Comparison of Mandibular Volume and Linear Measurements in Patients with Mandibular Asymmetry

In patients with mandibular asymmetry, the volume of the mandible divided by the mandibular median plane is significantly larger on the non-deviated (N-Dev) side than on the deviated (Dev) side. However, it has been reported that there is no significant difference between the volumes of the N-Dev and Dev sides when the mandibular ramus and body are divided. The purpose of this study was to investigate which region is responsible for the volume difference between the N-Dev and Dev sides. Cone Beam Computed Tomography (CBCT) images of patients with mandibular asymmetry were analyzed by measuring the volume, and linear analysis of the mandibular body, ramus, and condyle on the N-Dev and Dev side was performed. In this study, CBCT images of 37 patients (8 Japanese, 16 Korean, and 13 Egyptian) aged ≥ 18 years with mandibular asymmetry (men: 20, women: 17) were used to evaluate mandibular asymmetry. In patients with mandibular asymmetry, the N-Dev side showed significantly larger values than the Dev side for both volume and linear condyle, ramus, and mandibular body measurements. These results do not differ according to sex or ethnicity. Therefore, it is suggested that the N-Dev side of mandibular asymmetry is large without any regional specificity in pathophysiology.

Methods in Genetic Analysis for Evaluation Mandibular Shape and Size Variations in Human Mandible

ABSTRACT

The human mandible has been investigated from both clinical and evolutionary perspectives. Recent advances in genome science have identified the genetic regulation of human mandibular shape and size. Identification of genes that regulate mandibular shape and size would not only enhance our understanding of the mechanisms of mandibular growth and development but also help define a strategy to prevent mandibular dysplasia. This review provides a comprehensive summary of why and how the mandible was evaluated in the human mandible genome study. The variation in human mandibular shape and size has been progressively clarified, not only by focusing on the mandible alone but also by using extremely diverse approaches. The methods of data acquisition for evaluating human mandibular shape and size variation are well established. Furthermore, this review explains how to proceed with future research.

Publisher Correction: Electronic structure of the parent compound of superconducting infinite-layer nickelates

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Electronic structure of the parent compound of superconducting infinite-layer nickelates

The search continues for nickel oxide-based materials with electronic properties similar to cuprate high-temperature superconductors^1-10. The recent discovery of superconductivity in the doped infinite-layer nickelate NdNiO₂ (refs. ^11,12) has strengthened these efforts. Here, we use X-ray spectroscopy and density functional theory to show that the electronic structure of LaNiO₂ and NdNiO₂, while similar to the cuprates, includes significant distinctions. Unlike cuprates, the rare-earth spacer layer in the infinite-layer nickelate supports a weakly interacting three-dimensional 5d metallic state, which hybridizes with a quasi-two-dimensional, strongly correlated state with [Formula: see text] symmetry in the NiO₂ layers. Thus, the infinite-layer nickelate can be regarded as a sibling of the rare-earth intermetallics^13-15, which are well known for heavy fermion behaviour, where the NiO₂ correlated layers play an analogous role to the 4f states in rare-earth heavy fermion compounds. This Kondo- or Anderson-lattice-like 'oxide-intermetallic' replaces the Mott insulator as the reference state from which superconductivity emerges upon doping.

Three-dimensional evaluation of mandibular volume in patients with cleft lip and palate during the deciduous dentition period

OBJECTIVES

To examine the relationship between mandibular volume and craniofacial morphology in patients with cleft lip and palate using cone beam computed tomography (CBCT) and to compare these findings with control (noncleft) patients undergoing CBCT for other purposes during the deciduous dentition period.

MATERIALS AND METHODS

Eighty-four patients were categorized into the unilateral cleft lip and alveolus (UCLA) group (n = 25; mean age, 4.60 ± 0.40 years), unilateral cleft lip and palate (UCLP) group (n = 23; mean age, 4.52 ± 0.39 years), bilateral cleft lip and palate (BCLP) group (n = 22; mean age, 4.54 ± 0.37 years), and control group without cleft (n = 14; mean age, 5.19 ± 0.52 years). Mandibular volume and craniofacial cephalometric measurements were obtained using CBCT. All measurements were assessed by analysis of covariance (ANCOVA) using Bonferroni post hoc pairwise comparison tests.

