[Total Arch Replacement with Frozen Elephant Trunk for Treatment of Traumatic Aortic Injury with Stanford Type A Aortic Dissection].

An 83-year-old woman was injured in a traffic accident. Enhanced computed tomography (CT) showed aortic injury on the isthmus, Stanford type A aortic dissection and intracranial hemorrhage. Neurological deficit was not noted. We immediately started to lower the blood pressure, and her hemodynamic status remained stable. Although intracranial bleeding had not worsened on the next day, a false lumen of the aortic arch was newly enhanced on CT. Emergency total arch replacement with frozen elephant trunk was performed under deep hypothermia and selective cerebral perfusion. Intraoperative angiography showed no endoleak at the descending aorta. Postoperative course was uneventful, and the patient was discharged on the 21st postoperative day. This procedure is useful for aortic injury involving the ascending aorta and the arch.

Differential expression of the ghrelin-related mRNAs GHS-R1a, GHS-R1b, and MBOAT4 in Japanese patients with schizophrenia.

OBJECTIVES: Ghrelin regulates appetite and also plays important roles in cognition and may be involved in vulnerability to SCZ. METHODS: In this study, we measured mRNA expression of the ghrelin-related molecules, growth hormone secretagogue receptor 1a (GHS-R1a) and 1b (GHS-R1b), and the ghrelin activator, membrane bound O-acyltransferase 4 (MBOAT4). Peripheral leukocytes from Japanese patients with SCZ (n = 49; 23 males, 26 females; age = 61.8 ±â€¯13.3 years) and controls (n = 50; 25 males, 25 females; age = 62.0 ±â€¯14.3 years) were recruited according to their clinical information. We also studied the DNA methylation rates of these genes in DNA from leukocytes. RESULTS: The mRNA expression of GHS-R1a was significantly decreased in SCZ (SCZ vs. control: 0.35 ±â€¯0.081 vs. 1.00 ±â€¯0.059, respectively, p = 0.007), but expression levels of GHS-R1b and MBOAT4 were significantly increased in SCZ (SCZ vs. control: 2.02 ±â€¯0.91 vs. 1.00 ±â€¯0.32, p = 0.023, 1.37 ±â€¯0.21 vs. 1.00 ±â€¯0.11, respectively, p = 0.014). No differences in methylation rates for any genes were found. CONCLUSION: We conclude that opposite expression of GHS-R1a and GHS-R1b, and elevated MBOAT4 mRNA expression may reflect the mechanisms of SCZ.

A Case of Ruptured Immunoglobulin G4-Related Periaortitis.

An 80-year-old man had high serum immunoglobulin G4 (IgG4) concentration and fibrous thickening of the soft tissue mass surrounding the region from the abdominal aorta to the bilateral iliac arteries, suggestive of IgG4-related periaortitis. He presented to our emergency department with sudden-onset abdominal pain and lumbago. Computed tomography revealed a ruptured abdominal aorta. He was a poor candidate for open surgery due to his hostile abdomen. Therefore, endovascular aneurysm repair was performed. No consensus about the surgical indication for IgG4-related arterial disease has been reached yet. We believe that a novel indicator is needed for this disease.

Ghrelin cascade changes in the peripheral blood of Japanese patients with Alzheimer's disease.

