EAACI Molecular Allergology User's Guide 2.0

Since the discovery of immunoglobulin E (IgE) as a mediator of allergic diseases in 1967, our knowledge about the immunological mechanisms of IgE-mediated allergies has remarkably increased. In addition to understanding the immune response and clinical symptoms, allergy diagnosis and management depend strongly on the precise identification of the elicitors of the IgE-mediated allergic reaction. In the past four decades, innovations in bioscience and technology have facilitated the identification and production of well-defined, highly pure molecules for component-resolved diagnosis (CRD), allowing a personalized diagnosis and management of the allergic disease for individual patients. The first edition of the "EAACI Molecular Allergology User's Guide" (MAUG) in 2016 rapidly became a key reference for clinicians, scientists, and interested readers with a background in allergology, immunology, biology, and medicine. Nevertheless, the field of molecular allergology is moving fast, and after 6 years, a new EAACI Taskforce was established to provide an updated document. The Molecular Allergology User's Guide 2.0 summarizes state-of-the-art information on allergen molecules, their clinical relevance, and their application in diagnostic algorithms for clinical practice. It is designed for both, clinicians and scientists, guiding health care professionals through the overwhelming list of different allergen molecules available for testing. Further, it provides diagnostic algorithms on the clinical relevance of allergenic molecules and gives an overview of their biology, the basic mechanisms of test formats, and the application of tests to measure allergen exposure.

Gibberellin-regulated proteins: Emergent allergens

About 10 years ago, a protein family was shown for the first time to contain allergenic members, gibberellin-regulated protein (GRP). The first reported member was from peach, Pru p 7. One can hypothesize that it was not detected before because its physicochemical characteristics overlap with those of lipid transfer protein (LTP), a well-known allergen, or because the exposure to GRP increased due to an increase in the gibberellin phythormone level in plant food, either exogenous or endogenous. Like LTPs, GRPs are small cationic proteins with disulfide bridges, are resistant to heat and proteolytic cleavage, and are involved in the defense of the plant. Besides peach, GRP allergens have been described in Japanese apricot (Pru m 7), sweet cherry (Pru av 7), orange (Cit s 7), pomegranate (Pun g 7), bell pepper (Cap a 7), strawberry (Fra a GRP), and also in pollen with a restriction to Cupressaceae tree family (Cup s 7, Cry j 7, and Jun a 7). IgE cross-reactivities were described between GRPs, and the reported peach/cypress and citrus/cypress syndromes may therefore be explained because of these GRP cross-reactivities. GRPs are clinically relevant, and severe adverse reactions may sometimes occur in association with cofactors. More than 60% and up to 95% sequence identities are calculated between various allergenic GRPs, and three-dimensional models show a cleft in the molecule and predict at least three epitopic regions. The structure of the protein and its properties and the matrix effect in the original allergenic source should be unraveled to understand why, despite the ubiquity of the protein family in plants, only a few members are able to sensitize patients.

Capsicum Allergy: Involvement of Cap a 7, a New Clinically Relevant Gibberellin-Regulated Protein Cross-Reactive With Cry j 7, the Gibberellin-Regulated Protein From Japanese Cedar Pollen

The Capsicum genus belongs to the Solanaceae family. Bell or chili peppers are consumed worldwide, but allergy to Capsicum is rare. It is involved in the celery-birch-mugwort-spice syndrome and cross-reactivities were reported with latex. Several allergens have been described, but only 2 are referenced in the World Health Organization/International Union of Immunological Societies allergen data bank, a thaumatin-like protein and a profilin. A patient allergic to bell/chili pepper, peach, orange and Japanese cedar pollen was clinically and biologically analyzed including direct and competitive immunoblots and basophil activation tests (BATs) with allergenic source extracts and recombinant gibberellin-regulated proteins (GRPs). The patient was shown to be sensitized to Cap a 7, the GRP of Capsicum annuum newly described herein. Cross-reactivities were demonstrated between various GRPs from bell/chili pepper, peach, orange and Japanese cedar pollen either in native form in the different extracts or as recombinant allergens. A similar immunoglobulin E reactivity was found also in Capsicum chinense and against snakin-1, the GRP from potato. The patient showed a positive BAT with recombinant Cry j 7, Pru p 7 and Cap a 7, but not with recombinant snakin-1. Despite the ubiquitous nature of GRPs in plants and the immunochemical cross-reactivity observed between different GRPs, clinically relevant sensitization to this protein family seems restricted to some allergenic sources, often associated with Cupressaceae pollen allergy, and to some patients, therefore reflecting very specific and peculiar mechanisms of conditional sensitization.