RESULTS

ANCOVA revealed no statistically significant differences in mandibular volume among the groups. SNA° and ANB° were significantly larger in the UCLA and BCLP groups than in the control group. SN-MP° was smallest in the UCLA group. Co-A in the UCLP group was shorter than in the UCLA and BCLP groups. Go-Gn was shortest in the UCLP and BCLP groups compared with the control group.

CONCLUSIONS

Three-dimensional evaluation of craniofacial morphology using CBCT can provide valuable information on malocclusion and other dentoskeletal problems among patients with CLP.

Three-dimensional assessment of the pharyngeal airway in Japanese preschoolers with orofacial clefts

OBJECTIVES/HYPOTHESIS

Individuals with orofacial clefts often experience respiratory problems because of nasopharyngeal abnormalities. Pharyngeal airway morphology is thought to differ among the various cleft types. We measured three-dimensional (3D) airway volume using cone-beam computed tomography (CBCT) analysis to evaluate and compare pharyngeal airways in Japanese preschoolers with and without orofacial clefts.

STUDY DESIGN

Retrospective case-control study.

METHODS

We enrolled 83 subjects (37 boys, 46 girls; mean age = 4.66 ± 0.56 years) with nonsyndromic orofacial clefts and 16 noncleft healthy subjects (seven boys, nine girls; mean age = 5.30 ± 0.52 years) as controls. The subjects were divided into five groups. Four groups were based on the cleft type: isolated cleft palate, unilateral cleft lip and alveolus), unilateral cleft lip and palate, and bilateral cleft lip and palate. The fifth group included the noncleft controls. All subjects were examined with CBCT, and the 3D airway volume was measured. We analyzed group differences statistically using analysis of covariance with the Bonferroni post hoc pairwise comparison tests for the corrected means.

RESULTS

Compared with the noncleft group, each cleft group exhibited significantly decreased total and nasal airway volumes and increased superior and inferior pharyngeal airway volumes. The differences were all statistically significant.

CONCLUSIONS

Our findings suggest that anatomical differences exist in pharyngeal airway volumes among various cleft groups and in those without a cleft.

LEVEL OF EVIDENCE

3b Laryngoscope, 130:533-540, 2020.

Comparison of condylar size among different anteroposterior and vertical skeletal patterns using cone-beam computed tomography

OBJECTIVES

To compare condylar size among different anteroposterior and vertical skeletal patterns using cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

The study included 166 subjects (61 men, mean age: 27.2 ± 7.6 years; 105 women, mean age: 27.4 ± 9.2 years). The anteroposterior skeletal patterns of the subjects were classified into Classes I (-1° ≤ A point-nasion-B point angle [ANB] < 4°), II (ANB ≥ 4°), and III (ANB < -1°). The vertical skeletal patterns were classified into hypodivergent (mandibular plane [MP] ≤ 23°), normodivergent (23° < MP < 30°), and hyperdivergent (MP ≥ 30°) groups. The condylar length, height, and width were examined using CBCT images. Analysis of covariance was used to compare three condylar size measurements among the three anteroposterior groups and the three vertical groups using sex as a covariate. Both left and right sides were examined. Nine groups were further divided according to the anteroposterior and vertical groups, and two-way analysis of covariance (ANCOVA) was applied to estimate the composite effect of skeletal patterns in both directions.

RESULTS

Sex as a covariate showed statistical significance in most examinations. The condylar height on both sides had statistically different anteroposterior skeletal patterns ( P < .001). The condylar width on both sides also had statistically different vertical skeletal patterns ( P < .001). After adjusting for sex, the condylar height and width on both sides increased from Class II, Class I, and Class III. The condylar width on both sides increased from the hypodivergent group, the normodivergent group, and the hyperdivergent group. No composite effect of skeletal patterns in both directions was observed.

CONCLUSIONS

Condylar height and width considerably differed among subjects with different anteroposterior or vertical skeletal patterns. The anteroposterior or vertical skeletal patterns independently affected the condylar size.

Orthognathic surgery induces genomewide changes longitudinally in DNA methylation in saliva

OBJECTIVE

Orthognathic surgery dramatically changes morphology of the maxillofacial deformity and improves the malocclusion morphologically and functionally. We investigated the influence of orthognathic surgery on genomewide DNA methylation in saliva.

METHODS

Saliva was obtained from nine patients undergoing orthognathic surgery and two healthy reference individuals before and 3 months after orthognathic surgery. Genomewide DNA methylation profiling of saliva (341,482 CpG dinucleotides) was conducted using Infinium HumanMethylation450 BeadChips.

