Moderating effect of cognitive reserve on the association between grey matter atrophy and memory varies with age in older adults.

BACKGROUND: Educational attainment and verbal intelligence, which indirectly reflect an individual's cognitive reserve (CR), is suggested to buffer the effect of late-life brain degradation on cognitive performance outcome. We aimed to explore how the relationship between whole grey matter volume (GMV) and episodic memory function is altered by CR proxy as well as age in healthy older adults. METHODS: Elderly Verbal Learning Test (EVLT) and structural magnetic resonance imaging were administered to 110 community-residing older adults. Moderated moderation model tested whether the association between whole GMV and episodic memory was moderated by both CR and chronological age. RESULTS: The results showed that the moderating effect of CR on Immediate Recall, Short-delay Recall, and Recognition scores of EVLT differed across age groups. The elderly with higher CR showed steeper GMV effect on EVLT at the Age-Younger condition, while such moderating effect was reversed in the Age-Older condition, suggesting an alleviated brain atrophy effect in higher CR elderly. CONCLUSION: These findings suggest that although higher CR elderly may exhibit earlier GMV-related memory decline, the buffering effect of CR on the cognitive decline due to brain atrophy would become more evident in old-old elderly people who are likely to have accumulated more neuropathological changes. This study underscores chronological age as an important moderating factor in examining the moderating role of CR in late-life memory function.

Availability of a 5% lidocaine patch used prophylactically for venipuncture- or injection-related pain in children.

PURPOSE: Venipuncture- or injection-related pain is still major problem during anesthetic induction in children. This study was designed to determine the availability of a 5% lidocaine patch used prophylactically for venipuncture- or injection-related pain during the induction of anesthesia. METHODS: In a randomized, double-blind study, 72 pediatric patients were allocated to one of two groups: pretreatment with a 5% lidocaine patch (Lidoderm(®), Endo Pharmaceuticals, Chadds Ford, PA, USA) (group A) or pretreatment with a placebo patch (group B). Pain severity was evaluated on the Faces, Legs, Activity, Cry, and Consolability Scale (FLACC) during venipuncture, and a 4-point scale during the injection of rocuronium. RESULTS: The FLACC score during venipuncture was significantly lower for group A than group B (p < 0.001). There was no significant difference in the grades of the 4-point scale observed during the injection of rocuronium between groups A and B. No significant adverse effect was noted for the groups. CONCLUSION: Although pretreatment with a 5% lidocaine patch was found to be a safe, effective, and simple method of preventing venipuncture pain in children, this method did not reduce drug injection pain during the induction of anesthesia.

Hypothermic cardiopulmonary bypass for minimally invasive mitral valve plasty in adult moyamoya disease.

A 43-year-old man underwent minimally invasive mitral valve plasty of a flail mitral valve. Four years previously, he had been diagnosed with moyamoya disease (MMD) by cerebral magnetic resonance imaging/angiography findings. In MMD, risk factors for cerebral stroke include changes in arterial carbon dioxide partial pressure, blood pressure, and body temperature. And during cardiopulmonary bypass (CPB), these hemodynamic changes can be challenging. However, hypothermia during CPB can decrease cerebral oxygen consumption and have a cerebral protective effect. We performed a minimally invasive mitral valve plasty, using hypothermic CPB, in a patient with MMD, without any neurological deficits.

Accidental epidural injection of rocuronium.

Epidural administration of local anesthetics or opioid during general anesthesia is a widespread method for postoperative analgesia. Despite the availability of this technique, inadvertent administration of nonepidural medications into the epidural space can be associated with serious neurological complications. We report a case of accidental epidural rocuronium injection.

The effectiveness of a couple-based intervention for people living with mild Alzheimer's disease and their spousal caregivers in Korea.

BACKGROUND AND OBJECTIVES: We evaluated the effectiveness of a Korean version of the Couples Life Story Approach (CLSA-K), a structured life-review program originally developed in the U.S. to help older adults with dementia and their spousal caregivers engage with each other and improve their quality of life.Research design and methods: Fifty mild people living with mild Alzheimer's disease and their spouses were recruited and 37 couples completed the five-week CLSA-K program. Data on psychosocial outcomes-i.e., depressive symptoms, talkativeness, mutuality (for both caregivers and care recipients) and burden (for caregivers)-were collected one week prior to (Time 1) and one week after the intervention (Time 2). Using repeated measures generalized linear models, we examined the differences in the amounts and patterns of the changes in outcomes according to age, gender, and the care-recipients' level of cognitive impairment. RESULTS: Some participants benefited from the CLSA-K program, while others did not. For caregivers, mental health, and marital quality remained stable, while caregiver burden increased among those with spouses who had moderate levels of cognitive impairment. For care-recipients, younger and male participants showed increased talkativeness. DISCUSSION AND IMPLICATIONS: CLSA-K appears to be promising for specific subgroups of participants in Korea. Multi-component or other approaches may be more beneficial for other couples. Cultural differences as well as social positions may play a role in the acceptability and efficacy of the couple-based intervention.

