Premature Chromatid Separation Trait Found During the Diagnosis of Male Infertility: A Case Report.

Premature chromatid separation (PCS)/mosaic variegated aneuploidy (MVA) syndrome is a rare chromosome instability syndrome. This syndrome is inherited in an autosomal recessive pattern. Although heterozygous carriers of a monoallelic mutation reportedly have a normal phenotype, PCS-positive cells are found at a higher rate in such carriers than in the general population. We herein report a case in which a PCS carrier was incidentally diagnosed during investigation of male infertility. A diagnosis of nonobstructive azoospermia was made, and chromosome analysis revealed the PCS trait in 81 of 200 cells (40.5%), indicating that the patient was a PCS carrier. PCS carriers are not uncommon, and if both members of a couple are carriers, there would be a 25% likelihood of the child presenting with PCS syndrome. Therefore, a clinical psychological approach that includes genetic counseling should be considered before proceeding to microsurgical testicular sperm extraction.

Causes of Iatrogenic Median Nerve Injury after Endoscopic Carpal Tunnel Release.

Background: Endoscopic carpal tunnel release (ECTR) is a less invasive procedure but has a higher risk of complications. We analysed ECTR cases dividing them into three periods according to a single surgeon's experience when the ECTR was performed: the initial, midterm and late period. Cases of iatrogenically induced median nerve injuries that occurred after ECTR were then noted and evaluated. Methods: We reviewed 195 ECTRs done with the 2-portal technique and divided the patients into three groups according to periods of when ECTR was done. The indications for ECTR surgery were limited to severe CTS cases. These groups of patients were similar in terms of age, duration of disease, electrophysiological study results and severity of the disease. The patients were evaluated for median neuropathy pre- and postoperatively using Semmes-Weinstein monofilament test (SWT), Disabilities of the arm, shoulder and hand (DASH) Score, Coin-flip test (CFT), postoperative paraesthesias and complications, such as pillar pain, and so on. Electrophysiological evaluation was performed only preoperatively. Results: Postoperative median nerve recovery was overall good. Normal recovery was noted in 181 cases (93%). SWT, DASH and CFT were all significantly improved upon follow-up in all three groups. In terms of iatrogenic neuropathy, median nerve palsy worsened (including those transiently worsened) after ECTR in 11 cases (5.6%), even in the later period. The sensory disturbance was equally worsening from the radial to the ulnar side. Conclusions: The fact that there were neurologically worsened cases even in the later period, when the operator is higher skilled in the technique, suggests that the surgical technique itself may be the one posing higher risk than the level of surgical skill. The most likely causes of aggravated nerve palsy were a direct injury by cannula insertion at the proximal portal, or additional median nerve compression during cannula insertion into the carpal tunnel. Level of Evidence: Level IV (Therapeutic).

Accuracy and influencing factors of maxillary and mandibular repositioning using pre-bent locking plates: a prospective study.

In-house repositioning methods based on three-dimensional (3D)-printing technology and the use of pre-bent plates has been gaining popularity in orthognathic surgery. However, there remains room for further improvement in methods and investigations on clinical factors that affect accuracy. This single-centre, prospective study included 34 patients and aimed to evaluate the accuracy and factors influencing maxillary and mandibular repositioning using pre-bent locking plates. The plates were manually pre-bent on the 3D-printed models of the planned position, and their hole positions were scanned and reproduced intraoperatively with osteotomy guides. The accuracy of repositioning and plate-hole positioning was calculated in three axes with the set landmarks. The following clinical factors that affect repositioning accuracy were also verified: deviation of the plate-hole positioning, amount of planned movement, and amount of simulated bony interference. The median deviations of the repositioning and hole positioning between the preoperative plan and postoperative results were 0.26 mm and 0.23 mm, respectively, in the maxilla, and 0.69 mm and 0.36 mm, respectively, in the mandible, suggesting that the method was highly accurate, and the repositioning concept based on the plate hole and form matching was more effective in the maxilla. Results of the correlation test suggest that large amounts of bony interference and plate-hole positioning errors in the up/down direction could reduce mandibular repositioning accuracy.

A Novel Orthognathic Surgery With a Half-Millimeter Accuracy for the Maxillary Positioning Using Prebent Plates and Computer-Aided Design and Manufacturing Osteotomy Guide.

This retrospective study aimed to assess the accuracy of prebent plates and computer-aided design and manufacturing osteotomy guide for orthognathic surgery. The prebent plates correspondent to the planning model were scanned with a 3-dimensional printed model for guide design and used for fixation. Forty-two patients who underwent bimaxillary orthognathic surgery using computer-aided design and manufacturing intermediate splint with the guide (guided group: 20 patients) or with conventional fixation under straight locking miniplates (SLMs) technique (SLM group: 20 patients) were analyzed. A deviation of the maxilla between the planned and postoperative positions was evaluated using computed tomography, which was taken 2 weeks before and 4 days after the surgery. The surgery time and the infraorbital nerve paranesthesia were also evaluated. The mean deviations in the mediolateral ( x ), anteroposterior ( y ), and vertical directions ( z ) were 0.25, 0.50, and 0.37 mm, respectively, in the guided group, while that in the SLM group were 0.57, 0.52, and 0.82 mm, respectively. There were significant differences in x and z coordinates ( P <0.001). No significant difference in the surgery duration and paranesthesia was seen, suggesting the present method offers a half-millimeter accuracy for the maxillary repositioning without increasing the risk of extending surgery duration and nerve complication.