The neuroprotective effect of ghrelin has recently been reported in Alzheimer's disease (AD). Ghrelin is converted from des-acyl ghrelin to the activated form, acyl ghrelin, by membrane bound o-acyltransferase 4 (MBOAT4), and then binds to growth hormone secretagogue receptor (GHS-R). We examined the levels of plasma acyl/des-acyl ghrelin in 75 AD subjects and age- and sex-matched controls, as well as the DNA methylation and mRNA expression of MBOAT4 and GHS-R in peripheral leukocytes. The acyl ghrelin concentration was significantly higher in AD subjects than in controls (2.18 ±â€¯1.25 vs. 1.49 ±â€¯2.3, p = 0.001). The methylation rate of MBOAT4 CpG 2 was significantly lower in AD subjects than in controls (4.0 ±â€¯0.9 vs. 4.7 ±â€¯1.2, p < 0.001). The mRNA expression levels of MBOAT4 and GHS-R1b were significantly higher in AD subjects than in controls (MBOAT4: 1.10 ±â€¯0.48 vs. 1.0 ±â€¯0.55, p = 0.049; GHS-R1b: 1.76 ±â€¯3.18 vs. 1.0 ±â€¯1.56, p = 0.030). These changes in the ghrelin cascade in peripheral blood may reflect those in the brain, and may be a neuroprotective biomarker in AD.

Endothelial nitric oxide synthase in rat brain is downregulated by sub-chronic antidepressant treatment.

BACKGROUND: Nitric oxide (NO) is a neurotransmitter that may be related to major depressive disorder (MDD) because the selective neuronal NO synthase (NOS) inhibitor, 7-nitroindazole, induces a dose-dependent antidepressant-like effect. NO modulates major neurotransmitters involved in the neurobiology of MDD, such as norepinephrine, serotonin, dopamine, and glutamate. In this study, we investigated the effects of antidepressants as NO modulators in acute and sub-chronic treatments. METHODS: Rats were injected with the SSRI paroxetine (PAR, 10 mg/kg), the SNRI milnacipran (MIL, 30 mg/kg), or the NaSSA mirtazapine (MIR, 10 mg/kg) for acute (1 h) or sub-chronic (3 weeks) treatment prior to analysis of nine brain regions (frontal cortex, temporal cortex, striatum, thalamus, hippocampus, midbrain, pons, cerebellum, and olfactory bulb). The mRNA expression levels of three NOS subtypes (neuronal: nNOS, inducible: iNOS, and endothelial: eNOS) were analyzed using real-time PCR with Taqman probes. RESULTS: Acute MIR treatment significantly increased nNOS mRNA expression in the hippocampus, midbrain, cerebellum and olfactory bulb, and iNOS mRNA expression in the frontal cortex and midbrain. Acute PAR and MIR treatments significantly increased eNOS mRNA expression in most brain regions. Conversely, sub-chronic treatment with all types of antidepressants resulted in significant decreases of eNOS mRNA expression in most brain regions. CONCLUSIONS: Sub-chronic treatment with the three types of antidepressants consistently decreased eNOS mRNA expression levels in the rat brain. These effects may be associated with the involvement of the NO system in the mechanism of action of antidepressants.

Low methylation rates of dopamine receptor D2 gene promoter sites in Japanese schizophrenia subjects.

OBJECTIVES: According to the dopamine hypothesis, several studies on the gene for the dopamine receptor D2 (DRD2) have been conducted. However, no trait biomarkers on DRD2 are available. We examined whether the methylation rates in the upstream region of DRD2 in leukocytes are different in schizophrenia (SCZ) subjects compared to control subjects. METHODS: We selected seven CpG sites in the upstream region of DRD2 that may theoretically bind major transcription factors. The methylation rates in these regions of 50 medicated and 18 drug-naïve SCZ subjects were compared with those of age-matched control subjects. RESULTS: The methylation rates were significantly lower in medicated (CpG2, P < 0.0001; CpG4, P = 0.013; CpG7, P < 0.0001; and average: 12.9 ± 1.8 vs. 14.1 ± 2.2, P = 0.005) and drug-naïve SCZ subjects (CpG1, P = 0.006; CpG2, P = 0.001; CpG3, P = 0.001; CpG5, P = 0.02; CpG6, P = 0.015; CpG7, P = 0.027; and average: 9.86 ± 0.9 vs. 11.2 ± 1.3, P = 0.002). CONCLUSIONS: We confirmed low methylation rates in the upstream region of DRD2 in both medicated and drug-naïve SCZ subjects. Low methylation rates of DRD2 in leukocytes may be a trait biomarker for SCZ.