RESULTS

Comparison between pre- and postsurgery saliva samples revealed significant changes in DNA methylation patterns at 2,381 CpG sites (p < 0.01) with suggestive significance. The differentially methylated probe sets were significantly associated with the cancer pathway (p = 2.8 × 10^-7 ; a false discovery rate q-value = 3.7 × 10^-4 ) and PI3K-Akt signalling pathway (p = 2.4 × 10^-5 ; a false discovery rate q-value = 3.1 × 10^-2 ).

CONCLUSION

Pathway enrichment analysis of genes with suggestive significance demonstrated that altered DNA methylation in saliva of patients undergoing orthognathic surgery, possibly as a response to surgical stress or bone injury. Further studies with a large sample size and long-term observation are needed to validate the phenomena identified in this study.

Association between the FGFR1 rs13317 single nucleotide polymorphism and orbitale-nasion depth based on cephalometric images

The fibroblast growth factor receptor 1 (FGFR1) gene plays an important role in craniofacial morphogenesis. In our previous study, an association between FGFR1 single nucleotide polymorphisms (SNPs) and craniofacial morphology was demonstrated in Japanese and Korean subjects. The present study aimed to evaluate the relationship between a common FGFR1 SNP (rs13317) with craniofacial morphology, increasing the number of measurements and examining Egyptian subjects (n = 191) in addition to the Japanese (n = 211) and Korean (n = 226) subjects. Genotyping for rs13317 was performed using the TaqMan assay, and its associations with 81 craniofacial measurements derived from lateral and posteroanterior cephalograms were analyzed by multiple regression analysis controlling sex and facial size. The results from each of the populations were then statistically combined. In the Egyptian subjects, rs13317 was significantly associated with the nasion-orbitale depth (P = 0.00040), and a suggestive association was also observed in the Japanese (P = 0.037) and Korean subjects (P = 0.045). The combined analysis revealed that only the nasion-orbitale depth showed a significant association (P = 0.000062) and that several measurements showed a suggestive association. Our results strongly indicate that rs13317 is associated with a smaller depth between the nasion and orbitale, representing a relative protrusion of the cheekbones and retrusion of the nasal root. A similar characteristic is also observed in individuals with Pfeiffer syndrome, which is caused by a dysfunctional FGFR1 mutation.

Growth hormone receptor gene is related to root length and tooth length in human teeth

OBJECTIVES

To examine the relationship between tooth length and growth hormone receptor (GHR) gene variants in a healthy Japanese population.

MATERIALS AND METHODS

The subjects consisted of 193 Japanese adults (69 men, 124 women), aged 13 to 56 years. Genomic DNA was extracted from saliva and genotyped GHR rs6184 and rs6180 variants using the Taqman genotyping. Computed tomography (CT) images were acquired using a dental cone-beam CT scanner and reconstructed using open-source OsiriX medical image processing software. The maxillary (upper; U) and mandibular (lower, L) central incisors (1), lateral incisors (2), canines (3), first premolars (4), second premolars (5), first molars (6), and second premolars (7) were evaluated. Teeth were assessed for crown height (CH), root length (RL), overall tooth length (C+R), and crown to root ratio (C/R). The relationships between GHR variants and CH, RL, C+R, and C/R were statistically examined.

RESULTS

The GHR variant rs6184 was associated with the root lengths and tooth length for the upper and lower lateral incisors and upper canines (U2 RL; U3 RL, C+R; L2 RL [ P < .05]).

CONCLUSIONS

The results indicate that the GHR rs6184 variant is associated with tooth length and ratio dimensions in a Japanese cohort. Further studies utilizing a larger sample size are needed to confirm this finding.

Relationship between tooth length and three-dimensional mandibular morphology

OBJECTIVES

To clarify the relationship between tooth length and three-dimensional mandibular morphology in a healthy Japanese population.

MATERIALS AND METHODS

This study included 181 Japanese adults: 66 men and 115 women. Cone-beam computed tomography (CBCT) images were acquired with a dentofacial cone-beam x-ray CT scanner. Tooth length was measured with open-source OsiriX medical image processing software. Crown height and root length were measured in the maxillary and mandibular central incisors, lateral incisors, canines, first premolars, second premolars, first molars, and second molars. Based on these measurements, principal component (PC) analysis was performed. The following measurements were used to assess three-dimensional mandibular morphology: CD-GO, GO-GN, RCD-LCD, RGO-LGO, RCP-LCP, and the gonial angle. Stepwise multiple regression analysis was performed to examine the associations between three-dimensional mandibular morphology and the patterns of crown and root lengths using the mandibular measurements as explanatory variables and each PC as the dependent variable.

