Factors influencing postoperative bleeding after dental extraction in older adult patients receiving anticoagulation therapy

OBJECTIVES

To investigate factors influencing postoperative bleeding occurrence after dental extraction in older patients receiving anticoagulation therapy.

MATERIALS AND METHODS

This retrospective study included patients aged ≥ 65 years receiving one of the following anticoagulants: apixaban, edoxaban, rivaroxaban, and warfarin. Patients who underwent one to multiple tooth extractions in the geriatric dentistry clinic at Tokyo Medical and Dental University Hospital between August 1, 2016, and November 30, 2020, were included. The outcome variable was postoperative bleeding occurrence. Logistic regression analysis was performed with the following ten factors as explanatory variables: age, sex, maximum systolic blood pressure during the extraction, type of local anesthesia, vertical incision, osteotomy, usage of surgical splints, the mesiodistal width of the extracted tooth on a radiograph, use of antiplatelet agents, and history of diabetes requiring medication.

RESULTS

Among 395 participants (mean age, 82.3 ± 6.5 years) included in this study, 75 patients experienced postoperative bleeding after tooth extraction. Logistic regression analysis revealed that the odds ratios for the vertical incision (18.400, p < 0.001), osteotomy (3.630, p = 0.00558), usage of surgical splints (1.860, p = 0.0395), and the mesiodistal width of the extracted tooth on a radiograph (1.060, p = 0.0261) were statistically significant.

CONCLUSIONS

For dental extraction in older patients receiving anticoagulants, postoperative bleeding is more likely to occur in patients with vertical incision, osteotomy, and posterior or multiple tooth extractions.

CLINICAL RELEVANCE

Dentists should consider suturing and adjunctive hemostatic procedures for patients undergoing vertical incision, osteotomy, and multiple tooth extractions while receiving anticoagulation therapy to minimize the risk of postoperative bleeding.

Role of raising the upper limb of the non-rising side when performing rising movements from bed

Rising movements from bed comprise an important aspect of recovery from the bedridden state; however, they have not been sufficiently investigated using motion analysis studies. In particular, the effect of using the upper limb of the non-rising side before waist flexion on rising movements remains to be analyzed; this study aimed to clarify this effect. Accordingly, motion analyses were performed on rising movements under two constraint conditions, namely raising the upper limb of the non-rising side (upper limb use-condition) and keeping it in contact with the pelvis (upper limb non-use-condition); subsequently, the kinematics and kinematics parameters were compared. In comparison with the upper limb use-condition, in the upper limb non-use-condition, the distance traveled by the center of mass of the body (CoM trajectory, p < 0.01) increased while switching from the half-side-lying to on-hand postures, horizontal body movement (movement speed (Normalized time/total time), p < 0.01 and weight of center of body mass (CoM momentum in horizontal plane), p < 0.05) during the same period increased, and the half-side-lying time approached the peak value of the waist flexion angular velocity (Time lag between from half-side-lying to waist angler peak velocity, p < 0.05). The compensatory movement that occurred due to the upper limb non-use-condition denoted an increase in body momentum in the horizontal direction, rather than in the sagittal plane. Therefore, the upper limb on the non-rising side contributed to the smooth movement of the body in the horizontal direction. Moreover, this study demonstrated that asymmetrical rising movement in the diagonal direction is a characteristic movement wherein the horizontal movement of the body constitutes the main movement.

Fully Digital Workflow for the Fabrication of Three-Dimensionally Printed Surgical Splints for Preventing Postoperative Bleeding: A Case Report

The management of postoperative bleeding is mandatory in patients receiving anticoagulants. In this case report, we introduce a fully digital workflow for surgical splint fabrication to prevent postoperative bleeding in patients receiving anticoagulants and/or at risk of inadvertent extraction of a mobile tooth during impression making. An 87-year-old woman using apixaban had a left mandibular canine that required extraction due to chronic apical periodontitis. A digital impression was obtained using an intraoral scanner. First, the tooth to be extracted was deleted using three-dimensional (3D) computer-aided design (CAD) software (Geomagic Freeform, 3D Systems) and a stereolithography (STL) file was exported. This modified STL file was imported into another CAD software (3Shape Dental System, 3Shape) and a surgical splint was designed. The splint was fabricated using a 3D printer (Form 3; Formlabs) and light-curable resin (Dental LT Clear, Formlabs) and was delivered after the tooth extraction. The patient was followed-up 2 days after the extraction; no postoperative bleeding was detected and the surgical splint was removed. The additively manufactured surgical splint fabricated using a fully digital workflow was efficacious for managing postoperative bleeding after a dental extraction.

