Inferior Alveolar Nerve Block Using the Anterior Technique to Anesthetize Buccal Nerve and Improve Anesthesia Success Rates for Third Molar Extraction: A Randomized Controlled Trial and Magnetic Resonance Imaging Evaluation.

PURPOSE: The lack of anesthesia to the buccal nerve and an insufficient volume of anesthetic have been reported to be responsible for failed inferior alveolar nerve blocks (IANBs) using the Halsted approach (conventional IANB). We aimed to determine the extent of anesthesia in the buccal nerve innervation area and evaluate the anesthetic efficacy of injecting a larger volume of anesthetic during IANB using the anterior approach (anterior technique) in the clinical setting and with magnetic resonance imaging (MRI) analysis. PATIENTS AND METHODS: The prospective randomized controlled trial included patients scheduled for removal of a mandibular third molar. The primary predictor variables were the approach for IANB (anterior technique vs conventional IANB) and anesthetic dose (1.8 vs 2.7 mL). The primary outcome variables were the extent of anesthesia and the anesthesia success rate, defined as completion without additional anesthesia. The secondary outcome variable was the anesthetic drug distribution related to the pterygomandibular space measured on T2-weighted MRI scans. Statistical independence of the anesthesia success rate among the primary predictor variables was tested with statistical significance set at P ≤ .05. RESULTS: A total of 108 patients and 10 volunteers were enrolled in the clinical and MRI studies, respectively. Anesthesia of the buccal nerve was evident in patients receiving the anterior technique with 2.7 mL of anesthetic. The success rate of the anterior technique with 2.7 mL of anesthetic (96%) was greater than that with 1.8 mL of anesthetic (67%; P = .0113), and increasing the dose had no effect on the efficacy of conventional IANB (78% vs 81%; P = 1.000). The MRI study showed that the anesthetic was distributed over the anterior surface of the temporalis tendon and in the pterygomandibular space after the anterior technique. CONCLUSIONS: Anesthesia of the buccal nerve using the anterior technique with 2.7 mL of anesthetic solution might contribute to increasing the success rate of anesthesia for removal of mandibular third molars.

Periodontal pathogens participate in synovitis in patients with rheumatoid arthritis in clinical remission: a retrospective case-control study.

OBJECTIVE: The objective of this study was to investigate the role of periodontal pathogens in RA in remission. METHODS: Twenty-one patients with active RA and 70 patients in clinical remission, including 48 patients with synovitis [US power Doppler (USPD)(+) group] and 22 patients without synovitis [USPD(-) group] were clinically assessed by US. CRP, ESR, haemoglobin, MMP-3, RF and ACPA were measured. Antibody titres against four types of periodontal pathogen [Aggregatibacter actinomycetemcomitans, Eikenella corrodens (Ec), Porphyromonas gingivalis and Prevotella intermedia (Pi)] were analysed using ELISA. RESULTS: Musculoskeletal US examination showed that 68.6% of patients with RA in clinical remission exhibited synovitis. CRP, ESR, haemoglobin, MMP-3 and RF levels in both the USPD(+) and USPD(-) groups were clearly lower compared with the RA group in non-remission. The IgG serum antibody titre against Ec in the non-remission RA(+) group was significantly greater than that in the USPD(+) group, and the IgG antibody titre against Pi in the non-remission RA and USPD(+) groups was greater than in the USPD(-) group. CONCLUSION: More than half of RA patients in remission showed persistent synovitis. This synovitis may be associated with periodontal disease-causing Pi. Thus, treating periodontal disease should also be considered in order to achieve more profound remission of RA.

Toxicological aspects of cadmium and occupational health activities to prevent workplace exposure in Japan: A narrative review.

Chemicals are an essential part of modern manufacture processes. Their use must be managed with great attention in occupational settings to avoid serious detrimental effects to the health of employees. For example, cadmium compounds are indispensable for the production of nickel-cadmium rechargeable batteries or as chemical stabilizer in plastics. It is an exceptionally toxic heavy metal and personnel exposed to cadmium in the workplace meet with potential health risks that can lead to the development of kidney, skeletal and respiratory disorders. In consequence, proactive and systematical development of occupational hygiene and health activities are necessary to reduce chemical exposure to cadmium in the workplace. This review describes the known facts of cadmium toxicity, the biological effects of cadmium exposure, possible regulation measures to prevent occupational cadmium exposure in three industrial health management systems and discusses future cooperation programs in these systems, proactive safety activities and occupational safety and health management strategies.

Efficacy of intravenous sedation and oral nifedipine in dental implant patients with preoperative hypertension - a retrospective study of 516 cases.