RESULTS

CD-GO was positively associated with PC1, which represented overall tooth length. RGO-LGO was positively associated with PC2, whereas GO-GN, RCP-LCP, and gonial angle were negatively associated with PC2, which was the axis denoting relatively longer root (+) vs higher crown (-). Being female was associated with PC3, which was the axis denoting relatively longer posterior tooth (+) vs anterior tooth (-).

CONCLUSIONS

The present clinical study effectively used CBCT images and PC analysis to reveal significant correlations between tooth length and mandibular morphology in a modern human population, confirming in part the statement that "large teeth necessitate large jaws."

Interferon regulatory factor 6 variants affect nasolabial morphology in East Asian populations

OBJECTIVE

The interferon regulatory factor 6 gene (IRF6) is one of the most conspicuous genes among a large number of candidate risk genes for non-syndromic cleft lip with or without cleft palate, which is considered to be a multifactorial defect. Variants of IRF6 are also suggested to affect normal craniofacial variations, especially in the area of the nose and the upper lip. In the present study, we used lateral cephalograms to establish the relationship between IRF6 and sagittal nasolabial morphology in healthy East Asian subjects.

DESIGN

Genomic DNA was extracted from 215 Japanese and 226 Korean individuals, and genotyped for five IRF6 single nucleotide polymorphisms (SNPs): rs17389541, rs642961, rs2013162, rs2235371, and rs7802. These SNPs were tested by multiple regression analyses for their association with craniofacial measurements obtained from lateral cephalometrics.

RESULTS

We detected a significant association between the derived variants, rs2013162 and rs2235371 and the distances between a facial bone plane indicated by distance from Nasion and Point A (NA plane) to soft tissue landmarks; the Subalare (NA-Sbal) and the Subnasale (NA-Sn) in the sagittal plane.

CONCLUSION

Our results indicate that IRF6 variants play an important role in the normal range of variation in nasolabial soft-tissue morphology.

Contribution of FGFR1 Variants to Craniofacial Variations in East Asians

FGFR1 plays an important role in the development of the nervous system as well as the regulation of the skeletal development and bone homeostasis. Mutations in FGFR1 genes affect skull development, specifically suture and synchondrosis, resulting in craniosynostosis and facial abnormalities. We examined subjects with normal skull morphology for genetic polymorphisms that might be associated with normal craniofacial variations. Genomic DNA was obtained from 216 Japanese and 227 Korean subjects. Four FGFR1 SNPs, namely, rs881301, rs6996321, rs4647905, and rs13317, were genotyped. These SNPs were tested for association with craniofacial measurements obtained from lateral and posteroanterior cephalometries, in which principle component analysis was performed to compress the data of the craniofacial measurements. We observed that SNPs rs13317 and rs6996321 were correlated with the overall head size and midfacial development, indicating that FGFR1 SNPs played crucial roles in the normal variation of human craniofacial morphology. Subjects with the derived alleles of SNPs rs13317 and rs6996321 had a small face and a facial pattern associated with a retruded midface and relatively wide-set eyes. These facial features were similar to but were milder than those of individuals with Pfeiffer syndrome, which is caused by a dysfunctional mutation in FGFR1.

Evaluation of mandibular volume classified by vertical skeletal dimensions with cone-beam computed tomography

OBJECTIVE

 To investigate the relationship between anteroposterior and vertical differences in maxillofacial morphology and mandibular volume.

MATERIALS AND METHODS

 Subjects comprised 213 Japanese adults (84 males and 129 females) who were divided into three groups based on mandibular basal arch (ANB) and Wits, measured in a cephalometric analysis: Class I (-1° ≤ ANB < 4°,-1 mm ≤ Wits < 0 mm), Class II (ANB ≥ 4°, Wits ≥ 0), and Class III (ANB <-1°, Wits <-1 mm). Subjects were also divided into three groups based on the mandibular plane angle (Mp), as follows: hypodivergent (Mp < 23°), normodivergent (Mp  =  23-30°), and hyperdivergent (Mp > 30°) groups. Mandibular volume was measured from cone-beam computed tomographic images that were analyzed using Analyze™ image processing software and compared among the three groups in each classification.

