclic loading tests according to the specifications of ISO 14801. Load position was set at 0, 4, or 8 mm, and load was set at 100 or 300 N. On the external joint system, the reverse torque values decreased with distal shift in the loading position and an increase in magnitude of load, and abrasion and deformation on the anti-rotation device were observed. On the internal joint system, no large decrease in reverse torque was observed even though increasing the load position and load, however, abrasion and deformation on the anti-rotation device as well as fracture at implant/abutment connection were observed.

Undifferentiated carcinoma of the gallbladder with endothelial differentiation: A case report and literature review.

Undifferentiated carcinoma of the gallbladder is a rare cancer type with a poor prognosis. The present study described a case of undifferentiated gallbladder carcinoma of the spindle- and giant-cell type, according to the 2010 World Health Organization classification. Hematoxylin and eosin staining revealed that the tumor consisted of dense interlacing bundles of spindle-shaped cells. No evidence of cartilaginous, osseous or rhabdomyosarcomatous differentiation was observed. Immunohistochemical staining revealed that spindle- and polygonal-shaped cells of the undifferentiated carcinoma were positive for cytokeratin AE1/3, vimentin and vascular endothelial growth factor. Furthermore, numerous spindle-shaped cells were positive for cluster of differentiation (CD)34 and CD31, and certain spindle-shaped cells were positive for Factor VIII. These results suggested classification of the present case as 'undifferentiated gallbladder carcinoma with endothelial differentiation'.

A Case of Simultaneous Ectopic Tooth Extraction and Removal of Migrated Dental Implant from Maxillary Sinus.

When a dental implant migrates to the maxillary sinus it should be extracted immediately as it may cause sinusitis or further migrate to one of the other paranasal sinuses. Although usually detected due to symptoms such as nasal obstruction, nasal discharge, and nasal bleeding, an ectopic tooth in the maxillary sinus can sometimes be revealed incidentally on radiographic examination. Here, we report a case of simultaneous extraction of a dental implant that had migrated to the maxillary sinus and removal of an ectopic tooth that had arisen in the same location. The patient was a 73-year-old man who had received the implant to replace the first left maxillary molar at a local dental office. The implant had subsequently migrated to the left maxillary sinus and the patient was referred to us for its removal. On locating the implant on a CT scan at our hospital, an ectopic tooth was also observed at the base of the maxillary sinus. With patient consent, the decision was made to remove the ectopic tooth and extract the implant simultaneously. Excision of the lateral wall of the maxillary sinus allowed easy extraction of the implant. The ectopic tooth was removed by slightly expanding a fenestration in the sinus wall. Ectopic teeth in the maxillary sinus are sometimes put on follow-up if asymptomatic. Removal should be considered, however, if there is a risk of it becoming infected due to implantation-induced inflammation.