Femoral nerve block for patient undergoing total knee arthroplasty: Prospective, randomized, double-blinded study evaluating analgesic effect of perineural fentanyl additive to local anesthetics.

BACKGROUND: The existence of peripheral opioid receptors and its effectiveness in peripheral nerve block remain controversial. The aim of this prospective, randomized, double-blinded study was to examine the analgesic effects of adding fentanyl to ropivacaine for continuous femoral nerve block (CFNB) using patient-controlled analgesia after total knee arthroplasty (TKA). METHODS: The patients were divided into 2 groups, each with n = 40 in ropivacaine (R) group and n = 42 in R with fentanyl (R + F) group. After operation, the patients in each group received R + F and R alone via a femoral nerve catheter, respectively. We assessed the visual analog scale (VAS) pain immediately before administration (baseline) and at 15, 30, and 60 minutes on postanesthesia care unit (PACU), and resting and ambulatory VAS score up to 24 hours. RESULTS: Overall, the average VAS scores in the R + F group were slightly lower than those of the R group. However, the VAS score differences between groups were not statistically significant, except for 30 minutes (P = 0.009) in PACU. R group showed higher supplemental analgesics consumption in average compared with R + F group, but not significant. CONCLUSION: Additional fentanyl did not show prominent enhancement of analgesic effect in the field of CFNB after TKA.

Molecular recognition of proteolytic activity in metastatic cancer cells using fluorogenic gold nanoprobes.

We describe the development of biomarker-sensitive nanoprobes based on nanoparticle surface energy transfer (NSET) effect that enabling recognition of the expression of membrane type-1 matrix metalloproteinase (MT1-MMP) anchored on invasive cancer cells and its proteolytic activity simultaneously. First of all, we confirmed invasiveness of cancer cell lines (HT1080 and MCF7) via migration and invasion assay. We also prepared gold nanoparticle (GNP) acts as a quencher for fluorescein isothiocyanate (FITC). This FITC is conjugated in end-terminal of activatable fluorogenic peptide (ActFP). The ActFP attach to surface of GNP (GNP-ActFP) for a targeting moiety and proteolytic activity ligand toward MT1-MMP. The GNP-ActFP can generate fluorescence signal when ActFP is cleaved by proteolytic activity after targeting toward MT1-MMP. In order to study specificity for MT1-MMP, GNP-ActFP is treated to HT1080 and MCF7 cells, and then, we determine the in vitro targeting potential and fluorogenic activity of GNP-ActFP for MT1-MMP via fluorescence multi-reader. We also confirmed fluorogenic activity of GNP-ActFP via confocal microscopic imaging, and finally, endocytosis of GNP-ActFP is observed via cellular transmission electron microscopic imaging.

Effect of bite force on orthodontic mini-implants in the molar region: Finite element analysis.

OBJECTIVE: To examine the effect of bite force on the displacement and stress distribution of orthodontic mini-implants (OMIs) in the molar region according to placement site, insertion angle, and loading direction. METHODS: Five finite element models were created using micro-computed tomography (microCT) images of the maxilla and mandible. OMIs were placed at one maxillary and two mandibular positions: between the maxillary second premolar and first molar, between the mandibular second premolar and first molar, and between the mandibular first and second molars. The OMIs were inserted at angles of 45° and 90° to the buccal surface of the cortical bone. A bite force of 25 kg was applied to the 10 occlusal contact points of the second premolar, first molar, and second molar. The loading directions were 0°, 5°, and 10° to the long axis of the tooth. RESULTS: With regard to placement site, the displacement and stress were greatest for the OMI placed between the mandibular first molar and second molar, and smallest for the OMI placed between the maxillary second premolar and first molar. In the mandibular molar region, the angled OMI showed slightly less displacement than the OMI placed at 90°. The maximum Von Mises stress increased with the inclination of the loading direction. CONCLUSIONS: These results suggest that placement of OMIs between the second premolar and first molar at 45° to the cortical bone reduces the effect of bite force on OMIs.