RESULTS

 No significant differences were noted in mandibular volume among Classes I, II, and III. An inverse relationship was found between mandibular volume and Mp, and a significant difference was noted in mandibular volume between the hypodivergent and hyperdivergent groups.

CONCLUSIONS

 In addition to two-dimensional analysis, such as lateral cephalometry, three-dimensional information such as volume, provided by cone-beam computed tomography, contributes to a more detailed assessment of maxillofacial morphology.

Growth hormone receptor gene variant and three-dimensional mandibular morphology

OBJECTIVE

To examine the relationship between three-dimensional mandibular morphology and growth hormone receptor (GHR) gene variants in a healthy Japanese population.

MATERIALS AND METHODS

The subjects, who were unrelated Japanese orthodontic patients, consisted of 64 men and 114 women. Using the Taqman genotyping assay, GHR gene rs6184 and rs6180 variants were detected in genomic DNA extracted from saliva. Mandibular volume and length were measured from cone-beam computed tomography images that were analyzed using Analyze image-processing software. The relationship between GHR gene variants and three-dimensional mandibular morphology was statistically examined.

RESULTS

Statistical significance for the relationship between the distance between the left and right coronoid processes and rs6180 was noted (P < .05).

CONCLUSION

Our results indicate that the GHR variant rs6180 is associated with the distance between the left and right coronoid process in the Japanese subjects.

Titanium dxy ferromagnetism at the LaAlO3/SrTiO3 interface

A number of recent transport and magnetization studies have shown signs of ferromagnetism in the LaAlO3/SrTiO3 heterostructure, an unexpected property with no bulk analogue in the constituent materials. However, no experiment thus far has provided direct information on the host of the magnetism. Here we report spectroscopic investigations of the magnetism using element-specific techniques, including X-ray magnetic circular dichroism and X-ray absorption spectroscopy, along with corresponding model calculations. We find direct evidence for in-plane ferromagnetic order at the interface, with Ti(3+) character in the dxy orbital of the anisotropic t2g band. These findings establish a striking example of emergent phenomena at oxide interfaces.

Subband structure of a two-dimensional electron gas formed at the polar surface of the strong spin-orbit perovskite KTaO3

We demonstrate the formation of a two-dimensional electron gas (2DEG) at the (100) surface of the 5d transition-metal oxide KTaO3. From angle-resolved photoemission, we find that quantum confinement lifts the orbital degeneracy of the bulk band structure and leads to a 2DEG composed of ladders of subband states of both light and heavy carriers. Despite the strong spin-orbit coupling, our measurements provide a direct upper bound for the potential Rashba spin splitting of only Δk(parallel)}~0.02 Å(-1) at the Fermi level. The polar nature of the KTaO3(100) surface appears to help mediate the formation of the 2DEG as compared to nonpolar SrTiO3(100).

Fermi surface and superconductivity in low-density high-mobility δ-doped SrTiO3

The electronic structure of low-density n-type SrTiO3 δ-doped heterostructures is investigated by angular dependent Shubnikov-de Haas oscillations. In addition to a controllable crossover from a three- to two-dimensional Fermi surface, clear beating patterns for decreasing dopant layer thicknesses are found. These indicate the lifting of the degeneracy of the conduction band due to subband quantization in the two-dimensional limit. Analysis of the temperature-dependent oscillations shows that similar effective masses are found for all components, associated with the splitting of the light electron pocket. The dimensionality crossover in the superconducting state is found to be distinct from the normal state, resulting in a rich phase diagram as a function of dopant layer thickness.

Dominant mobility modulation by the electric field effect at the LaAlO3/SrTiO3 interface

Caviglia et al. [Nature (London) 456, 624 (2008)] have found that the superconducting LaAlO3/SrTiO3 interface can be gate modulated. A central issue is to determine the principal effect of the applied electric field. Using magnetotransport studies of a gated structure, we find that the mobility variation is almost 5 times that of the sheet carrier density. Furthermore, superconductivity can be suppressed at both positive and negative gate bias. These results indicate that the relative disorder strength strongly increases across the superconductor-insulator transition.