Motion-Induced Transition of Positronium through a Static Periodic Magnetic Field in the Sub-THz Region

Atoms moving in a static periodic field experience a time-dependent oscillating field in their own rest frame. By tuning the frequency, an atomic transition can be induced. So far, this type of transition has been demonstrated in the EUV region or at higher frequencies by crystalline fields and in the microwave region by artificial fields. Here, we present the observation of the transition of positronium (Ps) in the sub-THz region by using an energy-tunable Ps beam with a multilayered magnetic grating. This grating produces a microsized periodic field, whose amplitude corresponds to a huge energy flux of ∼100  MW cm^{-2}, resulting in the efficient magnetic dipole transition.

Randomized controlled trial on efficacy of oligomeric formula (HINE E-GEL®) versus polymeric formula (MEIN®) enteral nutrition after esophagectomy for esophageal cancer with gastric tube reconstruction

The efficacy of early enteral nutrition after esophageal cancer surgery has been reported. However, the choice of formula and management of diarrhea are important to achieve the goal of enhanced recovery after surgery. The aim of this study is to assess the frequency of diarrhea/completion rate of enteral nutrition regimen as primary endpoints and the postoperative nutritional status/body composition analysis/operative morbidity as secondary endpoints was compared between the two nutrition groups. Among the 122 patients who underwent esophagectomy for esophageal cancer between December 2015 and September 2017, 67 patients who met the eligibility criteria were randomly assigned to receive enteral nutrition with either HINE E-GEL® (HINE group; n = 33) or MEIN® (MEIN group; n = 34). The incidence of diarrhea was significantly lower in the HINE group (18.2 % vs. 64.7 %, P < 0.001). The score of Bristol scale of POD 6/7 was significantly lower in the HINE group (P = 0.019/P = 0.006, respectively). The completion rate of enteral nutrition regimen was significantly higher in the HINE group (97.4 % vs. 86.6 %, P = 0.002). The Controlling Nutritional Status scores and total protein levels at 6 months after surgery were significantly better in the HINE group (P = 0.030 and P = 0.023, respectively), indicating improved tendency in nutritional status in the HINE group. However, there were no significant differences in Prognostic Nutritional Index values, blood test results, rapid turnover proteins, body mass index, or body composition between the two groups. HINE E-GEL compared with MEIN may reduce the frequency of diarrhea, enabling patients to adhere to the scheduled enteral nutrition plan. Also, maintenance of nutritional status with HINE E-GEL was comparable or potentially better in some nutrition components to that with MEIN, indicating that HINE E-GEL can be an option for enteral nutrition following esophageal surgery to achieve the goal of successful completion of scheduled enteral nutrition and smooth transition to the normal diet.

Effectiveness of modified oral steroid administration for preventing esophageal stricture after entire circumferential endoscopic submucosal dissection

Esophageal stricture occurs at a high rate after endoscopic submucosal dissection, especially after entire circumferential dissection, leading to poor quality of life. This retrospective cohort study evaluated the stricture rate in circumferential mucosal defect cases following modified steroid administration. We enrolled 22 consecutive patients who underwent entire circumferential endoscopic submucosal dissection for superficial esophageal cancer between April 2010 and April 2015 at our hospital. Until January 2013, a systemic steroid-prednisolone-was administered at 30 mg/day and tapered over 8 weeks in the original method group (original group). From February 2013, 30 mg of prednisolone was administered orally for 3 weeks and then the dose was reduced in 5 mg decrements every 3 weeks. This group was classified as the modified method group (modified group). We retrospectively compared the stricture rates between the two groups. The postoperative stricture rate was significantly lower in the modified group (36.4%; 4/11 patients) than in the original group (82%; 9/11 patients; P = 0.04). The mean number of endoscopic balloon dilatation procedures was significantly lower in the modified group (6.2 ± 11.3) than in the original group (19.4 ± 15.3; P = 0.023). Pneumonia and oral herpes infection, which are adverse events potentially associated with steroid administration, were observed in the original group. Candida esophagitis, arthritis, and steroid-related myopathy were observed in the modified group. This modified systemic steroid administration was effective for patients with entire circumferential mucosal defect. The safety of this method was also demonstrated.