Inhibition of Akt/FOXO3a signaling by constitutively active FOXO3a suppresses growth of follicular thyroid cancer cell lines.

Akt-dependent FOXO3a cytoplasmic translocation is an important tumorigenic mechanism for escaping from apoptosis in cancer cells. In the present study, we examined whether non-phosphorylatable FOXO3a can inhibit cell growth of various follicular thyroid carcinoma (FTC) cell lines. Adenovirus carrying the FOXO3a-triple mutant (TM) sequence including point mutations at three Akt phosphorylation sites (Ad-FOXO3a-TM) was generated and transduced to the cells to mimic inhibition of Akt/FOXO3a signal. Transduction of Ad-FOXO3a-TM to FTC133 cells induced cell cycle arrest and apoptosis. Injection of Ad-FOXO3a-TM suppressed the growth of xenograft tumors in athymic mice. Consequently, our results indicate that gene therapy based on Ad-FOXO3a-TM has therapeutic potential for FTC.

CpG island methylation in familial colorectal cancer patients not fulfilling the Amsterdam criteria.

To determine the role of methylation in colorectal cancer patients with a family history, we enrolled 25 colorectal cancer patients with a family history of colorectal cancer but without a mutation in the hMLH1 and hMSH2 genes. Thirty patients with sporadic colorectal cancer were included as control. The methylation status of COX2, MGMT, hMLH1, TIMP3, p16, and MINT2 in normal mucosa and tumor were assessed using methylation-specific PCR. In patients with a family history, the methylation frequency ranged from 4.0% for TIMP3 to 44.4% for MGMT, whereas, in patients with sporadic colorectal cancer, it ranged from 6.7% for TIMP3 to 50.0% for p16. Nine of the 25 patients with family history (36.0%) were classified as methylation-prone, and nine of the 30 patients with sporadic cancers (30.0%) were as methylation-prone, making their methylation indices 0.19 and 0.16, respectively (p=0.522). As for the individual genes, the methylation rate of MGMT was higher in colorectal cancer patients with family history (44.0% vs. 13.0%, p=0.016), whereas the methylation rate of p16 was higher in sporadic colorectal cancers (50.0% vs. 8.7%, p=0.046). While CpG island methylation of tumor suppressor genes may play a role in colorectal carcinogenesis, the genes involved may be different between tumors of patients with and without a family history of colorectal cancer.

Vertical alveolar ridge augmentation using autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement.

OBJECTIVE: The aim of this study was to evaluate the combined use of autogenous bone and platelet-enriched fibrin glue as grafting material for vertical alveolar ridge augmentation with simultaneous implant placement in a canine alveolar ridge defect model. STUDY DESIGN: In 6 mongrel dogs, bilateral vertical alveolar ridge defects were created in the mandible. After 3 months of healing, 2 dental implants were placed in each defect of the mandible, creating 6-mm supra-alveolar peri-implant defects. The 2 implants per defect were subjected to surgical treatments involving either a combination of autogenous bone grafts and platelet-enriched fibrin glue, or a conventional flap procedure only (control). After a healing period of 6 months, the dogs were humanely killed for histological and histometric analyses. RESULTS: Implant placement alone produced limited vertical alveolar height (0.6 +/- 0.4 mm). However, alveolar augmentation including a combination of autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement resulted in alveolar ridge augmentation amounting to 4.2 +/- 1.0 mm, comprising 63% of the defect height. New bone-implant contact was 40.5% in the defects treated with combined autogenous bone grafts and platelet-enriched fibrin glue, and was 48.4% in the resident bone; this difference was not statistically significant. CONCLUSION: The present study demonstrates that vertical alveolar ridge augmentation using autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement might effectively increase vertical alveolar ridge height and allow for an acceptable level of osseointegration.

A retrospective study of the effects on sinus complications of exposing dental implants to the maxillary sinus cavity.