[Cardiac Surgery in Two Patients with Parkinson's Disease who were Using Deep Brain Stimulation Devices].

For the treatment of Parkinson's disease, deep brain stimulation( DBS) devices are implanted for the control of motor symptoms including tremor. We performed cardiac surgery in 2 patients with Parkinson's disease who were using DBS devices. Coronary artery bypass was performed in one patient, and closure of ventricular septal perforation after acute myocardial infarction was performed in the other. There is a risk of injury and electromagnetic interference of DBS devices. No device failure or aggravation of Parkinson's symptom was observed in these cases. In many cases of cardiac surgery, various devices are concomitantly used, and the potential interference with the devices should be carefully examined in perioperative management.

Antidepressant action via the nitric oxide system: A pilot study in an acute depressive model induced by arginin.

Nitric oxide (NO) may be a neurotransmitter related to major depressive disorder (MDD) because the selective neuronal NO synthase (NOS) inhibitor, 7-nitroindazole, induces dose-dependent antidepressant-like effects. However, its role in MDD is not yet known. The purpose of our study was to determine if antidepressants improve depression via the NO pathway using an acute depressive rat model induced by L-arginine (AR). Three types of antidepressants were examined, fluoxetine (FLX, 10 mg/kg), milnacipran (MIL, 30 mg/kg), and mirtazapine (MIR, 10 mg/kg), in a depressive model that used AR (750 mg/kg) pretreatment. mRNA expression levels of three NOS subtypes were analyzed by real-time PCR, as well as serum NO levels. Significant increases in iNOS mRNA expression levels were found in brain regions after AR treatment, although the eNOS gene tended to decrease with AR injection. After antidepressant treatment, there were no mRNA expression changes in either nNOS or iNOS. However, eNOS mRNA expression significantly increased with FLX (cerebellum, P=0.011; hippocampus, P=0.011; midbrain, P=0.011; pons, P=0.013; striatum, P=0.011; and thalamus, P<0.001). There was a statistically significant increase in serum NO levels with MIL treatment (P=0.011). We conclude that changes in eNOS mRNA levels in the brain with FLX treatment, and amount of serum NO with MIL treatment may be related to antidepressant effects of both agents, but further experiments are needed to confirm involvement of the NO system in MDD.

Ascending to Abdominal Aorta Extraanatomic Bypass for Descending Aortic Coarctation: A Reconstruction Technique without Laparotomy or Left Thoracotomy.

The descending aortic coarctation is often difficult to anatomically reconstruct. We report two cases of ascending aorta to abdominal aorta bypass without laparotomy or thoracotomy. This approach enabled us to avoid anastomosis close to the inflammatory lesion and left thoracotomy causing bleeding from the collateral vessels, and to allow concomitant cardiac procedures to be performed. The graft contact with the intestines can be preventable by the retroperitoneal approach. This technique is useful for the selective patients.

Evaluation of well-balanced lip position by Japanese orthodontic patients.

INTRODUCTION: The purposes of this study were to assess and determine the range of a well-balanced anteroposterior lip position as evaluated by orthodontic patients from a series of varying lip positions in facial silhouettes, and whether the rater's sex and age were factors in the assessment. METHODS: The average profiles were constructed from 30 Japanese male and female subjects with normal occlusion. A series of 13 profiles was developed for males and females, respectively. The lips were protruded or retruded by 1-mm increments from the average profile. One hundred fifty Japanese orthodontic patients were asked to choose the top 3 most-favored, well-balanced profiles for each sex. RESULTS: The orthodontic patients tended to prefer a slightly retruded lip position than the average facial profile for both the male and female profiles. There was no significant difference between male and female raters in selecting the top 3 most-favored profiles. In the comparison of age groups, the over 30-year-old patients significantly preferred a more retruded lip position than did the 15- to 19-year-old and the 20- to 29-year-old patients for the female profile. CONCLUSIONS: These results suggest that, when we formulate a treatment plan, we should ask the patients about lip position before we start treatment.