BACKGROUND: To examine the effects of intravenous sedation and oral nifedipine on blood pressure and pulse rate in patients with perioperative high blood pressure undergoing implant surgery, the clinical records of dental implant patients managed by intravenous sedation at our outpatient dental offices were retrospectively evaluated. METHODS: A total of 516 clinical charts were evaluated. The subjects were divided into two groups: a normotensive group with no history of hypertension and a hypertensive group with a history of hypertension. The patients in the hypertensive group were further divided into two subgroups: with or without nifedipine administration before operation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR), and rate pressure product (RPP) were assessed. RESULTS: In 30 patients (33%) of the hypertensive group, the high blood pressure on arrival obviously declined to around or less than 160 mmHg; in the remaining patients in the group who showed a mean SBP of 182.1 ± 13.8 mmHg on arrival, the blood pressure did not decrease after a 30-min rest. Oral nifedipine administered to the patients with sustained high blood pressure decreased SBP to 144.7 ± 23.1 mmHg in 28.1 ± 9.3 min after administration, comparable to that in hypertensive patients without nifedipine. CONCLUSIONS: For patients with stage 2 hypertension before operation, it may be difficult to maintain the recommended blood pressure during surgery by only intravenous sedation; reduction of blood pressure by antihypertensive drugs may be necessary.

Occlusal support including that from artificial teeth as an indicator for health promotion among community-dwelling elderly in Japan.

AIM: The Eichner index (EI) is used to evaluate occlusal support. However, this index is based on existing natural tooth contact. This study aimed to establish whether a modified EI that included artificial teeth reflected individual oral condition of elderly people, and to clarify the relationship between this index and: (i) mental condition; (ii) physical condition; and (iii) physical function. METHODS: We recruited 286 people (145 men, 141 women) aged 65-79 years. They were divided into three groups by modified EI, and then underwent assessment of oral condition. After establishing that the index was clearly related to oral condition, we investigated psychological factors (satisfaction with life, self-rated health and anxiety regarding falling), indicators of walking and balance (Timed Up & Go test [TUG] and one-leg standing balance), physical condition (higher-level functional capacity [HLFC]: instrumental activities of daily living [IADL], intellectual activity and social role; continuous walking over 15 min; and frequency of outings), and health history in the previous year (history of hospital admissions and falls). RESULTS: Modified EI was a good indicator of occlusal condition. The index was significantly correlated in men with satisfaction with life, TUG test, one-leg standing balance, overall HLFC and HLFC-IADL, and in women with TUG test, one-leg standing balance and HLFC-Intellectual activity. CONCLUSION: The evaluation of occlusal support including that from artificial teeth is beneficial in the elderly as an indicator of health and oral function, in particular firm bite.

Handgrip strength as a predictor of higher-level competence decline among community-dwelling Japanese elderly in an urban area during a 4-year follow-up.

This 4-year observational study examined whether handgrip strength can predict functional decline in higher-level competence in a cohort of urban community-dwelling Japanese elderly. Subjects were 406 community-dwelling Japanese, 65 years or older at baseline who scored as "independent in higher-level competence" (11 and over) according to the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). Independent variables were handgrip strength and usual walking speed at baseline survey. Dependent variables were functional status in higher-level competence at 4-year follow-up. Logistic regression analysis, after adjustment for age and body mass index (BMI), revealed that handgrip strength was significantly correlated with decline of higher-level competence in both sexes. Usual walking speed was significantly correlated with decline in higher-level competence only in women. This study revealed that handgrip strength is a predictor for decline in higher-level competence in urban community-dwelling Japanese elderly men and women. Results suggest that handgrip strength may be used to screen for functional capacity decline in community-dwelling elderly.

Association between sarcopenia and higher-level functional capacity in daily living in community-dwelling elderly subjects in Japan.

This study aimed to determine the association between sarcopenia, defined by muscle mass, muscle strength, and physical performance, and higher-level functional capacity in community-dwelling Japanese elderly people. Subjects were 1158 elderly, community-dwelling Japanese people aged 65 or older. We used bioelectrical impedance analysis to measure muscle mass, grip strength to measure muscle strength, and usual walking speed to measure physical performance. Sarcopenia was characterized by low muscle mass, plus low muscle strength or low physical performance. Subjects without low muscle mass, low muscle strength, and low physical performance were classified as "normal." Examination of higher-level functional capacity was performed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC). The TMIG-IC is a 13-item questionnaire completed by the subject; it contains five questions on self-maintenance and four questions each on intellectual activity and social role. Sarcopenia was identified in 11.3% and 10.7% of men and women, respectively. The percentage of disability for instrumental activities of daily living (IADL) was 39.0% in men with sarcopenia and 30.6% in women with sarcopenia. After adjustment for age, in men, sarcopenia was significantly associated with IADL disability compared with intermediate and normal subjects. In women, sarcopenia was significantly associated with every subscale of the TMIG-IC disability compared with intermediate and normal subjects. This study revealed that sarcopenia, defined by muscle mass, muscle strength, and physical performance, had a significant association with disability in higher-level functional capacity in elderly Japanese subjects. Interventions to prevent sarcopenia may prevent higher-level functional disability among elderly people.