Persistent influence of precession on northern ice sheet variability since the early Pleistocene

Prior to ~1 million years ago (Ma), variations in global ice volume were dominated by changes in obliquity; however, the role of precession remains unresolved. Using a record of North Atlantic ice rafting spanning the past 1.7 million years, we find that the onset of ice rafting within a given glacial cycle (reflecting ice sheet expansion) consistently occurred during times of decreasing obliquity whereas mass ice wasting (ablation) events were consistently tied to minima in precession. Furthermore, our results suggest that the ubiquitous association between precession-driven mass wasting events and glacial termination is a distinct feature of the mid to late Pleistocene. Before then (increasing), obliquity alone was sufficient to end a glacial cycle, before losing its dominant grip on deglaciation with the southward extension of Northern Hemisphere ice sheets since ~1 Ma.

Hepatocellular uptake index obtained with gadoxetate disodium-enhanced magnetic resonance imaging in the assessment future liver remnant function after major hepatectomy for biliary malignancy

Background

Functional assessment of the future liver remnant (FLR) after major hepatectomy is essential but often difficult in patients with biliary malignancy, owing to obstructive jaundice and portal vein embolization. This study evaluated whether a novel index using gadoxetate disodium-enhanced MRI (EOB-MRI) could predict posthepatectomy liver failure (PHLF) after major hepatectomy for biliary malignancy.

Methods

The remnant hepatocellular uptake index (rHUI) was calculated in patients undergoing EOB-MRI before major hepatectomy for biliary malignancy. Receiver operating characteristic (ROC) curve analyses were used to evaluate the accuracy of rHUI for predicting PHLF grade B or C, according to International Study Group of Liver Surgery criteria. Multivariable logistic regression analyses comprised stepwise selection of parameters, including rHUI and other conventional indices.

Results

This study included 67 patients. The rHUI accurately predicted PHLF (area under the curve (AUC) 0.896). A cut-off value for rHUI of less than 0.410 predicted all patients who developed grade B or C PHLF. In multivariable analysis, only rHUI was an independent risk factor for grade B or C PHLF (odds ratio 2.0 × 10³, 95 per cent c.i. 19.6 to 3.8 × 10⁷; P < 0.001). In patients who underwent preoperative portal vein embolization, rHUI accurately predicted PHLF (AUC 0.885), whereas other conventional indices, such as the plasma disappearance rate of indocyanine green of the FLR and FLR volume, did not.

Conclusion

The rHUI is potentially a useful predictor of PHLF after major hepatectomy for biliary malignancy.

Cervical Interferential Current Transcutaneous Electrical Sensory Stimulation for Patients with Dysphagia and Dementia in Nursing Homes

Purpose

We aimed to determine the efficacy of interferential current transcutaneous electrical sensory stimulation (IFC-TESS) in patients with dementia who were being treated for dysphagia in nursing homes under normal living conditions.

Patients and Methods

This study recruited 54 nursing home residents (13 males, 41 females; mean age, 84.5 ± 10.7 years) with dysphagia and dementia. IFC-TESS was performed with Gentle Stim^® (Careido Co. Ltd., Kanagawa, Japan) for 15 minutes. Two sessions per day were administered 5 days per week, for 3 weeks. The outcomes included the improvement of the patients' cough reflexes and nutritional states across the 3 weeks of intervention; the former was evaluated with the cough test based on the changes in cough latency time and cough frequency, while the latter was assessed based on changes in the functional oral intake scale (FOIS) score and oral calorie intake.

Results

The cough latency times before and after the 3-week intervention were 15.8 (7.0-60.0) and 6.7 (3.6-30.7) s/min, respectively; the cough frequencies were 5.0 (0.0-5.0) and 5.0 (5.0-5.0) t/min, respectively; the FOIS scores were 5.0 (5.0-6.0) and 5.0 (5.0-6.0), respectively; and oral calorie intakes were 1300.0 (862.5-1420.0) and 1300.0 (1005.0-1462.5) kcal/day, respectively. All parameters significantly improved across the intervention (p < 0.05). When the results were adjusted for age, sex, body mass index, mini nutritional assessment results, Barthel index, and mini-mental state examination scores, IFC-TESS improved the cough reflex and oral calorie intake in older nursing home residents with dementia.

Conclusion

Cervical IFC-TESS can improve the cough reflexes and nutritional states of patients with dysphagia and dementia in nursing homes. As it has previously been difficult to perform active rehabilitation with dementia patients, IFC-TESS may be effective and practicable for the rehabilitation of this patient population.