Effects of retraction of anterior teeth and initial soft tissue variables on lip changes in Japanese adults.

The aim of this study was to examine the effects of retraction of anterior teeth and the initial soft tissue profile variables on upper and lower lip changes in Japanese adults. Pre- and post-treatment cephalometric radiographs of 33 Japanese female adults (aged 23.0±5.0 years), with a Class II division 1 malocclusion, who had two or four first premolars extracted, were evaluated. Lateral cephalograms taken with the lips in a voluntary relaxed position were traced and compared. Nine linear and eight angular measurements were constructed for the hard tissue measurements and 16 linear and 2 angular for the soft tissue measurements. Stepwise multiple regression analysis revealed that the horizontal upper lip position could be explained by the position of the maxillary incisor cervical point and the occlusal plane to SN with a 54 percent contribution ratio, and horizontal lower lip position, maxillary incisor tip position, initial interlabial gap, and aesthetic line to the tip of lower lip with a 51 percent contribution ratio. All parameters employed explained the horizontal position of the upper and lower lip with higher than 96 percent confidence. While the horizontal positions could not be predicted by a limited number of parameters, the vertical positions of lips could be explained by three parameters with higher than 62 percent confidence. The predictability found in this study could be beneficial for orthodontists in treatment planning.

Influence of gingival display on smile aesthetics in Japanese.

The aim of this study was to evaluate the influence of the amount of gingival display on smile aesthetics as assessed by Japanese orthodontists and dental students. A coloured photograph of a smiling female, displaying the first molar to first molar, whose upper lip was tangent to the upper gingival margin of the upper central incisors (zero point), was constructed from different subjects. Gingival displays were modified by moving the teeth within the lip frame in 1 mm increments, from -5 to 5. Using a visual analogue scale (VAS), 31 Japanese orthodontists and 55 Japanese dental students rated the attractiveness of the 11 smiles with altered gingival display. There was no significant difference when judging the effects of the gingival display on the smile attractiveness between the male and the female raters for both the orthodontists and dental students. Kruskal-Wallis tests revealed significant differences in the median aesthetic scores for both the orthodontists and dental students. For the orthodontists, the median aesthetic score increased gradually from -5 to 0 mm and then decreased from 0 to 5 mm. In particular, it decreased to become clinically significant (15 per cent VAS difference) from 0 to 3 mm. For the dental students, the median aesthetic score increased gradually from -5 to -2 mm and then decreased from -2 to 5 mm. The dental students were less tolerant of a more 'gummy' smile than the orthodontists.

Lip morphology changes following orthognathic surgery for Class III malocclusion.

OBJECTIVES: To test the hypothesis that there is no difference in the morphology of the lips and to determine the degree of improvement in the smile after orthognathic surgery for Class III malocclusion. MATERIALS AND METHODS: The sample subjects included 30 adult female patients with dento-skeletal Class III malocclusion and 28 adult female volunteers with normal occlusion. Frontal facial photographs were taken before and after treatment, and 35 landmarks were placed on each tracing made from the frontal facial photograph. Thereafter, the landmarks were digitized into an x and y coordinate system with the subnasal point as the origin. The pretreatment rest and smile conditions were compared with the posttreatment conditions, respectively, using paired t-tests. In addition, two sample t-tests were used to test for differences between groups. RESULTS: Both the upper and lower lips in the smiles of the Class III pretreatment group were positioned downward, and the upward movement of the upper lip and commissure points were smaller compared with the control group. When smiling, the horizontal direction of the mouth corners was statistically significantly different between the pretreatment and posttreatment conditions, whereas these were wider in the posttreatment than in the pretreatment conditions. These characteristics of the Class III smile improved after orthognathic treatment, but the differences with the control group remained unchanged immediately after treatment. CONCLUSION: The hypothesis is rejected. The soft tissue morphology of patients with dento-skeletal Class III malocclusion shows a significant improvement after orthognathic surgery.

