Evaluation of the plasma protein S dynamics during pregnancy using a total protein S assay: Protein S-specific activity decreased from the second trimester.

AIM: The relationship between congenital protein S (PS) deficiency and complications during pregnancy remains unclear, partly due to the difficulty of precisely evaluating the PS level with conventional assays and the physiological decrease of PS during pregnancy. A new PS assay was developed to measure the total PS antigen and activity quantitatively and calculate PS-specific activity. This study aimed to evaluate the plasma PS dynamics during pregnancy using the new PS assay and establish the reference interval for pregnant women. METHODS: A total of 253 pregnant women without a personal or family history of thromboembolism were recruited. Blood samples were obtained in the first, second and third trimesters and at one month post-partum. The total PS antigen, activity, and PS-specific activity were studied. Results were analyzed by the repeated measures single-factor anovas followed by a post-hoc test using Excel Statistics. RESULTS: The mean ± standard deviation (IU/mL) of the total PS antigen levels in the first, second and third trimesters and 1 month post-partum were 0.67 ± 0.12, 0.67 ± 0.09, 0.68 ± 0.11 and 0.92 ± 0.13, respectively. The total PS activity (IU/mL) in the first, second and third trimesters and 1 month post-partum were 0.69 ± 0.14, 0.59 ± 0.10, 0.58 ± 0.12 and 0.87 ± 0.15, respectively. The PS-specific activity was within the normal range of nonpregnant women in the first trimester (1.02 ± 0.10) but decreased in the second and third trimesters (0.88 ± 0.09 and 0.85 ± 0.09, respectively) before increasing in the post-partum period (0.94 ± 0.08). CONCLUSION: The total PS antigen and activity decrease throughout pregnancy, while the PS-specific activity decreases in the second and third trimesters.

Comparative evaluation of reagents for measuring protein S activity: possibility of harmonization.

Patients with congenital protein S (PS) deficiency show a hereditary predisposition for thrombosis, and PS deficiency is prevalent among Japanese populations. Diagnosis is based on symptoms of thrombosis and reduced PS activity. Three reagents that use different measurement principles for determining PS activity are available in Japan. This study aimed to confirm the possibility of harmonization of these three reagents to establish a universal standard for PS activity in Japanese populations. Commercial normal plasma and plasma samples obtained from healthy individuals and healthy pregnant women were tested at three facilities using three reagents for measuring PS: STA-Staclot Protein S (STA-PS), HemosIL Protein S (Clotting) (IL-PS), and a total PS assay (SNT-PS). The within-run precision of each reagent was good, as each had a coefficient of variation of ≤ 3.8%. The dilution linearity for each reagent was also good. The correlation coefficient was 0.94 for STA-PS vs. IL-PS, 0.93 for SNT-PS vs. STA-PS, and 0.90 for SNT-PS vs. IL-PS, indicating a good correlation. Although the three reagents available in Japan for measuring PS activity use different measurement methods, each showed good performance, and large differences were not observed between the obtained values. Harmonization among them appears possible.

Beneficial role of periosteum in distraction osteogenesis of mandible: its preservation prevents the external bone resorption.

Distraction osteogenesis (DO) is a surgical process of new bone generation through the gradual extension of two segments of existing bone. DO is applied for maxillofacial surgeries to manage defects in mandibular continuity. Vertical DO with an oral device is often employed to augment the alveolar bone height for better implant anchorage for esthetic purposes or functional prosthetic requirements. To determine how the periosteum affects the vertical DO in mandibular reconstruction, we extracted the teeth and resected the alveolar parts of the mandible on both sides of dogs, along with removal of the surrounding periosteum in the right, but not left side. Three months later, box-shaped bone segments (vectors) were prepared from the resected alveolar part, and the segments were vertically elongated using a distraction device on both sides at 0.9 mm/day for one week. The extent of bone formation after distraction was determined with micro-focused computed tomography and by measuring incorporation of tetracycline and calcein with confocal laser scanning microscopy. During the initial two months after distraction, new bone formation was observed more prominently in the left side than in the right side of mandible with the periosteum. However, this difference was less clear during the bone-remodeling period. One notable change was the reduced height of the alveolar part of the right-side mandible, a sign of external bone resorption, observed in two out of three dogs at 6-month post-consolidation. These findings suggest that preservation of periosteum prevents the external bone resorption during the vertical DO of mandible.

Improving oral health-related quality of life for a traumatic brain injury patient: A case report.