Usefulness of Muscle Synergy Analysis in Individuals With Knee Osteoarthritis During Gait

OBJECTIVE

To clarify whether there are any muscle synergy changes in individuals with knee osteoarthritis, and to determine whether muscle synergy analysis could be applied to other musculoskeletal diseases.

METHODS

Subjects in this study included 11 young controls (YC), 10 elderly controls (EC), and 10 knee osteoarthritis patients (KOA). Gait was assessed on a split-belt treadmill at 3 km/h. A non-negative matrix factorization (NNMF) was applied to the electromyogram data matrix to extract muscle synergies. To assess the similarity of each module, we performed the NNMF analysis assuming four modules for all of the participants. Further, we calculated joint angles to compare the kinematic data between the module groups.

RESULTS

The number of muscle modules was significantly lower in the EC (2-3) and KOA (2-3) groups than in the YC group (3-4), which reflects the merging of late swing and early stance modules. The EC and KOA groups also showed greater knee flexion angles in the early stance phase. Contrarily, by focusing on the module structure, we found that the merging of early and late stance modules is characteristic in KOA.

CONCLUSION

The lower number of modules in the EC and KOA groups was due to the muscle co-contraction with increased knee flexion angle. Contrarily, the merging of early and late stance modules are modular structures specific to KOA and may be biomarkers for detecting KOA.

SIGNIFICANCE

Describing the changes in multiple muscle control associated with musculoskeletal degeneration can serve as a fundamental biomarker in joint disease.

Relationship between tongue pressure and back muscle strength in healthy elderly individuals

BACKGROUND

Aging is associated with a decrease in muscle mass and strength in swallowing muscles, as well as in whole-body muscles. A decrease in tongue pressure (TP) is related with whole-body function, and the trunk, including abdominal and back muscles, forms the core of the body. However, the direct relationship between TP and trunk muscle strength remains unclear.

AIMS

To clarify the association between back muscle strength, an indicator of trunk muscle strength, and TP in healthy elderly individuals.

METHODS

In all, 112 healthy community-dwelling individuals aged ≥ 60 years (men: 35, median age 74.0; women: 77, median age 69.0) were included. Body mass index (BMI), TP, and back muscle strength (BMS) were measured. Tooth loss pattern was evaluated by the Eichner classification. Participants were divided into two groups based on the median of the BMS and classified into three groups based on the Eichner index (Eichner A, B, and C). The effects of BMS and occlusal support on TP were analyzed.

RESULTS

In the low BMS group, there was a significant difference in TP between the Eichner B and Eichner C (p = 0.017) groups. However, in the high BMS group, occlusal support did not affect TP. Moreover, the explanatory factors for TP were BMS (β = 0.373, p = 0.001) and the Eichner index (β = 0.190, p = 0.036).

CONCLUSIONS

TP was correlated more with BMS than aging and occlusal support in healthy elderly individuals. This study indicated that the clinical evaluation of the whole body is important when assessing oral and swallowing function.

Bone marrow-derived NGFR+ cells regulate arterial remodeling and those poor mobilizations in peripheral blood in acute coronary syndrome predicts plaque progression at the non-targeted lesion

Background

In our previous 5-year cohort study, we demonstrated that low gene expression of nerve growth factor receptor (NGFR) in peripheral leucocytes in acute coronary syndrome (ACS) predicted repetitive coronary interventions at the de novo lesions. An NGFR-positive cell has been demonstrated to reside in bone marrow (BM) stromal fraction and to be increased in peripheral blood mononuclear cell (MNCs) fraction in patients with ischemic heart disease.

Purpose

To investigate whether the BM-NGFR+ cell is associated with arterial remodeling and the relationship between the levels of peripheral NGFR+ cells after ACS and coronary plaque progression in an experimental and prospective clinical study.