Regeneration of the Junctional Epithelium and Connective Tissue after Transplantation of Detergent-Processed Allo-Teeth

The authors have developed a new artificial dental implant and evaluated it in a dog model in terms of its potential to produce: I) regeneration of junctional epithelium; II) regeneration and attachment of connective tissue. The implants were constructed from allo-teeth. We removed the cell components from the periodontal ligaments of these teeth with a detergent (1% TritonX-100); the remaining acellular periodontal ligament acted as an extracellular matrix upon which regeneration and attachment could proceed. We placed 10 of these implants in the just-extracted sites of three beagle dogs. We observed regeneration of both junctional epithelium and connective tissue at all implant sites after 3 months. The connective tissue was attached in all cases. Use of the acellular periodontal ligament as an extracellular matrix may facilitate regeneration of host periodontal ligament tissue, thus contributing to recovery of host immunological defense and long-term oral function.

Development of a System for Measurement and Analysis of Tremor Using a Three-axis Accelerometer

Objectives: The aim of the study was to develop a low-cost and compact system for analysis of tremor using a three-axis accelerometer (the Wii Remote (Nintendo)). To analyze tremor, we hypothesized that the influence of gravitational acceleration should be separated from that of movement. This hypothesis was tested experimentally and we also attempted to record and analyze tremor using our system in a clinical ward.

Methods: A system for tremor measurement and analysis was developed using the three-axis accelerometer built into the Wii Remote. The frequency and amplitude of mechanical oscillation were calculated using methods for frequency analysis of the axis of largest variance and an estimation of tremor amplitude.

Results: The system consists of a program for measurement and analysis of Wii Remote acceleration (Tremor Analyzer), a Wii Remote, a Bluetooth USB adapter and a Web camera. The Tremor Analyzer has a GUI (graphical user interface) that is divided into five segments. The sampling period of the analyzer is 30 msec. To confirm the hypothesis, mechanical oscillations were fed to the Wii Remote. The peak frequency of the power spectrum and the frequency of the oscillation generator were in good agreement, except at 1 Hz (0.01 G) and 2 Hz (0.02 G). With a change in the sum of squares of the three axes from 1.0 to 1.8 (G), the estimated and generated amplitude (0.3 cm) were in close agreement.

Conclusions: This system using a Wii Remote is capable of analyzing frequency and estimated amplitude of tremor between 3 Hz and 15 Hz.

Polyglycolic acid sheet and fibrin glue for preventing esophageal stricture after endoscopic submucosal dissection: a historical control study

There have been several reports that steroid administration is effective at preventing strictures after endoscopic submucosal dissection (ESD). However, adverse events after steroid use are of great concern. We have reported that shielding with a polyglycolic acid (PGA) sheet and fibrin glue can be useful for prevention of stricture after ESD. We conducted a retrospective analysis of efficiency of shielding with a PGA sheet and fibrin glue for prevention of esophageal stricture compared with intralesional steroid injection. ESD was performed on a total of 489 lesions in 400 patients for superficial esophageal cancer from January 2012 to July 2016. Of these, 39 lesions were enrolled in the study group (PGA sheet and fibrin glue) and 31 lesions were enrolled in the control group. The incidence of postoperative stricture at 6 weeks and the number of sessions of endoscopic balloon dilatation (EBD) required to resolve any strictures were evaluated. The post-ESD stricture rate was 9.1% in the study group (3/33 patients), which was not significantly lower than the stricture rate of 10.3% in the historical control group (3/29 patients; p = 1.00). The mean number of EBD was 0.057 ± 0.24 in the study group and 1.9 ± 5.1 in the control group, which was not significant (P = 0.95). PGA sheet and fibrin glue appear to be a promising option for the prevention of esophageal stricture similar to the effect of intralesional steroid injection.

Vascular density of superficial esophageal squamous cell carcinoma determined by direct observation of resected specimen using narrow band imaging with magnifying endoscopy