[Treatment of Parastomal Hernia Following Robot-Assisted Radical Cystectomy and Cutaneous Ureterostomy : A Case Report].

The patient was an 82-year-old woman with localized muscle-invasive bladder cancer, who underwent robot-assisted radical cystectomy and cutaneous ureterostomy. On the 3rd day after the operation, she suddenly complained of abdominal pain. Abdominal computed tomographic scans revealed parastomal hernia. The patient underwent manual reduction of hernia, but had repeated recurrences of parastomal hernia within a few days. On the 14th day we performed a laparoscopic hernia repair. Observation of the stoma site revealed a laceration of the peritoneum and fascia, and the small intestine was prolapsed. We pulled the small intestine out and ligated the laceration with Mediflex® Suture Grasper Closure Device. After re-operation, there was no recurrence of bladder cancer and parastomal hernia, and the stoma appliances could be put on without any trouble.

Straight Locking Miniplate Technique Achieves Submillimeter Accuracy of Condylar Positional Change During Bimaxillary Orthognathic Surgery for Patients With Skeletal Class III Malocclusion.

PURPOSE: The straight locking miniplate (SLM) technique is a straightforward method to accurately reposition the maxilla during bimaxillary orthognathic surgery. The present study evaluated the accuracy of the SLM technique in maintaining the condylar position during surgery without the use of a cutting guide. PATIENTS AND METHODS: The present prospective, single-center study was conducted at Yokohama City University between 2016 and 2017 and included patients with skeletal Class III malocclusion. The patients were divided into 2 groups according to the fixation method used for the mandibular segments. The mandibular segments were fixed with miniplates either manually (manual group) or using the SLM technique (SLM group). Computed tomography was performed before and 3 days after surgery to compare the condylar position. The bodily and rotational movements of the condyle were analyzed. RESULTS: The subjects were 18 Japanese patients (36 condyles) who had undergone bilateral set back surgery with Le Fort I osteotomy. The amount of bodily movements in the manual and SLM groups were 1.44 and 0.62 mm, respectively. The degree of rotational movement in the sagittal plane in the manual and SLM groups was 3.33° and 0.23°, respectively. The bodily and rotational movements in the SLM group were significantly smaller than those in the manual group (P < .05 and P < .01, respectively). CONCLUSIONS: These results suggest that use of the SLM technique reduces the risk of condylar positional changes to less than 1 mm during orthognathic surgery without the use of any complex devices or a cutting guide.

An accurate bimaxillary repositioning technique using straight locking miniplates for the mandible-first approach in bimaxillary orthognathic surgery.

Bimaxillary orthognathic surgery has been widely performed to achieve optimal functional and esthetic outcomes in patients with dentofacial deformity. Although Le Fort I osteotomy is generally performed before bilateral sagittal split osteotomy (BSSO) in the surgery, in several situations BSSO should be performed first. However, it is very difficult during bimaxillary orthognathic surgery to maintain an accurate centric relation of the condyle and decide the ideal vertical dimension from the skull base to the mandible. We have previously applied a straight locking miniplate (SLM) technique that permits accurate superior maxillary repositioning without the need for intraoperative measurements in bimaxillary orthognathic surgery. Here we describe the application of this technique for accurate bimaxillary repositioning in a mandible-first approach where the SLMs also serve as a condylar positioning device in bimaxillary orthognathic surgery.

Acute eosinophilic pneumonia following heat-not-burn cigarette smoking.

A 20-year-old man was admitted with acute respiratory failure. He had started smoking 20 heat-not-burn cigarettes (HC) per day 6 months previously, then purchased a second device for smoking HC to increase smoking to 40 cigarettes per day 2 weeks before hospitalization. Acute eosinophilic pneumonia (AEP) was diagnosed based on medical history, chest high-resolution computed tomographic findings, and bronchoalveolar lavage fluid eosinophilia. On starting treatment with prednisolone, the patient exhibited complete recovery. A relationship between cigarette smoking and AEP has been suggested. HC were released in September 2015 in Japan, Italy, and Switzerland. HC attract attention as a cigarette generating less harmful substances than a conventional cigarette. We herein report the first case of AEP caused by smoking HC. HC are expected to spread around the world. In the same way as a conventional cigarette, HC should be recognized as a potential cause of AEP.

U-shaped Osteotomy Around the Descending Palatine Artery to Prevent Posterior Osseous Interference for Superior/Posterior Repositioning of the Maxilla in Le Fort I Osteotomy.