Methods and results

In an experimental study, 8-week-old C57B6/J wild type male mice were subjected to irradiation with 9.6 Gy and transplantation with BM (BMT) isolated from GFP-transgenic NGFR wild type (WT) or knock-out (KO) mice at day 1. Four weeks after BMT, the right carotid artery was ligated for 4 weeks. Induced neointimal area was increased (p&lt;0.05), where cells under apoptosis were decreased (p&lt;0.05) in NGFR-KO-BMT group compared to WT-BMT group (n=4). NGFR+ cells were not detected in wild type sham-operated artery, whereas in the ligated artery in WT-BMT group NGFR+ cells assembled in the developed neointima and exclusively presented double positive with GFP, but absent in NGFR-KO-BMT group (p&lt;0.05, n=4). In a clinical study, thirty patients with ACS who underwent primary percutaneous coronary intervention (PCI) were enrolled. The peripheral blood sample was collected on days 0, 3 and 7, and 9 months follow-up and the number of NGFR+MNCs were measured by flowcytometric analysis. The plaque volume at non-targeted coronary lesion (non-TL:&gt;5 mm proximal or distal to the implanted stents) were quantitatively analysed using gray-scale intravascular ultrasound (IVUS) and Q-IVUS™ software at the acute phase and 9 months follow-up. The number of NGFR+MNCs in peripheral blood was 1.5-fold increased at day 3 (0.064±0.056%) compared to day 0 (0.042±0.030%) (p&lt;0.05). The change in normalized total plaque volume (TAVN) at non-TL at 9 months was negatively correlated with the number of NGFR+MNCs at day 0 (r=−0.51), day 3 (r=−0.51) and 9 months (r=−0.59) after ACS (p&lt;0.05). Multiple regression analysis showed that NGFR+MNCs at day 0 (β=−0.48, p=0.01) and CRP (β=−0.53, P&lt;0.01) are independent factors associating with TAVN change at non-TL at 9 months, regardless of LDL-cholesterol control level. ROC analysis revealed that NGFR+MNCs &lt;0.049 at day 0 predicted the increase of TAVN with AUC 0.78; sensitivity 0.82 and specificity 0.67.

Conclusions

Bone marrow-derived peripheral NGFR+ cells negatively regulate arterial remodeling through appropriate apoptosis of neointimal cells and the peripheral level of NGFR+ cells in ACS predicts plaque progression at the non-targeted lesion.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): KAKENHI

Postoperative bleeding after dental extraction among elderly patients under anticoagulant therapy

OBJECTIVES

This study aimed to assess and compare postoperative bleeding occurrence after dental extraction in medically compromised elderly patients under anticoagulant therapy.

MATERIALS AND METHODS

This retrospective study included medically compromised elderly patients aged ≥ 65 years who were taking apixaban, dabigatran, edoxaban, rivaroxaban, or warfarin and had undergone single or multiple dental extractions. The primary outcome measure was postoperative bleeding occurrence, which was defined as oozing or marked hemorrhage from 24 h to 7 days after dental extraction. Postoperative bleeding occurrence was calculated for each anticoagulant and compared using Fisher's exact test, followed by multiple comparisons.

RESULTS

Two hundred thirty-two patients met the inclusion criteria. The highest postoperative bleeding occurrence was recorded for rivaroxaban (12/37: 32.4%), followed by apixaban (8/44: 18.2%), warfarin (17/98: 17.3%), and edoxaban (2/35: 5.7%). Patients taking dabigatran did not present postoperative bleeding (0/18: 0%). Fisher's exact test, followed by multiple comparison tests, revealed a significant among-anticoagulant difference (p = 0.0095). Postoperative bleeding was significantly higher in patients taking rivaroxaban than in those taking edoxaban or dabigatran (p = 0.03088).

CONCLUSIONS

Within the limitations of this retrospective study design, these findings suggest that different anticoagulants may affect postoperative bleeding occurrence after dental extraction among medically compromised elderly patients.

CLINICAL RELEVANCE

Clinicians should carefully consider postoperative bleeding after dental extraction in patients taking anticoagulant therapy, especially rivaroxaban.

Comparison of cardiovascular response between patients on warfarin and hypertensive patients not on warfarin during dental extraction

OBJECTIVE

To evaluate cardiovascular response in patients on warfarin and hypertensive patients not on warfarin during dental extraction.

MATERIALS AND METHODS

This retrospective study included 53 patients who had undergone dental extraction while on warfarin (mean age 78.8 ± 6.3 years, 26 men) and 66 with hypertension who had undergone dental extraction but were not on warfarin (mean age 77.4 ± 6.8 years, 22 men). Vital signs were monitored in both groups during extraction.

RESULTS

The highest systolic blood pressure (SBP) values (mean 150.1 ± 21.1 mmHg) were observed in patients on warfarin before (9.0%) and after (10.3%) administration of local anesthesia (LA), during extraction (39.7%), and during (33.3%) and after (7.7%) suturing (n = 78; p < 0.01), and in hypertensive patients not receiving warfarin (160.6 ± 24.8 mmHg) before (19.2%) and after (27.3%) administration of LA, during extraction (29.3%), and during (18.2%) and after (6.1%) suturing (n = 99; p < 0.01). The highest SBP was linearly correlated with SBP before administration of LA in patients on warfarin (highest SBP = 0.9415 × SBP before LA + 23.243, R² = 0.75481) and in hypertensive patients not on warfarin (highest SBP = 1.0027 × SBP before LA + 15.789, R² = 0.60341).