Coronary artery disease investigated using 99mTc-tetrofosmin myocardial SPECT

BACKGROUND

Coronary artery disease can be diagnosed from stress and delayed images of myocardial single photon emission computed tomography (SPECT) using technetium-99 m-tetrofosmin (TcTF). However, the negative predictive value of stress SPECT images after a single injection of a low tracer dose remains unknown. Thus, the present study investigates whether normal stress SPECT results predict event-free survival.

MATERIALS AND METHODS

We screened 302 consecutive patients who were randomly assigned to two groups for myocardial ischaemia using either stress SPECT with a low dose of TcTF (296 MBq, TcTF group, n = 150) or stress together with rest SPECT using thallium(201) chloride (TlCl, 111 MBq; TlCl group, n = 152) as the tracer. A total of 80 patients with abnormal SPECT findings were excluded and the remaining 222 with normal results (age, 66.5 +/- 0.7 years; TcTF/TlCl, 112/110) were enrolled in the present study and followed up for 401 +/- 9 days, with the endpoint being ischaemic cardiac events.

RESULTS

The incidence of cardiac events did not differ between the two groups (0.9% and 0.0% in TcTF and TlCl groups, respectively). The cost and duration of TcTF and TlCl SPECT examinations were about 425 and 603 Euros and 50 and 280 min, respectively.

CONCLUSIONS

The negative predictive values of stress SPECT using a low dose of TcTF and of combined stress and rest SPECT using TlCl did not differ and both were clinically acceptable. Thus, stress SPECT using low dose TcTF is useful in screening patients for myocardial ischaemia.

Sampling methods and residential factors affecting formaldehyde concentration in indoor air

Formaldehyde (HCHO) is the most serious residential pollutant. In order to evaluate residential HCHO levels, two sampling methods have been recommended; one is a 30 minute sampling in a closed room, and the other is a 24 hour sampling with an ordinary lifestyle routine. The aim of this report was to clarify the difference between the HCHO levels obtained by the two sampling methods. Residential air in 58 rooms was sampled for 30 minutes by an active sampling method more than 5 hours after residents closed windows, and by a passive sampling method for 24 hours with an ordinary lifestyle routine. The HCHO concentration with the 30 minute sampling was 0.118+/-0.065 ppm (range: 0.034-0.295 ppm) and 36 rooms (62%) exceeded the Japanese guideline value of 0.08 ppm, while 5% were higher than 0.25 ppm. The HCHO concentration with the 24 hours sampling was 0.053+/-0.039 ppm (range: 0.02-0.167 ppm) and only 13 rooms (22%) exceeded 0.08 ppm. The relationship between the concentrations obtained by the two methods was linear. However, the level with the 24 hour sampling significantly reduced with prolonged window opening time, meaning that occupants made an effort to reduce the usual exposure to about 40% of the exposure in a closed room by opening windows in order to escape from irritation. Since major adverse effects of HCHO are irritation and sensitization, the occasional peak concentration must be focused. In order to evaluate residential HCHO levels, measurement in a closed room is recommended even if people are living there.

Cloning and nucleotide sequence of the gene encoding a serine proteinase inhibitor named marinostatin from a marine bacterium, Alteromonas sp. strain B-10-31

The gene (mstI) encoding a serine proteinase inhibitor named marinostatin from marine Alteromonas sp. strain B-10-31 was cloned and its nucleotide sequence was analyzed. A short open reading frame of 192 bp encoded 63 amino acids with a molecular weight of 6,985. Furthermore, the initial product of marinostatin (marinostatin L) was purified and its amino acid sequence was analyzed. These results indicate that marinostatin is produced as a unique precursor consisting of the mature peptide and the leader peptide for an ATP-binding cassette (ABC) transporter, and furthermore the initial product of marinostatin is dehydrated and processed by proteolysis to give homologous forms of marinostatin.