Observation of the microvasculature using narrow band imaging (NBI) with magnifying endoscopy is useful for diagnosing superficial squamous cell carcinoma. Increased vascular density is indicative of cancer, but not many studies have reported differences between cancerous and noncancerous areas based on an objective comparison. We observed specimens of endoscopic submucosal dissection (ESD) using NBI magnification, and determined the vascular density of cancerous and noncancerous areas. A total of 25 lesions of esophageal squamous cell carcinoma that were dissected en bloc by ESD between July 2013 and December 2013 were subjected to NBI magnification. We constructed a device that holds an endoscope and precisely controls the movement along the vertical axis in order to observe submerged specimens by NBI magnification. NBI image files of both cancerous (pathologically determined invasion depth, m1/2) and surrounding noncancerous areas were created and subjected to vascular density assessment by two endoscopists who were blinded to clinical information. The invasion depth was m1/2 in 20, m3/sm1 in four and sm2 in one esophageal cancer lesion. Mean vascular density was significantly increased in cancerous areas (37.6 ± 16.3 vessels/mm2) compared with noncancerous areas (17.6 ± 10.0 vessels/mm2) (P < 0.05). The correlation coefficients between vascular density determined by two endoscopists were 0.86 and 0.81 in cancerous and noncancerous areas, respectively. Receiver operating curve (ROC) analysis revealed that the area under the curve (AUC) of vascular density was 0.895 (95% CI, 0.804-0.986). For this ROC curve, sensitivity was 78.3% and specificity was 87.0% when the cutoff value of vascular density was 26 vessels/mm2. NBI magnification confirmed significant increases in vascular density in cancerous areas compared with noncancerous areas in esophageal squamous cell carcinoma. The rates of agreement between vascular density values determined by two independent operators were high.

Propofol-fentanyl interaction in Beagles - Apnea, response to mechanical ventilation, endotracheal tube, and tetanic stimulation

The objective of this study was to characterize the propofol-fentanyl interaction in Beagles for four pharmacodynamic endpoints: apnea, response to mechanical ventilation, endotracheal tube, and tetanic stimulation. After anesthesia was induced with varying combinations of propofol and fentanyl, the pharmacodynamic endpoints were assessed in intubated dogs (n=6) using the cross-over design. Effective concentrations of propofol plasma concentration (Cp) and fentanyl Cp were assessed using additive, reduced Greco, Minto, and hierarchical interaction models. The interaction was best described as synergistic by the hierarchical model. A 1ng/mL fentanyl Cp reduced the effective propofol Cp to half or less of that without fentanyl for all endpoints. An additional increment of fentanyl Cp to 5ng/mL or higher hardly reduced effective propofol Cp for all endpoints except response to tetanic stimulation. Additionally, the effective propofol Cp in 50% dogs for response to tetanic stimulation (15% increase of heart rate) was lower than that for the other endpoints at fentanyl Cp >7ng/mL. Peripheral oxygen saturation decreased below 90% after extubation in five treatments in which fentanyl Cps were ≥5ng/mL. Propofol and fentanyl interacted synergistically. To avoid patient-ventilator dyssynchrony and hypoxemia after extubation, fentanyl Cp at 1-5ng/mL may be appropriate in intubated dogs. When a dog responds to mechanical ventilation or endotracheal tube at a high fentanyl Cp >5ng/mL under propofol anesthesia even if the dog tolerate to tetanic stimulation, it may be necessary to increase propofol Cp to eliminate the responses because an additional fentanyl may be little impact.

Polymorphisms in PTCH1 Affect the Risk of Ameloblastoma

Ameloblastoma is the most common odontogenic tumor, but the genetic nature of the changes in the tumor cells has been unclear. Mutations of CTNNB1 or PTCH1 are observed in many human tumors. Both CTNNB1 and PTCH1 are important in tooth development and are expressed in ameloblastoma. The aim of this study was to investigate whether genetic alterations of CTNNB1 and PTCH1 are present in ameloblastoma. We investigated 14 cases of ameloblastoma. The polymorphisms found in the ameloblastoma patients were further examined in a subsequent case-control study. We found a CTNNB1 mutation in one case of plexiform-type ameloblastoma. CGG triplet repeat-number polymorphism (CGG7/CGG8) in the 5′-untranslated region of PTCH1 was observed. The proportion of CGG8 alleles was significantly higher in the ameloblastoma group. The results of this study indicate a possible relationship between the CGG8 allele in PTCH1 and the risk for ameloblastoma.

Electromyogram biofeedback training for daytime clenching and its effect on sleep bruxism

Bruxism contributes to the development of temporomandibular disorders as well as causes dental problems. Although it is an important issue in clinical dentistry, no treatment approaches have been proven effective. This study aimed to use electromyogram (EMG) biofeedback (BF) training to improve awake bruxism (AB) and examine its effect on sleep bruxism (SB). Twelve male participants (mean age, 26·8 ± 2·5 years) with subjective symptoms of AB or a diagnosis of SB were randomly divided into BF (n = 7) and control (CO, n = 5) groups to undergo 5-h daytime and night-time EMG measurements for three consecutive weeks. EMG electrodes were placed over the temporalis muscle on the habitual masticatory side. Those in the BF group underwent BF training to remind them of the occurrence of undesirable clenching activity when excessive EMG activity of certain burst duration was generated in week 2. Then, EMGs were recorded at week 3 as the post-BF test. Those in the CO group underwent EMG measurement without any EMG BF training throughout the study period. Although the number of tonic EMG events did not show statistically significant differences among weeks 1-3 in the CO group, events in weeks 2 and 3 decreased significantly compared with those in week 1, both daytime and night-time, in the BF group (P < 0·05, Scheffé's test). This study results suggest that EMG BF to improve AB tonic EMG events can also provide an effective approach to regulate SB tonic EMG events.