CONCLUSIONS

The highest SBP was not distributed evenly between patients on warfarin and hypertensive patients not on warfarin during dental extraction and was strongly associated with SBP before LA regardless of anticoagulant status.

CLINICAL RELEVANCE

Thorough management of SBP is required in patients on warfarin to avoid thromboembolism and major hemorrhagic complications. Knowing the SBP value before dental treatment would help predict the risk of cardiovascular complications.

Using a quality of life (QoL)-monitor: preliminary results of a randomized trial in Dutch patients with early breast cancer

Purpose

The diagnosis and treatment of cancer negatively affect patients’ physical, functional and psychological wellbeing. Patients’ needs for care cannot be addressed unless they are recognized by healthcare providers (HCPs). The use of quality of life (QoL) assessments with feedback to HCPs might facilitate the identification and discussion of QoL-topics.

Methods

113 patients with stage I–IIIB breast cancer treated with chemotherapy were included in this randomized controlled trial. Patients were randomly allocated to receive either usual care, or usual care with an intervention consisting of a QoL-monitor assessing QoL, distress and care needs before every chemotherapy cycle visit. Patients completed questionnaires regarding QoL, illness perceptions, self-efficacy, and satisfaction with communication. From the 2nd visit onwards, patients in the intervention arm and their HCPs received a copy of the QoL overview and results were shown in patients’ medical files. Audio-recordings and patients’ self-reports were used to investigate effects on communication, patient management and patient-wellbeing. A composite score for communication was calculated by summing the number of QoL-topics discussed during each consultation.

Results

Use of the QoL-monitor resulted in a higher communication score (0.7 topics increase per visit, p = 0.04), especially regarding the disease-specific and psychosocial issues (p < 0.01). There were no differences in patient management, QoL, illness perceptions or distress. Patients in the experimental arm (n = 60) had higher scores on satisfaction with communication (p < 0.05).

Conclusions

Use of a QoL-monitor during chemotherapy in patients with early breast cancer might result in a more frequent discussion of QoL-topics, associated with high levels of patients’ satisfaction.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02549-8) contains supplementary material, which is available to authorized users.

Role of tumour location and surgical extent on prognosis in T2 gallbladder cancer: an international multicentre study

BACKGROUND

In gallbladder cancer, stage T2 is subdivided by tumour location into lesions on the peritoneal side (T2a) or hepatic side (T2b). For tumours on the peritoneal side (T2a), it has been suggested that liver resection may be omitted without compromising the prognosis. However, data to validate this argument are lacking. This study aimed to investigate the prognostic value of tumour location in T2 gallbladder cancer, and to clarify the adequate extent of surgical resection.

METHODS

Clinical data from patients who underwent surgery for gallbladder cancer were collected from 14 hospitals in Korea, Japan, Chile and the USA. Survival and risk factor analyses were conducted.

RESULTS

Data from 937 patients were available for evaluation. The overall 5-year disease-free survival rate was 70·6 per cent, 74·5 per cent for those with T2a and 65·5 per cent among those with T2b tumours (P = 0·028). Regarding liver resection, extended cholecystectomy was associated with a better 5-year disease-free survival rate than simple cholecystectomy (73·0 versus 61·5 per cent; P = 0·012). The 5-year disease-free survival rate was marginally better for extended than simple cholecystectomy in both T2a (76·5 versus 66·1 per cent; P = 0·094) and T2b (68·2 versus 56·2 per cent; P = 0·084) disease. Five-year disease-free survival rates were similar for extended cholecystectomies including liver wedge resection versus segment IVb/V segmentectomy (74·1 versus 71·5 per cent; P = 0·720). In multivariable analysis, independent risk factors for recurrence were presence of symptoms (hazard ratio (HR) 1·52; P = 0·002), R1 resection (HR 1·96; P = 0·004) and N1/N2 status (N1: HR 3·40, P < 0·001; N2: HR 9·56, P < 0·001). Among recurrences, 70·8 per cent were metastatic.

CONCLUSION

Tumour location was not an independent prognostic factor in T2 gallbladder cancer. Extended cholecystectomy was marginally superior to simple cholecystectomy. A radical operation should include liver resection and adequate node dissection.