In maxillary orthognathic surgery, superior repositioning of the maxilla is sometimes difficult, and removal of bony interference, especially around the descending palatine artery (DPA), is very time-consuming in cases of severe maxillary impaction. Posterior repositioning of the maxilla for removal of bony interference between the posterior maxilla and the pterygoid process is also technically difficult. Because the most common site of hemorrhage in Le Fort I osteotomy is the posterior maxilla, this bone removal is a source of frustration for surgeons in DPA injury. When the DPA is injured during bone removal and ligation is performed, aseptic necrosis of the maxilla may occur. Therefore, a simple and safe method for maxillary superior/posterior repositioning is required to remove osseous interference around the DPA. The authors describe here U-shaped osteotomy around the DPA to prevent posterior osseous interference for superior/posterior repositioning of the maxilla in Le Fort I osteotomy.

Vital staining of palatal soft tissue in horseshoe Le Fort I osteotomy for superior repositioning of the maxilla.

In maxillary orthognathic surgery, superior repositioning of the maxilla is sometimes difficult, and removal of the bony interference, especially around the descending palatine artery, is very time-consuming in cases of severe maxillary impaction. A useful method introduced for superior repositioning of the maxilla is horseshoe-shaped osteotomy combined with Le Fort I osteotomy (horseshoe Le Fort I osteotomy). However, injury to the palatal soft tissue during horseshoe-shaped osteotomy may cause aseptic complications of the maxilla. Therefore, a safe method is required to prevent such injury to reduce the risk for aseptic necrosis. We describe here vital staining of palatal soft tissue in horseshoe Le Fort I osteotomy for safer superior repositioning of the maxilla.

Removal of migrated dental implants from maxillary sinus 4 years 10 months after implant placement.

INTRODUCTION: Dental implant treatment has been applied widely in recent years. However, several complications sometimes have been reported. Although displacement of dental implants into the maxillary sinus commonly occurs during surgery, the migration of dental implants after a period of function, especially several years after dental implant placement, is very rare. CASE REPORT: We report here removal of migrated dental implants from the maxillary sinus 4 years and 10 months after dental implant placement.

New members of the mammalian glycerophosphodiester phosphodiesterase family: GDE4 and GDE7 produce lysophosphatidic acid by lysophospholipase D activity.

The known mammalian glycerophosphodiester phosphodiesterases (GP-PDEs) hydrolyze glycerophosphodiesters. In this study, two novel members of the mammalian GP-PDE family, GDE4 and GDE7, were isolated, and the molecular basis of mammalian GP-PDEs was further explored. The GDE4 and GDE7 sequences are highly homologous and evolutionarily close. GDE4 is expressed in intestinal epithelial cells, spermatids, and macrophages, whereas GDE7 is particularly expressed in gastro-esophageal epithelial cells. Unlike other mammalian GP-PDEs, GDE4 and GDE7 cannot hydrolyze either glycerophosphoinositol or glycerophosphocholine. Unexpectedly, both GDE4 and GDE7 show a lysophospholipase D activity toward lysophosphatidylcholine (lyso-PC). We purified the recombinant GDE4 and GDE7 proteins and show that these enzymes can hydrolyze lyso-PC to produce lysophosphatidic acid (LPA). Further characterization of purified recombinant GDE4 showed that it can also convert lyso-platelet-activating factor (1-O-alkyl-sn-glycero-3-phosphocholine; lyso-PAF) to alkyl-LPA. These data contribute to our current understanding of mammalian GP-PDEs and of their physiological roles via the control of lyso-PC and lyso-PAF metabolism in gastrointestinal epithelial cells and macrophages.

Cervicofacial subcutaneous and mediastinal emphysema caused by air cooling spray of dental laser.

Cervicofacial subcutaneous emphysema is a rare complication of dental procedures with an air turbine or syringe, and dentists and oral surgeons sometimes encounter mediastinal emphysema following the presentation of extensive subcutaneous emphysema. Most emphysema occurs incidentally during tooth extraction, restorative treatment, or endodontic treatment, with only a few cases reported of cervicofacial subcutaneous emphysema associated with dental laser treatment. We report a case of cervicofacial subcutaneous and mediastinal emphysema caused by the air cooling spray of dental laser during dental treatment in a 76-year-old woman. After she underwent dental laser treatment, cervicofacial swelling was noted and she was referred to our department. Computed tomography showed both cervicofacial subcutaneous emphysema and mediastinal emphysema. Antibiotics were administered prophylactically and the emphysema disappeared 5 days after the dental laser treatment, without any complications.

Involvement of membrane protein GDE2 in retinoic acid-induced neurite formation in Neuro2A cells.

We show that a glycerophosphodiester phosphodiesterase homolog, GDE2, is widely expressed in brain tissues including primary neurons, and that the expression of GDE2 in neuroblastoma Neuro2A cells is significantly upregulated during neuronal differentiation by retinoic acid (RA) treatment. Stable expression of GDE2 resulted in neurite formation in the absence of RA, and GDE2 accumulated at the regions of perinuclear and growth cones in Neuro2A cells. Furthermore, a loss-of-function of GDE2 in Neuro2A cells by RNAi blocked RA-induced neurite formation. These results demonstrate that GDE2 expression during neuronal differentiation plays an important role for growing neurites.