Effects of a benzothiazepine calcium blocker on electrolyte alteration in human ischemic and reperfused myocardium

Intracellular electrolyte alterations of the myocardial cells from the patients pretreated and non-treated with diltiazem in coronary surgery were measured by means of X-ray microanalysis. Myocardial biopsy specimens were obtained at the right atrial wall at non-ischemia, ischemia and reperfusion periods. The ion concentrations at non-ischemia which is the condition of pre-open heart surgery in patients were: Ca 0.8 +/- 0.05, K 108 +/- 2.3, Na 10 +/- 1.9, Cl 30 +/- 1 (mean +/- S.E., mmol/kg wet weight, n = 100-130), and there were no significant differences for Ca, K, Na and Cl with diltiazem administration. The intracellular Ca increased without diltiazem in reperfusion after open heart surgery. However, there was no Ca increase in either the ischemia or reperfusion states with diltiazem. The K content was significantly lower, and the Na and Cl contents were higher than those of non-ischemia in both ischemia and reperfusion without diltiazem. The K loss, and Na and Cl increases in the reperfusion period were recovered to the levels in the non-ischemia state with diltiazem administration. This study showed that the use of calcium-free cardioplegic solution caused intracellular calcium accumulation in a hypothermic global ischemic and reperfused conditions during coronary surgery, whereas, diltiazem could suppress the calcium accumulation. The alterations of potassium, sodium and chlorine were also favourable in patients with diltiazem. The possible mechanism of the effects of diltiazem on the element alterations of myocardium are discussed.

[The causes and timing of reoperation for coronary artery disease]

In eight hundred and sixteen consecutive patients undergoing coronary artery bypass grafting (CABG) within the past 19 years (1974 to 1993), repeated CABG were performed on 12 patients (1.47%). The main reasons for repeated CABG were graft failure (GF), progression of native disease (NP) and incomplete revascularization (IR). The incidence of GF only and GF combined NP were high either within a half year or around 5 years after CABG. When the recurrence of angina is noted after CABG, the catheter intervention should be chosen at first but the reoperation should be done not so late. Although all patients survived from reoperation, three patients continued to have mild angina pectories. If a reoperation is inevitable, maximum utilization of arterial graft and accomplishment of complete revascularization are emphasized.

[The effect of Ryanodine for the myocardial protection in the working heart model of rabbit]

The purpose of this paper is to evaluate the effects of Ryanodine for myocardial protection. Twenty-four rabbits were studied using the working heart model divided four groups. The first is control group with no Ryanodine, the second is 10(-9) M, the third is 10(-8) M and the last one is 10(-7) M Ryanodine with GIK cardioplegic solution respectively. The hemodynamics was studied and the elemental concentrations (Ca, Mg, K, Na, Cl) of myocardial cell was measured using X-ray microanalysis. The results showed that intracellular Ca accumulation was dose-dependently suppressed with Ryanodine during reperfusion and also Ryanodine was significantly effective to maintain the hemodynamics during same one.

[Coronary artery bypass utilizing vein grafts: why didn't we use an arterial graft?]

Internal thoracic artery (ITA) grafts for coronary artery bypass grafting (CABG) are superior to SVG in the long-term patency and survival. In spite of our effort to utilize ITA whenever possible, we still have some cases which have to receive only vein grafts. Among the consecutive 201 patients undergoing CABG in the past three years, 32 patients (16%) received only vein grafts. We compared these patients (SVG group) with those who received ITA grafts (ITA group). The SVG group consisted of all emergency cases and many cases with single and double vessel disease. In the SVG group, perioperative use of IABP was more frequent and operative mortality was higher, although the number of grafts was fewer (2.66 vs 3.61) and aortic cross clamping time was shorter in this group. Main reasons for selecting only vein grafts were emergency surgery, inadvertent injury of ITA, inadequate ITA free flow etc. Technical refinement in the preparation of ITA is important to make possible wider application of arterial grafts for CABG.

[Surgical management of stab wound of the chest]

During the past three and half years, we experienced eighteen patients with stab wound of the chest. Ten patients were homicidal victims and the remainders were suicides. According to our indications (Table 4), thoracotomy was done in eight patients (44%). The major reason for thoracotomy in this series was massive bleeding. Five pulmonary, four diaphragmatic, four intercostal-artery's and two pericardial injuries were repaired. In our series, six patients (33%) were accompanied with abdominal stab wound and laparotomy was done in five patients. Four liver's one stomach's, one spleen's, one intestine's and one omentum's injuries were repaired. There were three DOA's (dead on arrival). The causes of DOA's were massive bleedings from the heart in two patients and from the liver in one patients. Except for the DOA's, four patients (27%) were not operated on. In conclusion, three DOA's, could not be resuscitated, but all remainders (the thoracotomy's, the laparotomy's and the non-surgical patients) survived and had no complications.