Far-infrared optical conductivity of CeCu2Si2

We investigated the optical reflectivity of the heavy-fermion metal CeCu(2)Si(2) in the energy range 3 meV-30 eV for temperatures between 4 and 300 K. The results for the charge dynamics indicate a behavior that is expected for the formation of a coherent heavy quasiparticle state: upon cooling the spectra of the optical conductivity indicate a narrowing of the coherent response. Below temperatures of 30 K a considerable suppression of conductivity evolves below a peak structure at 13 meV. We assign this gap-like feature to strong electron correlations due to the 4f-conduction electron hybridization.

Optical study of archetypical valence-fluctuating Eu systems

We have investigated the optical conductivity of the prominent valence-fluctuating compounds EuIr(2)Si(2) and EuNi(2)P(2) in the infrared energy range to get new insights into the electronic properties of valence-fluctuating systems. For both compounds, we observe upon cooling the formation of a renormalized Drude response, a partial suppression of the optical conductivity below 100 meV, and the appearance of a midinfrared peak at 0.15 eV for EuIr(2)Si(2) and 0.13 eV for EuNi(2)P(2). Most remarkably, our results show a strong similarity with the optical spectra reported for many Ce- or Yb-based heavy-fermion metals and intermediate valence systems, although the phase diagrams and the temperature dependence of the valence differ strongly between Eu systems and Ce- or Yb-based systems. This suggests that the hybridization between 4f and conduction electrons, which is responsible for the properties of Ce and Yb systems, plays an important role in valence-fluctuating Eu systems.

Clinical advantage of endoscopic submucosal dissection over endoscopic mucosal resection for early mesopharyngeal and hypopharyngeal cancers

BACKGROUND AND STUDY AIMS

In previous series, endoscopic mucosal resection (EMR) has been used for the treatment of early-stage mesopharyngeal and hypopharyngeal cancers to preserve patients' quality of life. Endoscopic submucosal dissection (ESD) offers potential advantages in comparison to EMR. So the aim of this retrospective study was to assess the utility of ESD compared with EMR for early-stage cancers of the meso- and hypopharynx.

PATIENTS AND METHODS

We studied 56 patients with 69 lesions who underwent either EMR or ESD between April 2001 and December 2008. EMR was performed until January 2007, and ESD was performed from February 2007 onward. We evaluated the en bloc resection rate, R0 resection rate, and treatment-related complications as short-term outcomes. Local recurrence, lymph node metastasis, and disease-related deaths were compared to evaluate long-term outcomes.

RESULTS

The en bloc and R0 resection rates were respectively 98 % and 79 % in the ESD group and 37 % and 26 % in the EMR group. There were no cases of treatment-related complications in the EMR group, but postoperative subcutaneous emphysema was observed in two patients in the ESD group. In the EMR group, one patient developed a local recurrence and one developed metastasis to the cervical lymph node and died of primary cancer.

CONCLUSIONS

ESD is a useful method of treatment for early mesopharyngeal and hypopharyngeal cancers and may be superior to EMR.

Low Temperature Fabrication of (Ba, Sr)TiO3 Thin Films by ECR Plasma CVD

Physical and electrical properties are investigated for (Ba, Sr)TiO3 (BST) films prepared by electron cyclotron resonance (ECR) plasma chemical vapor deposition (CVD) at relatively low temperatures, between 450 °C and 500 °C. The crystallinity of BST, estimated by X-ray diffraction and from the grain size, is greatly improved when the temperature is raised from 450 °C to 500 °C. Also better crystallinity is obtained for films grown at a deposition rate of 1.1 nn/min than at 2.7 nm/min. The mass transport rates of metal organic sources under our deposition conditions are estimated. The BST film composition is precisely controlled using the results of the investigation on mass transport. At near stoichiometric composition, i.e., (Ba+Sr)/Ti=0.97, and Ba/(Ba+Sr)=0.4, the films grown at 500 °C are found to have the largest dielectric constant, measured using flat capacitors with Pt bottom electrodes. A dielectric constant of 160 is obtained for 27 nm thick films grown at 500 °C and at 1.1 nm/min, without post-deposition annealing. These films exhibit the smallest SiO2 equivalent thickness of 0.65 nm and a leakage current density of 4.6x10−7 A/cm2 at plus IV.