Comparison of the kinetic frictional force between conventional plastic brackets with thermoplastic low-friction module ligation and self-ligating brackets.

AIM: To compare the kinetic frictional force of a conventional plastic preadjusted bracket with thermoplastic low-friction module ligation and a self-ligating bracket. MATERIALS AND METHODS: The testing model consisted of four 0.022-inch conventional plastic preadjusted brackets; four 0.022-inch self-ligating brackets for the first premolar, canine, and lateral and central incisors; and a 0.014-inch superelastic nickel-titanium and a 0.019 × 0.025-inch stainless steel wire. The brackets were either aligned for both wires or out of line by 0.5, 1.0, 1.5, and 2.0 mm for only the 0.014-inch superelastic wire. The wires were pulled for 3.0 mm at a speed of 0.1 mm per second. Unpaired t tests were used to compare the mean differences of the measurements between the two bracket systems with both wires. RESULTS: No significant difference in the kinetic frictional force between the two bracket systems and the two wires were found for the 0.014-inch superelastic wire at 0-mm deflection. CONCLUSION: Both bracket systems demonstrate low friction, which is beneficial for effective orthodontic tooth movement with light forces.

Effects of buccal corridors on smile esthetics in Japanese.

OBJECTIVE: To test the hypothesis that the amount of buccal corridor has no influence on smile evaluations of Japanese orthodontists and dental students. MATERIALS AND METHODS: One photograph of a smiling female, displaying first molar to first molar, was constructed. Buccal corridors were modified digitally in 5% increments, from 0% to 25% buccal corridor compared with the inner commissural width. Using a visual analog scale (VAS), 32 Japanese orthodontists and 55 Japanese dental students rated the attractiveness of six smiles with altered buccal corridors. The Wilcoxon rank-sum test was conducted to compare the distributions of the median scores between the male and female raters for each of the rater groups. Differences in the median esthetic scores were analyzed using the Kruskal-Wallis test. We used 15% VAS difference to determine the clinical significance of the esthetic scores. RESULTS: There was no significant difference in judging the effects of buccal corridors on the smile attractiveness between the male and female raters for both the orthodontists and dental students. There were significant differences in the median esthetic scores for both the orthodontists and dental students. The median esthetic score decreased to become clinically significant from 10% to 25% buccal corridor for both the orthodontists and dental students. CONCLUSIONS: The hypothesis was rejected. Both the orthodontists and dental students preferred broader smiles to medium or narrow smiles.

Frictional resistance in plastic preadjusted brackets ligated with low-friction and conventional elastomeric ligatures.

OBJECTIVE: To compare frictional resistance of the plastic preadjusted brackets ligated with the low-friction ligatures with those of the conventional elastomeric ligatures. DESIGN: In vitro study. SETTING: Department of Orthodontics, Faculty of Dentistry, Kyushu University, Fukuoka, Japan. MATERIALS AND METHODS: The testing model consisted of four 0.022-inch plastic preadjusted brackets for the first premolar, the canine, the lateral incisor, and the central incisor. A superelastic nickel-titanium 0.014-inch wire and a stainless steel 0.019 x 0.025-inch wire were used for this test. The brackets were either aligned or out of line by 0.5, 1.0, 1.5 and 2.0 mm for the 0.014-inch wire and aligned for the 0.019 x 0.025-inch wire. The frictional forces in plastic preadjusted brackets with low-friction ligatures and conventional elastomeric ligatures were measured at a pulling speed of 0.1 mm/second. Welch t-tests were used to compare the mean differences of each testing measurement between the low-friction and the conventional elastomeric ligatures. RESULTS: In both use of the superelastic nickel-titanium 0.014-inch wire and the stainless steel 0.019 x 0.025-inch wire, the brackets with the low-friction ligatures showed significantly lower frictional forces than those of the conventional elastomeric ligatures in both aligned and all misaligned brackets (P < 0.0001). CONCLUSION: The study found the significantly lower frictional forces for the low-friction ligatures than those of the conventional elastomeric ligatures.