Substratum-bound elastin peptide inhibits aortic smooth muscle cell migration in vitro

Migration of smooth muscle cells (SMCs) of the media through the internal elastic lamina to the intima in response to various chemoattractants is considered to be an important event in the development of atherosclerosis. We evaluated the influence of elastin peptides prepared from normal aorta on migration of cultured rat aortic SMCs in vitro. Studies with filters coated with elastin peptides in a modified Boyden's chamber showed that the migratory response of cultured rat aortic SMCs in response to platelet-derived factors was impeded by filter-bound elastin peptides. The inhibitory effect appeared to be relatively specific for elastin peptides and for SMCs, as other matrix components (Types I, III, IV, and V collagens and fibronectin) did not impede SMC migration, and polymorphonuclear leukocytes were not impeded by elastin peptides. Elastin peptides in solution in the lower well caused the migratory response, and this response was also inhibited by filter-bound elastin peptides. Attractants such as platelet-derived factors and elastin peptides are likely to be present in the matrix around migrating SMCs. These studies suggest that elastin peptides adhering to the substratum or elastin, a major component of elastic fiber, may be one of the natural inhibitors of vascular SMC migration in response to chemoattractants in the fluid phase.

[Reevaluation of recalled infants by neonatal mass screening for congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Diagnostic value of pregnanetriolone in a single urine specimen using glass capillary gas chromatography]

To establish a detailed reevaluation system for infants who were recalled by a neonatal mass screening for congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency, pregnanetriol (PT) and pregnanetriolone (PTL) in a single urine specimen combined with plasma 17 alpha-hydroxyprogesterone (17-OHP) and 21-deoxycortisol (21-DOF) were determined by a simple method using glass capillary gas chromatography. A pilot study of neonatal mass screening for CAH with a determination of "disc 17-OHP" value in dried blood on filter paper was carried out in Western Shizuoka Prefecture. During the study period (32 months), 37472 neonates were determined by mass screening, and 362 neonates proved to be abnormal candidates who needed further evaluations. From out of these candidates, 262 neonates responded with recall and were studied. Amongst these 262 neonates, 241 neonates visited directly our outpatient clinic at Hamamatsu University Hospital. The reevaluation conducted at our clinic included a physical examination, detailed family history, measurement of serum electrolytes, disc 17-OHP, plasma 17-OHP and 21-DOF values, and PT and PTL in a single urine specimen. Consequently, 3 neonates appeared to be patients with CAH. Two of them were the salt-losing type and the other was the simple virilizing type. The rest of the candidates who received reevaluation were finally decided to be healthy neonates, indicating false positivity by mass screening. Compared to the candidates who showed false positivity in the mass screening, the CAH patients had an apparently high urinary PT and PTL titer of ten or one hundred fold. Additionally, despite corticosteroid treatment in one case, significantly elevated levels of PT and PTL were detected. To assay PTL was a more reliable parameter for the detection of CAH and for following up the candidates because PTL was not detectable in 63.3% of the false positive cases, suggesting that PTL was less likely to indicate false positive cases. PTL was detected at more than 0.01 microgram/ml urine in 19.4% of false positive cases, however, no case showed further elevation of PTL during the follow up period. In all false positive cases, PTL was not detectable until the age of six months. Despite problems to be resolved, determination of urinary PTL titer is valuable for the detection of CAH patients. In addition, urinary PTL could be a good parameter for the further follow up of false positive cases in neonatal mass screening.

A neonatal mass-screening for congenital adrenal hyperplasia in Japan

A pilot neonatal mass-screening for congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) was performed in the western region of Shizuoka Prefecture, Japan, using a simplified radioimmunoassay method for 'Disc-17-hydroxyprogesterone (17-OHP) determination. The results obtained during a 30-month period indicated that 3 infants out of the 34314 neonates examined were proved to have 21-OHD, and the incidence of homozygotes and heterozygotes were estimated to be 1:11438 and 1:54, respectively. At the time of recall, the concentrations of plasma 17-OHP and 21-deoxycortisol and their urine metabolites as well as plasma sodium levels were quite applicable to diagnosis, while the clinical signs that may be manifest in 21-OHD were of little value in this connection. Prematurity and perinatal complications of neonates tended to give false-positive results, being secondary to the function of the residual foetal adrenal cortex and non-specific stimulatory effects of various stresses. Despite several technical and practical problems to be solved, the present study demonstrated the importance and validity of a neonatal mass-screening program for CAH.