OBJECTIVE: The aim of this study was to investigate whether dental implant exposure to the maxillary sinus cavity increased the risk of maxillary sinus complications. STUDY DESIGN: Nine patients with 23 implants that had been inserted into the maxillary sinus more than 4 mm without lifting the sinus mucous membranes were evaluated for sinus complications 6 to 10 months after implant insertion, using a questionnaire and computerized tomography (CT). RESULTS: There were no clinical signs of sinusitis in any patient. However, CT scans showed postoperative sinus mucous thickening around 14 of the 23 implants. CONCLUSION: This study showed that implant exposure to the maxillary sinus cavity can cause sinus mucous thickening around the implants.

The effect of platelet-rich plasma on bone healing around implants placed in bone defects treated with Bio-Oss: a pilot study in the dog tibia.

OBJECTIVE: The aim of this study was to examine the influence of platelet-rich plasma (PRP) used as an adjunct to Bio-Oss for the repair of bone defects adjacent to titanium dental implants. STUDY DESIGN: In 6 mongrel dogs, 12 screw-shaped titanium dental implants were inserted into the osteotomy sites in the dogs' tibias. Before implantation, a standardized gap (2.0 mm) was created between the implant surface and the surrounding bony walls. The gaps were filled with either Bio-Oss cancellous granules alone or Bio-Oss cancellous granules mixed with PRP. RESULTS: After 4 months, the Bio-Oss-treated defects revealed a significantly higher percentage of bone-implant contact than the defects treated with Bio-Oss and PRP (60.1% vs. 30.8%; P < .05). CONCLUSION: The results indicate that when PRP is used as an adjunct to Bio-Oss in the repair of bone defects adjacent to titanium dental implants, PRP may decrease periimplant bone healing.

Flapless implant surgery: an experimental study.

OBJECTIVE: The purpose of this study was to examine the effect of flapless implant surgery on crestal bone loss and osseointegration in a canine mandible model. STUDY DESIGN: In 6 mongrel dogs, bilateral, edentulated, flat alveolar ridges were created in the mandible. After 3 months of healing, 2 implants in each side were placed by either flap or flapless procedures. After a healing period of 8 weeks, microcomputerized tomography at the implantation site was performed. Osseointegration was calculated as percentage of implant surface in contact with bone. Additionally, bone height was measured in the peri-implant bone. RESULTS: The mean osseointegration was greater at flapless sites (70.4%) than at sites with flaps (59.5%) (P < .05). The mean peri-implant bone height was greater at flapless sites (10.1 mm) than at sites with flaps (9.0 mm) (P < .05). CONCLUSION: Flapless surgery can achieve results superior to surgery with reflected flaps. The specific improvements of this technique include enhanced osseointegration of dental implants and increased bone height.

Maxillary sinus floor augmentation using autogenous bone grafts and platelet-enriched fibrin glue with simultaneous implant placement.

OBJECTIVE: The aim of this study was to evaluate the use of autogenous bone in combination with platelet-enriched fibrin glue as a grafting material for maxillary sinus augmentation with simultaneous implant placement in dogs. STUDY DESIGN: The mucous membranes of 12 sinuses in 6 dogs were elevated bilaterally. In the right sinus, autogenous bone mixed with platelet-enriched fibrin glue was grafted into the space between the membrane and the sinus wall. In the left sinus, autogenous bone alone was grafted as a control. At the same time, 2 dental implants were inserted into the grafting material through the maxillary sinus floor. The animals were killed 6 months after surgery. RESULTS: The mean bone-implant contact was 40.5% on the fibrin glue side and 32.3% on the control side (P < .05). The mean height of newly formed bone in the augmented area was 12.2 mm on the fibrin glue side and 10.7 mm on the control side (P < .05). CONCLUSION: The results indicate that the use of autogenous bone mixed with platelet-enriched fibrin glue can achieve results superior to those for grafts of autogenous bone alone. The specific improvements of this technique include enhanced osseointegration of dental implants and increased height of new bone.

The effects of exposing dental implants to the maxillary sinus cavity on sinus complications.

OBJECTIVE: The aim of this study was to investigate whether dental implant exposure to the maxillary sinus cavity increases the risk of maxillary sinus complications. STUDY DESIGN: An implant was placed bilaterally in the maxillary sinus of 8 adult female mongrel dogs in a way that it penetrated the bone and mucous membrane of the maxillary sinus floor to the extent of 2 mm, 4 mm, or 8 mm. The implants were left in place for 6 months. RESULTS: Radiographic and histologic examinations did not show any signs of pathologic findings in the maxillary sinus of the 8 dogs. CONCLUSION: This study indicates that implant protrusion into the maxillary sinus cavity is not related to the development of sinus complications in canines.