Therapeutic strategy involving endoscopic resection for cN0 superficial carcinoma of the esophagus

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Background: With the progress in endoscopic submucosal dissection (ESD) which enables en bloc resection irrespective of the size of lesion, a therapeutic strategy has become feasible whereby ESD is undertaken first, followed by considering additional treatment based on the results of histologic exploration. In this study, we attempted to clarify the clinical results in patients who had undergone additional treatment after endoscopic resection (ER) for cN0 superficial carcinoma.

Methods: Of 140 patients diagnosed as having T1a-MM-SM2 lesions of squamous cell carcinoma of the esophagus who had undergone ER between January 1998 and March 2010, 83 patients who received additional treatment after ER (surgery, 27 pts; chemoradiotherapy [CRT], 56 pts.) were the subjects of this study. The mean duration of observation was 45.1 months.

Results: The en bloc resection rate was 86%. There were 5 patients (6%) who had complications associated with ER, including perforation in 2 patients, secondary hemorrhage in a patient and pneumonia in 2 patients. Complications associated with additional treatment were noted in 13 patients (15.6%), including secondary hemorrhage, recurrent laryngeal nerve paralysis and pulmonary infarction in one patient each, pneumonia in 3, grade ≥ 3 myelosuppression in 5, and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and radiation pneumonitis in one patient each. Long-term follow-up revealed no local recurrence and no patients who experienced late toxicity due to CRT. The tumor recurred in 4 patients, the site of recurrent lesion being the mediastinum in 3 patients and the cervical lymph node in one patient, of whom 2 patients died of the primary disease. The 5-year survival rate was 88.4%.

Conclusions: Endoscopic resection plus additional treatment for superficial carcinoma of the esophagus did not entail the development of any serious complications; thus, such combined treatment was safe and feasible. The long-term follow-up results were fairly gratifying, and ER with subsequent additional treatment is considered to be valid for patients with cN0 superficial carcinoma of the esophagus.

No significant financial relationships to disclose.

Involvement of toll-like receptor 4 in alveolar bone loss and glucose homeostasis in experimental periodontitis

BACKGROUND AND OBJECTIVE

There is general agreement that certain fatty acids and lipopolysaccharides (LPS) promote inflammation through toll-like receptor 4 (TLR4), and that inflammation promotes insulin resistance. We therefore hypothesized that mice with periodontitis and a TLR4 loss-of-function (LOF) mutation fed a high-fat (HF) diet would develop improved glucose homeostasis compared with wild-type (WT) animals with periodontitis fed a HF diet.

MATERIAL AND METHODS

Wild-type and TLR4 mutant mice fed a HF diet were divided into four groups (n = 6/group): WT; WT with periodontitis (WT/P); mutant (Mut); and mutant with periodontitis (Mut/P). Periodontitis was induced by placing LPS soaked ligatures around maxillary second molars. Fasting insulin and glucose levels were measured weekly for 10 wk. Glucose tolerance was evaluated at baseline (week 1) and at 9 wk. Insulin signaling (phosphorylation of Akt) and tumor necrosis factor-α (TNF-α) mRNA levels in liver were determined when the mice were killed at week 10.

RESULTS

Mut/P mice developed less alveolar bone loss compared with WT/P mice (p < 0.05). Fasting glucose levels were improved after 8 wk of feeding a HF diet (weeks 9 and 10) in Mut/P mice compared with Mut, WT and WT/P mice (p < 0.05). Glucose tolerance was impaired in all groups compared with baseline (p < 0.05), except for the Mut/P group. Insulin signaling was improved (p < 0.05), and expression of TNF-α was decreased (p < 0.05) in the liver of Mut/P mice compared with the liver of WT/P mice.

CONCLUSION

The TLR4 LOF mutation partially protects against alveolar bone loss and improves glucose homeostasis in mice with periodontitis fed a HF diet.

Salivary microbial levels in relation to periodontal status and caries development

BACKGROUND AND OBJECTIVE

Although an inverse relationship between caries and periodontal disease has been suggested, some studies have reported a positive correlation between periodontal disease and the decayed, missing and filled teeth (DMF) index. The aim of the present study was to examine the relationship between caries and periodontal disease.