Distribution, elimination, and renal effects of single oral doses of europium in rats.

Single doses of europium (III) chloride hexahydrate were orally administered to several groups of rats. Cumulative urine samples were taken at 0-24 h, and blood samples were drawn after 24-h administration. The europium concentration was determined in these samples by inductively coupled plasma atomic emission spectroscopy. The volume, creatinine, ß-2-microglobulin, and N-acetyl-ß-D-glucosaminidase were measured in the urine samples to evaluate possible europium-induced renal effects. The blood samples showed low europium distribution, with an average of 77.5 µg/L for all groups. Although the urinary concentration and excretion showed dose-dependent increases, the percentage of europium excreted showed a dose-dependent decrease, with an average of 0.31% in all groups. The administration of europium resulted in a significant decrease of creatinine and a significant increase of urinary volume, N-acetyl-ß-D-glucosaminidase, and ß-2-microglobulin. Rare earth elements, including europium, are believed to form colloidal conjugates that deposit in the reticuloendothelial system and glomeruli. This specific reaction may contribute to low europium bioavailability and renal function disturbances. Despite low bioavailability, the high performance of the analytical method for determination of europium makes the blood and urine sampling suitable tools for monitoring of exposure to this element. The results presented in this study will be of great importance in future studies on the health impacts of rare earth elements.

Dlx5, the mouse homologue of the human-imprinted DLX5 gene, is biallelically expressed in the mouse brain.

The mouse Dlx5 gene encodes a distal-less-related DNA-binding homeobox protein first expressed during early embryonic development in anterior regions of mouse embryo and is located on chromosome 6, which is the syntenic region to the human chromosome 7q21-q31 imprinting cluster. Recently, its human homologue, DLX5, was identified to be imprinted and maternally expressed, at least in normal human lymphoblasts and in brain tissues. In our study, we analyzed the imprinting status of mouse Dlx5 by RT-PCR, first in the F1 of a reciprocal cross between two different mouse strains, and second in heterozygous Dlx5 mutant mice. Both approaches revealed that mouse Dlx5 followed a biallelic pattern of expression in brain tissue and in testis. Our findings suggest that the Dlx5 gene escapes genomic imprinting, at least in mice of certain genetic backgrounds.

Human chromosome 21q22.2-qter carries a gene(s) responsible for downregulation of mlc2a and PEBP in Down syndrome model mice.

Congenital heart disease (CHD) is a major clinical manifestation of Down syndrome (DS). We recently showed that chimeric mice containing a human chromosome 21 (Chr 21) exhibited phenotypic traits of DS, including CHD. Our previous study showed that myosin light chain-2a (mlc2a) expression was reduced in the hearts of chimeric mice and DS patients. We found that phosphatidylethanolamine binding protein (PEBP) was also downregulated in Chr 21 chimeras in this study. As mlc2a is involved in heart morphogenesis, and PEBP controls the proliferation and differentiation of different cell types, these genes are candidates for involvement in DS-CHD. The DS-CHD candidate region has been suggested to span between PFKL and D21S3, which is the STS marker near the ETS2 loci. To identify gene(s) or a gene cluster on Chr 21 responsible for the downregulation of mlc2a and PEBP, we fragmented Chr 21 at the EST2 loci, by telomere-directed chromosome truncation in homologous recombination-proficient chicken DT40 cells. The modified Chr 21 was transferred to mouse ES cells by microcell-mediated chromosome transfer (MMCT), via CHO cells. We used ES cell lines retaining the Chr 21 truncated at the ETS2 locus (Chr 21E) to produce chimeric mice and compared overall protein expression patterns in hearts of the chimeras containing the intact and the fragmented Chr 21 by two-dimensional electrophoresis. While mouse mlc2a and PEBP expression was downregulated in the chimeras containing the intact Chr 21, the expression was not affected in the Chr 21E chimeras. Therefore, we suggest that Chr 21 gene(s) distal from the ETS2 locus reduce mouse mlc2a and PEBP expression in DS model mice and DS. Thus, this chromosome engineering technology is a useful tool for identification or mapping of genes that contribute to the DS phenotypes.