Cardiovascular Comparison of 2 Types of Local Anesthesia With Vasoconstrictor in Older Adults: A Crossover Study

We assessed the effect of 2% lidocaine with 1:80,000 adrenaline (L + AD) and 3% prilocaine with 0.03 IU/mL felypressin (P + FP) on blood pressure and heart rate in older adults with systemic diseases undergoing dental extraction. This double-blind, randomized crossover study included 22 elderly participants, aged over 65 years. The participants were administered L + AD for one dental extraction and P + FP for the other. Blood pressure and heart rate were recorded immediately, 5, and 10 minutes after local anesthetic administration and the data were analyzed. The systolic and diastolic blood pressures in the P + FP group increased at all measurement points (p < .001). In the L + AD group, the diastolic blood pressure decreased at 5 and 10 minutes after local anesthetic administration (p < .05), whereas the heart rate increased at all measured time points (p < .001). There were statistically significant differences in systolic blood pressure at 5 and 10 minutes after local anesthetic administration and in diastolic blood pressure and heart rate at all time points between the 2 groups. In older adults, P + FP administration increased the systolic and diastolic blood pressures. L + AD administration increased the heart rate and decreased the diastolic blood pressure.

Alternating Current Iontophoresis for Control of Postoperative Pain

Control of early postoperative pain entails the use of various medications including acetaminophen, nonsteroidal anti-inflammatory drugs, selective cyclooxygenase-2 inhibitors, tramadol, and opioids. However, these medications should be carefully administered in patients with aspirin-exacerbated respiratory disease because some medications may trigger adverse reactions after maxillofacial surgeries. The goal of postoperative pain control in patients with aspirin-exacerbated respiratory disease is to eliminate pain without complications. Local anesthesia is an efficient tool for the control of postoperative pain after maxillofacial surgeries. We utilized a transdermal drug delivery system, iontophoresis by alternating current, in order to develop an alternative technique for administering local anesthetic to control postoperative pain in 2 patients with aspirin-exacerbated respiratory disease. A visual analogue scale was used to objectively measure the severity of pain. A 55-year-old woman who underwent mandibular wisdom tooth extraction and an 18-year-old woman who underwent sagittal split ramus osteotomy of the mandible both complained of pain multiple times. After application of iontophoresis, the visual analogue scale score was reduced to zero and postoperative pain could be controlled. There were no adverse events such as bronchospasm or skin irritation after the application of iontophoresis by alternating current.

Difficult Nasal Intubation Using Airway Scope® for a Child With Large Tumor

We report a case of difficult nasal intubation utilizing a Pentax-Airway scope^® AWS-100. A 4-month-old female with a rapidly growing melanotic neuroectodermal tumor was scheduled for resection under general anesthesia. The tumor was a large rubbery mass located in the middle of the mandible. For nasal intubation using the AWS, guidance of the tube toward the glottis was attempted using pediatric Magill forceps. Although we could hold the tube with the Magill forceps, it was difficult to insert the tube into the trachea due to the limited space in her hypopharynx. We then used a standard laryngoscope with a Miller straight blade for direct visual laryngoscopy and successfully intubated the patient with the aid of the pediatric Magill forceps. We often experience difficulty navigating a nasal endotracheal tube toward the glottis even when a clear glottic view is obtained with video laryngoscopes, especially in children with a small oropharyngeal space. However, some reports have been shown that video laryngoscopes are useful for intubation of the difficult airway and causes less stress to the upper airway than direct visual laryngoscopy. Video laryngoscopy can be an excellent way to provide nasal intubation in some but not all children.

Effects of mirogabalin, a novel ligand for the α₂δ subunit of voltage-gated calcium channels, on N-type calcium channel currents of rat dorsal root ganglion culture neurons

Mirogabalin, which is a novel ligand for the α₂δ subunit of voltage-gated calcium channels, is being developed for treating neuropathic pain including diabetic peripheral neuropathy and postherpetic neuralgia. Mirogabalin possesses unique α₂δ subunit binding characteristics and has potent and long-lasting analgesic effects in neuropathic pain models. In the present study, we investigated the effects of mirogabalin on N-type calcium channel currents of the rat dorsal root ganglion (DRG) culture neurons using the whole-cell patch clamp technique. Small or medium DRG neurons were isolated from Sprague-Dawley rats and were incubated for 20 to 24 h with mirogabalin or pregabalin. The DRG neurons were depolarised from a holding potential of -40 mV to +40 mV in steps of 10 mV for 220 ms, and elicited N-type calcium channel currents were recorded. The N-type calcium channel currents were verified by sensitivity to ω-conotoxin GVIA, a selective N-type calcium channel blocker. Mirogabalin inhibited the calcium channel currents of rat DRG neurons at 50 μM, and pregabalin inhibited them at 200 μM. Mirogabalin and pregabalin showed significant differences in the peak current densities at depolarisation to -20 and -10 mV when compared with that shown by the vehicle control. In conclusion, mirogabalin inhibits N-type calcium channel currents in rat DRG culture neurons. The potent and long-lasting analgesic effects of mirogabalin are thought to be associated with its potent and selective binding to α₂δ-1 subunits and following functional inhibition of calcium channel currents.