MATERIAL AND METHODS

We assessed the clinical parameters and salivary levels of Porphyromonas gingivalis and Streptococcus mutans using real-time polymerase chain reaction in 40 subjects with varying degrees of caries and periodontal disease.

RESULTS

The salivary levels of S. mutans were significantly higher in the periodontally healthy group than in the periodontitis group. The salivary levels of P. gingivalis were significantly higher in the caries-free group than in the periodontally healthy group with caries. The salivary levels of S. mutans were significantly increased after the initial periodontal treatment.

CONCLUSIONS

This study showed that an inverse relationship exists between periodontitis and caries in terms of the clinical and bacteriological findings.

Protease-activated receptor 2 mediates interleukin-8 and intercellular adhesion molecule-1 expression in response to Aggregatibacter actinomycetemcomitans

INTRODUCTION

We investigated the mechanisms by which extracts of Aggregatibacter actinomycetemcomitans affect the inflammatory response in gingival epithelial cells.

METHODS

Human gingival cells (Ca9-22) were cultured in bacterial extracts prepared from A. actinomycetemcomitans ATCC 29522. The cells were pretreated with protease inhibitors or transfected with small interfering RNA (siRNA) specific for protease-activated receptor 2 (PAR-2).

RESULTS

The pretreatment of cells with serine protease inhibitors significantly inhibited A. actinomycetemcomitans extract-induced expression of interleukin-8 (IL-8) and intercellular adhesion molecule-1 (ICAM-1) at both the messenger RNA and protein levels. In addition, A. actinomycetemcomitans extract-induced IL-8 and ICAM-1 expression was significantly decreased in PAR-2/siRNA-transfected cells.

CONCLUSIONS

A. actinomycetemcomitans extract-induced IL-8 and ICAM-1 expression in gingival epithelial cells is mediated by PAR-2.

Vasorelaxant effects of forsythide isolated from the leaves of Forsythia viridissima on NE-induced aortal contraction

Forsythide (F1) isolated from the leaves of Forsythia viridissima (Oleaceae) showed vasorelaxant effects on norepinephrine (NE)-induced contraction of rat aorta with or without endothelium. This compound did not affect contraction induced by high concentration potassium (60 mM K(+)) and phorbol 12,13-diacetate, but inhibited NE-induced contraction in the presence of nicardipine. These results demonstrated the inhibitory effects of F1 on NE-induced vasocontraction presumably due to decrease of calcium influx from extracellular area, which was induced by NE.

Endoscopic submucosal dissection for treatment of mesopharyngeal and hypopharyngeal carcinomas

BACKGROUND AND STUDY AIMS

Application of the endoscopic submucosal dissection (ESD) technique, as well as elevation of the larynx in cooperation with an otolaryngologist, under general anesthesia has enabled en-block resection of early mesopharyngeal and hypopharyngeal carcinomas. The aim of this study was to retrospectively evaluate the safety of ESD and the efficacy of the elevation of the larynx for treatment of early mesopharyngeal and hypopharyngeal carcinomas.

PATIENTS AND METHODS

The study included 16 lesions in 13 patients who underwent ESD. To provide a sufficient working space, the larynx was elevated under direct laryngoscopy, and a tube was inserted and fixed onto the laryngeal side using the slot on the back of the laryngoscope.

RESULTS

The median maximum diameter of the lesions was 12.5 mm (range 2 - 37 mm). The en-block resection rate was 93.8 %. Lateral surgical margins in two patients were difficult to evaluate for technical reasons. The tube could not be removed from four patients on the day of the procedure due to laryngeal edema caused by the local injection. No serious complications were observed. Oral food intake was possible after a mean of 3.3 postoperative days.

CONCLUSIONS

With adequate intraoperative and postoperative management, ESD with elevation of the larynx may be very efficient and safe for endoscopic treatment of pharyngeal lesions.