AIMS: A preliminary aim was to determine if a patient who had suffered a traumatic brain injury (TBI) could tolerate removal of his remaining teeth and replacement with partially implant-supported prosthetic replacements. The primary aim was to determine if the patient and also his main caregiver could assess a potential change in his oral health-related quality of life. METHODS AND RESULTS: Procedures for the patient were conservative dental restorations, removal of nonrestorable teeth, placement of implants, and fabrication of new dentures. The patient and his primary caregiver, independently, completed the Oral Health Impact Profile-14 (OHIP-14) before and after placement of the implants and Locators. The scores were then compared. The results were that both successfully completed the OHIP-14 and scores showed improvement at 3 and 6 months. CONCLUSION: This is the first report of both, a TBI patient and his primary caregiver independently self-assessing improvement in his quality of life using the OHIP-14 after fabrication of an implant-supported overdenture.

Non-invasive magnetic resonance imaging-guided focused ultrasound treatment for uterine fibroids - early experience.

OBJECTIVE: To describe early results regarding efficacy and safety of magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS) for the treatment of uterine leiomyomas among a population of Japanese women. STUDY DESIGN: In this single site study, 48 Japanese women, over 18 years of age, who were candidates for surgical intervention due to symptomatic fibroids, were recruited. Fifty-five uterine fibroids were treated by MRgFUS and followed up for 12 months. RESULTS: During the 12-month follow-up period, two patients (4%) required surgical interventions, and two patients required additional drug treatment for fibroids. The average reduction in fibroid volume determined by MR imaging at 6 months after treatment was 33%. This volume reduction is correlated with the fibroid's treated volume. No serious complications were recorded during the treatments or follow-up period. CONCLUSION: MRgFUS can safely be used to non-invasively treat symptomatic uterine fibroids and avoid the need for surgical intervention in the short term. With large treatment volumes, MRgFUS also results in significant fibroid shrinkage in a relatively short time. Additional follow-up is needed to determine the long-term durability of this promising non-invasive approach.

Third nerve palsy and serous retinal detachment with preeclampsia.

Visual disturbances occur more frequently during preeclampsia than during pregnancy in general, but visual disturbances due to cranial nerve palsy are rare. We present the case of a 35-year-old preeclamptic woman with left third nerve palsy and left serous retinal detachment. The patient complained of visual disturbance and double vision soon after cesarean section. Left third nerve palsy and left serous retinal detachment were diagnosed by urgent ophthalmologic evaluation. Aneurysm and organic brain lesion were ruled out by diagnostic imaging. By 2 months postpartum, the visual disturbance had improved spontaneously.

Influence of denture supporting tissue properties on pressure-pain threshold--measurement in dentate subjects.

PURPOSE: The present study was designed to clarify the relationship between the properties of the palatal mucosa and the pressure-pain threshold. METHODS: Three parts of the palatal mucosa of 17 dentate subjects were measured: the median part of the palate, the lateral part of the first molar, and the midpoint between these two parts. The subjects were instructed to press a pushbutton when he or she felt pressure-pain. The probe pressure was gradually increased (1N/s). The thickness (T) (mm) and elasticity (E) (MPa) were used as the parameters of the properties of the palatal mucosa, whereas pressure (P) (MPa), compressibility (C) (%), and subsidence (S) (mm) were used as the parameters of the pressure-pain threshold. The Shapiro-Wilk test was used to consider the data of distribution of normality for each measurement point, as obtained from the 17 subjects. A Kruskal-Wallis test and a Wilcoxon signed rank test were performed for multiple comparisons, the Bonferroni method was used to compensate for the P-value. Spearman's rank correlation coefficient was calculated. RESULTS: T correlated with the values of S at the median points (P=0.001) and midpoints (P=0.011). CONCLUSION: Thickness can be an index of the amount of relief where pain is caused easily. In addition, modulus of elasticity is important as an indicator of the bearing ability of denture support tissues, it is necessary to consider how to evaluate the modulus of elasticity and to evaluate the relationship between the parameters of the pain threshold.

Decreasing margins to the uterine serosa as a method for increasing the volume of fibroids ablated with magnetic resonance-guided focused ultrasound surgery.

OBJECTIVE: To demonstrate the safety of magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatments regardless of the distance between the treatment region and the uterine serosa. STUDY DESIGN: 83 pre-menopausal women with symptomatic uterine fibroids were treated with MRgFUS in 88 treatments. Treatment data was analyzed, measuring the distance between the treatment spots (sonications) and the serosa. Patients were followed up for 1 year and adverse events were collected. RESULTS: 79% and 37% of the sonications were less than 15 mm and 10 mm from the serosa, respectively. Treatment was always confined to the fibroid capsule. There were no unexpected or serious adverse events. CONCLUSION: Reducing the margin between the fibroid treatment area and the uterine serosa, when possible, enables MRgFUS treatment of greater fibroid volume, while maintaining a high safety profile. Special attention should be paid when the uterus lies adjacent to other sensitive organs to avoid unintentional heating of these organs, using the planning and real-time MR images.