Oral and maxillofacial surgery in patients undergoing dialysis for advanced renal disease: report of five cases

BACKGROUND

Perioperativemanagement of hemodialysis patients involves many difficulties. High mortality rate and circulatory or respiratory complications in these patients were reported. However, in such reports, there is no concrete information of perioperative management in hemodialysis patients to prevent surgical complications and successful outcomes.

CASE PRESENTATION

We retrospectively reviewed the cases of 5 hemodialysis patients who underwent oral surgery under general anesthesia between January 2005 and December 2017. Primary disease was oral squamous cell carcinoma (SCC) in 4 patients and mandibular ameloblastoma in 1 patient. Partial resection was performed in 2 cases, neck dissection in 1 case. Two cases underwent surgery including vascularized reconstruction. The patients were dialyzed the day before and after surgery for the control of fluid and electrolyte status. Patients received intraoperative and postoperative intravenous infusion of potassium-free solution at 20-40 mL/h. Erythropoiesis-stimulating agents (ESAs) were used on the day of hemodialysis during hospitalization. Nafamostat mesilate as an anticoagulant during hemodialysis were used from postoperative day (POD)1 to 7. From POD 1 to 10, cephalosporin as prophylactic antibiotics is adjusted to quarter from half the initial dose. The resuming time of oral intake was similar to that of other oral surgery patients without kidney disease. The daily intake limits of protein, salt and liquid were managed during hospitalization and no cases suffered from malnutrition. No cardiorespiratory complications occurred during the perioperative period. In a case of vascularized osteocutaneous scapular flap reconstruction, grafted scapular bone survived and scapular cutaneous flap necrotized. Necrotic tissue was debrided and split thickness skin was successfully used to cover the grafted scapular bone.

CONCLUSIONS

Postoperative better result could be achieved if adequate perioperative management specific to hemodialysis patients is carried out. Vascularized flap reconstruction at oral and maxillofacial region in hemodialysis patients is beneficial treatment. Even if the first flap has wound complication secondary flap reconstruction is success and aesthetically better results could be achieved by the strict wound management and debridement.

Factors associated with a positive willingness to practise oral health care in the future amongst oral healthcare and nursing students

OBJECTIVES

The purpose of this study was to identify the weak points in the knowledge and attitudes of first-year oral health care and nursing students towards oral health care and to identify the factors associated with their positive willingness to practise oral health care after becoming a health professional in order to develop oral healthcare curricula.

MATERIALS AND METHODS

The subjects were 88 first-year dental students (DSs), 64 dental hygiene students (DHSs) and 119 nursing students (NSs) enrolled in schools in Japan, as of April 2017. A questionnaire was distributed to subjects in each school to assess their knowledge and attitudes towards oral health care.

RESULTS

Less than half knew that oral health care was also provided in cancer hospitals, hospices, acute care hospitals, maternity wards and psychiatric wards. Only 46.2% knew that oral health care was effective in the prevention of aspiration pneumonia. The level of knowledge and attitudes in NSs regarding oral health care were likely to be lowest amongst the student groups. Only NSs' high interest towards oral health care was associated with their positive willingness to practise oral health care in the future although oral health students' high perceptions and interest regarding oral health care were associated with the willingness.

CONCLUSION

This study showed oral healthcare and nursing students' weak points regarding their attitudes and knowledge of oral health care at early stages. Oral health academic staff and professionals should develop effective oral healthcare curricula for oral healthcare students and help nursing staff develop a collaborative nursing oral healthcare curriculum to motivate nursing students.

Cross-cultural comparison of breast cancer patients' Quality of Life in the Netherlands and Japan

Purpose

Cultural differences are hypothesized to influence patients’ Quality of Life (QoL) reports. However, there is a lack of empirical cross-cultural studies comparing QoL of patients with cancer. This study aims to compare QoL of women with breast cancer in the Netherlands and Japan, and to investigate the association of QoL with sociodemographic, clinical, and psychological variables (illness perceptions).

Methods

Dutch (n = 116) and Japanese (n = 148) women with early breast cancer undergoing chemotherapy completed the EORTC QLQ-C30 and Brief Illness Perception Questionnaire immediately before their second cycle of chemotherapy.