Postnatal development of the organ of Corti in dominant-negative Gjb2 transgenic mice

Hereditary hearing loss is one of the most prevalent inherited human birth defects, affecting one in 2000. A strikingly high proportion (50%) of congenital bilateral nonsyndromic sensorineural deafness cases have been linked to mutations in the GJB2 coding for the connexin26. It has been hypothesized that gap junctions in the cochlea, especially connexin26, provide an intercellular passage by which K(+) are transported to maintain high levels of the endocochlear potential essential for sensory hair cell excitation. We previously reported the generation of a mouse model carrying human connexin26 with R75W mutation (R75W+ mice). The present study attempted to evaluate postnatal development of the organ of Corti in the R75W+ mice. R75W+ mice have never shown auditory brainstem response waveforms throughout postnatal development, indicating the disturbance of auditory organ development. Histological observations at postnatal days (P) 5-14 were characterized by i) absence of tunnel of Corti, Nuel's space, or spaces surrounding the outer hair cells, ii) significantly small numbers of microtubules in inner pillar cells, iii) shortening of height of the organ of Corti, and iv) increase of the cross-sectional area of the cells of the organ of Corti. Thus, morphological observations confirmed that a dominant-negative Gjb2 mutation showed incomplete development of the cochlear supporting cells. On the other hand, the development of the sensory hair cells, at least from P5 to P12, was not affected. The present study suggests that Gjb2 is indispensable in the postnatal development of the organ of Corti and normal hearing.

Neurological response to early removal of ovarian teratoma in anti-NMDAR encephalitis

We report an 18-year-old woman with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, who developed psychiatric symptoms, progressive unresponsiveness, dyskinesias, hypoventilation, hypersalivation and seizures. Early removal of an ovarian teratoma followed by plasma exchange and corticosteroids resulted in a prompt neurological response and eventual full recovery. Serial analysis of antibodies to NR1/NR2B heteromers of the NMDAR showed an early decrease of serum titres, although the cerebrospinal fluid titres correlated better with clinical outcome. The patients' antibodies reacted with areas of the tumour that contained NMDAR-expressing tissue. Search for and removal of a teratoma should be promptly considered after the diagnosis of anti-NMDAR encephalitis.

Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal

OBJECTIVE

To report the definitive diagnosis of anti-NMDA receptor (NMDAR) encephalitis in four Japanese women previously diagnosed with "juvenile acute nonherpetic encephalitis" of unclear etiology, and to describe their long-term follow-up in the absence of tumor resection.

METHODS

We extensively reviewed the case histories with current clinical and laboratory evaluations that include testing for antibodies to NR1/NR2 heteromers of the NMDAR in serum/CSF available from the time of symptom onset (4 to 7 years ago) and the present.

RESULTS

All patients sequentially developed prodromal symptoms, psychosis, hypoventilation, severe orofacial dyskinesias, and bizarre immunotherapy-resistant involuntary movements that lasted 1 to 12 months. Two patients required mechanical ventilation for 6 and 9 months. Initial tests were normal or unrevealing, including the presence of nonspecific CSF pleocytosis, and normal or mild changes in brain MRI. Eventually, all patients had dramatic recovery of cognitive functions, although one had bilateral leg amputation due to systemic complications. Antibodies to NR1/NR2 heteromers were found in archived serum or CSF but not in long-term follow-up samples. An ovarian teratoma was subsequently demonstrated in three patients (all confirmed pathologically).

CONCLUSION

1) These findings indicate that "juvenile acute nonherpetic encephalitis" or a subset of this disorder is mediated by an antibody-associated immune response against NR1/NR2 heteromers of the NMDA receptor (NMDAR). 2) Our patients' clinical features emphasize that anti-NMDAR encephalitis is severe but potentially reversible and may precede by years the detection of an ovarian teratoma. 3) Although recovery may occur without tumor removal, the severity and extended duration of symptoms support tumor removal.

Alveolar distraction osteogenesis: a systematic review

This literature review was performed to analyse the outcomes of clinical studies of alveolar distraction osteogenesis (DO) listed by PUBMED between January 1996 and December 2006. A PUBMED search identified 128 articles on alveolar DO. Twenty articles covering 209 cases were analysed, considering location, device and procedural parameters, rate of augmentation, aspect of final implant placement and follow up. The mean latency period was 7.26+/-2.31 days, distraction rate 0.71+/-0.27 mm/day, rate of augmentation 6.88+/-2.52 mm and consolidation period 12.22+/-5.58 weeks. A total of 469 implants were placed and followed post loading for an average of 14.19+/-11.03 months, with a survival rate of 97%. Of the different procedural parameters, only the difference between mean consolidation period for failed (8.10+/-2.51 weeks) and successful (12.43+/-5.62 weeks) implants was statistically significant (P=0.01). Use of DO may be advantageous in terms of the success rate of implants placed in augmented sites, but there is still a lack of sufficient data based on long-term follow up. Future experimental studies should evaluate the application of different methods with a view to shortening the overall treatment period and improving the performance of implants placed in distracted alveolar ridges.