Mechanomyogram and electromyogram analyses during isometric contraction in human masseter muscle.

AIMS: To investigate the relationship between mechanomyogram (MMG), electromyogram (EMG) and bite force during isometric contraction of the human masseter muscle. METHODS: Data were obtained from 16 healthy Japanese males (Mean age: 25.6 +/- 2.3 years). The measuring device for MMG consisted of an amorphous sensor and a small magnet. The bite force, MMG and EMG signals were recorded simultaneously during isometric contraction of the masseter muscle. The subjects were instructed to perform 0, 5, 10, 20, 30, 40, 50, and 60% maximal voluntary contractions (MVC) for 20 seconds. The average rectified value (ARV) for MMG and EMG were calculated from 1 to 5 second samples. The median frequency of the power spectrum (MFPS) for MMG and EMG were determined with the use of a fast Fourier transformation algorithm. RESULTS: The mean ARV for MMG increased up to 20% MVC and then gradually decreased at the higher force levels. The mean ARV for EMG increased with bite force in a monotonic fashion. The mean MFPS for MMG clearly increased up to 10% MVC and then gradually increased. On the other hand, the mean MFPS for EMG clearly increased up to 10% MVC, but then gradually decreased with bite force. CONCLUSION: These findings suggest that the MMG analysis combined with the EMG may be a more useful method for evaluating the status of the masseter muscle.

Comparison of anteroposterior lip positions of the most-favored facial profiles of Korean and Japanese people.

INTRODUCTION: A consensus on the contemporary perception of beauty might have been developed between different countries because of increased worldwide access to variations in pleasing facial profiles. The objectives of this study were to determine, assess, and compare the ranges of values of the most-favored facial profiles rated by young Korean and Japanese adults. METHODS: Average profiles were constructed from the profiles of 30 Japanese men and women with normal occlusions. A series of 13 profiles each was developed for men and women. In the series, the average profile was located in the center (number 7), and the lips were protruded or retruded in 1-mm increments from the average profile. Forty-six Korean dental students and 52 Japanese dental students were asked to rate the top 3 most-favored profiles. RESULTS: Both the Korean and the Japanese dental students tended to select a slightly more retruded lip profile compared with the averages for men and women, and the tendency to prefer a more retruded lip position was evident for the women. CONCLUSIONS: These findings suggest that young Korean and Japanese adults prefer a retruded profile, even though their profiles have historically been characterized by more convex facial features.

TMJ osteoarthritis/osteoarthrosis and immune system factors in a Japanese sample.

OBJECTIVE: To determine whether there is an association between temporomandibular joint (TMJ) osteoarthritis/osteoarthrosis (OA) and immune system factors in a Japanese sample. MATERIALS AND METHODS: The records of 41 subjects (7 men, aged 22.0 +/- 3.8 years; 34 women, aged 24.8 +/- 6.3 years) and 41 pair-matched controls (7 men, aged 22.1 +/- 2.3 years; 34 women, aged 24.8 +/- 6.4 years) based on age and gender were reviewed. Information on medical history included local or systemic diseases, details on medication type and use, and the presence of allergies and asthma. Dental history questions referred to details regarding past oral injuries. The validity of the hypothesis, defining allergies and asthma as risk factors in OA, was tested by using a logistic regression analysis. RESULTS: The incidence of allergy was significantly higher in the TMJ OA (P = .008), with a mean odds ratio of 4.125 and a 95% confidence interval of 1.446-11.769. CONCLUSION: These results suggest that allergy may be a risk factor in association with TMJ OA in this Japanese sample.