Results

Dutch women reported poorer Physical, Role, Emotional, and Cognitive functioning than Japanese women. Additionally, illness perceptions were significantly different in Japan and the Netherlands, but these did not vary across treatment type. In Japan, QoL of women receiving AC-chemotherapy was better than that of women receiving FEC-chemotherapy, whereas in the Netherlands, QoL did not vary as a function of chemotherapy. Illness perceptions about symptom severity, adverse consequences, and emotional representations were negatively related to most domains of patients’ QoL in both countries. Adding illness perceptions as covariates to the ANOVA analyses rendered the effects of country and treatment type on QoL non-significant.

Conclusions

Comparing Dutch and Japanese women with early breast cancer revealed important differences in treatment modalities and illness perceptions which both appear to influence QoL. Perceptions about cancer have been found to vary across cultures, and our study suggests that these perceptions should be considered when performing cross-cultural studies focusing on patient-reported outcomes.

Formal nucleophilic borylation and borylative cyclization of organic halides

Recent advances in borylations of organic halides, including both transition-metal-catalyzed and metal-free methods are summarized. Borylative cyclization is also discussed.

Transient receptor potential ankyrin 1 agonists improve intestinal transit in a murine model of postoperative ileus

BACKGROUND

Stimulation of transient receptor potential ankyrin 1 (TRPA1), which abundantly expressed in enterochromaffin cells (ECC), has been reported to exert apparently contradictory results in in vitro contractility and in vivo gastrointestinal (GI) transit evaluations. The pharmaceutical-grade Japanese traditional medicine daikenchuto (TU-100) has been reported to be beneficial for postoperative ileus (POI) and accelerate GI transit in animals and humans. TU-100 was recently shown to increase intestinal blood flow via stimulation of TRPA1 in the epithelial cells of the small intestine (SI).

METHODS

The effects of various TRPA1 agonists on motility were examined in a manipulation-induced murine POI model, in vitro culture of SI segments and an ECC model cell line, RIN-14B.

KEY RESULTS

Orally administered TRPA1 agonists, aryl isothiocyanate (AITC) and cinnamaldehyde (CA), TU-100 ingredients, [6]-shogaol (6S) and γ-sanshool (GS), improved SI transit in a POI model. The effects of AITC, 6S and GS but not CA were abrogated in TRPA1-deficient mice. SI segments show periodic peristaltic motor activity whose periodicity disappeared in TRPA1-deficient mice. TU-100 augmented the motility. AITC, CA and 6S increased 5-HT release from isolated SI segments and the effects of all these compounds except for CA were lost in TRPA1-deficient mice. 6S and GS induced a release of 5-HT from RIN-14B cells in a dose- and TRPA1-dependent manner.

CONCLUSIONS & INFERENCES

Intraluminal TRPA1 stimulation is a potential therapeutic strategy for GI motility disorders. Further investigation is required to determine whether 5-HT and/or ECC are involved in the effect of TRPA1 on motility.

The longitudinal mental health impact of Fukushima nuclear disaster exposures and public criticism among power plant workers: the Fukushima NEWS Project study

BACKGROUND

The Fukushima Daiichi and Daini Nuclear Power Plant workers experienced multiple stressors as both victims and onsite workers after the 2011 Great East Japan Earthquake and subsequent nuclear accidents. Previous studies found that disaster-related exposures, including discrimination/slurs, were associated with their mental health. Their long-term impact has yet to be investigated.

METHOD

A total of 968 plant workers (Daiichi, n = 571; Daini, n = 397) completed self-written questionnaires 2-3 months (time 1) and 14-15 months (time 2) after the disaster (response rate 55.0%). Sociodemographics, disaster-related experiences, and peritraumatic distress were assessed at time 1. At time 1 and time 2, general psychological distress (GPD) and post-traumatic stress response (PTSR) were measured, respectively, using the K6 scale and Impact of Event Scale Revised. We examined multivariate covariates of time 2 GPD and PTSR, adjusting for autocorrelations in the hierarchical multiple regression analyses.

RESULTS

Higher GPD at time 2 was predicted by higher GPD at time 1 (β = 0.491, p < 0.001) and discrimination/slurs experiences at time 1 (β = 0.065, p = 0.025, adjusted R 2 = 0.24). Higher PTSR at time 2 was predicted with higher PTSR at time 1 (β = 0.548, p < 0.001), higher age (β = 0.085, p = 0.005), and discrimination/slurs experiences at time 1 (β = 0.079, p = 0.003, adjusted R 2 = 0.36).

CONCLUSIONS

Higher GPD at time 2 was predicted by higher GPD and discrimination/slurs experience at time 1. Higher PTSR at time 2 was predicted by higher PTSR, higher age, and discrimination/slurs experience at time 1.