Over‐the‐scope clip system: A review of 1517 cases over 9 years

Rescue therapy for gastrointestinal (GI) refractory bleeding, perforation, and fistula has traditionally required surgical interventions owing to the limited performance of conventional endoscopic instruments and techniques. An innovative clipping system, the over‐the‐scope clip (OTSC), may play an important role in rescue therapy. This innovative device is proposed as the final option in endoscopic treatment. The device presents several advantages including having a powerful sewing force for closure of GI defects using a simple mechanism and also having an innovative feature, whereby a large defect and fistula can be sealed using accessory forceps. Consequently, it is able to provide outstanding clinical effects for rescue therapy. This review clarifies the current status and limitations of OTSC according to different indications of GI refractory disease, including refractory bleeding, perforation, fistula, and anastomotic dehiscence. An extensive literature search identified studies reported 10 or more cases in which the OTSC system was applied. A total of 1517 cases described in 30 articles between 2010 and 2018 were retrieved. The clinical success rates and complications were calculated overall and for each indication. The average clinical success rate was 78% (n = 1517) overall, 85% for bleeding (n = 559), 85% (n = 351) for perforation, 52% (n = 388) for fistula, 66% (n = 97) for anastomotic dehiscence, and 95% (n = 122) for other conditions, respectively. The overall and severe OTSC‐associated complications were 1.7% (n = 23) and 0.59% (n = 9), respectively. This review concludes that the OTSC system may serve as a safe and productive device for GI refractory diseases, albeit with limited success for fistula.     

Japanese version of The Cancer Genome Atlas,JCGA, established using fresh frozen tumors obtained from 5143 cancer patients

This study aimed to establish the Japanese Cancer Genome Atlas (JCGA) using data from fresh frozen tumor tissues obtained from 5143 Japanese cancer patients, including those with colorectal cancer (31.6%), lung cancer (16.5%), gastric cancer (10.8%) and other cancers (41.1%). The results are part of a single‐center study called “High‐tech Omics‐based Patient Evaluation” or “Project HOPE” conducted at the Shizuoka Cancer Center, Japan. All DNA samples and most RNA samples were analyzed using whole‐exome sequencing, cancer gene panel sequencing, fusion gene panel sequencing and microarray gene expression profiling, and the results were annotated using an analysis pipeline termed “Shizuoka Multi‐omics Analysis Protocol” developed in‐house. Somatic driver alterations were identified in 72.2% of samples in 362 genes (average, 2.3 driver events per sample). Actionable information on drugs that is applicable in the current clinical setting was associated with 11.3% of samples. When including those drugs that are used for investigative purposes, actionable information was assigned to 55.0% of samples. Germline analysis revealed pathogenic mutations in hereditary cancer genes in 9.2% of samples, among which 12.2% were confirmed as pathogenic mutations by confirmatory test. Pathogenic mutations associated with non–cancerous hereditary diseases were detected in 0.4% of samples. Tumor mutation burden (TMB) analysis revealed 5.4% of samples as having the hypermutator phenotype (TMB ≥ 20). Clonal hematopoiesis was observed in 8.4% of samples. Thus, the JCGA dataset and the analytical procedures constitute a fundamental resource for genomic medicine for Japanese cancer patients.     

The effects of epinephrine in local anesthetics on plasma catecholamine and hemodynamic responses

In order to clarify the influence of epinephrine in local anesthetics on endogenous epinephrine, we examined the concentration of plasma catecholamines (epinephrine and norepinephrine) and hemodynamics by administering 4 ml of 2% lidocaine containing different concentrations of epinephrine. Forty-three healthy adult male volunteers were divided into five groups according to epinephrine concentration: 0-µg (group I), 10-µg (group II), 20-µg (group III), 40-µg (group IV), and 50-µg (group V). The parameters were examined immediately, and at 1, 2, 3, 4, 5, 10, 15, and 20 min after the injection. In groups II, III, IV, and V, the plasma epinephrine concentration was elevated to peak at 5 min after the injection, after which it started to decline. The amount of increase in the plasma epinephrine concentration at 5 min showed a highly positive correlation with the amount of epinephrine added to the local anesthetic in groups II, III, and IV. In group V the plasma epinephrine concentration showed a marked increase as compared to the baseline level. Plasma norepinephrine concentrations were found to be significantly elevated at 15 and 20 min in group V. A decrease in systolic blood pressure was observed at 4 and 5 min in group II. A decrease in diastolic blood pressure was observed at 5 min in group II; at 3, 4, and 5 min in group IV; and at 2, 3, 4, and 5 min in group V. Heart rate revealed no significant differences from baseline level in any of the groups and there were no significant differences among the groups. It is suggested that exogenous epinephrine added to a local anesthetic may stimulate the presynaptic β₂ receptors on sympathetic nerve endings and on the adrenomedulla, and accelerate the release of endogenous epinephrine.     

Effect of electrical stimulation of the internal capsule on nociceptive neurons responding to orofacial stimuli in the medullary dorsal horn of the rat

Internal capsule (IC) stimulation has been used clinically to alleviate central pain. However, the neuronal mechanisms underlying pain relief by IC stimulation are poorly understood. In order to elucidate the analgesic mechanism, the effect of IC conditioning stimulation on nociceptive neurons in the rat medullary dorsal horn was investigated in the present study. Rats were anaesthetized with N(2)O-O(2) (2:1) and 0.5% halothane and were immobilized with pancuronium bromide. Two kinds of nociceptive neurons, wide dynamic range (WDR) and nociceptive specific (NS) neurons, responding to noxious stimulations of the face and oral structures were recorded in the trigeminal caudal nucleus and the medial reticular subnuclei. A test stimulus with a single rectangular pulse (2ms in duration, 5-70V) was applied to the centre of the receptive field. Responses in 55.9% of the WDR neurons and in 60% of the NS neurons were inhibited by conditioning stimuli to the ipsilateral IC with trains of 33 pulses (100-300microA) at 330Hz. The percents of peak inhibitory effects on WDR neurons and NS neurons were 78.1+/-25.0% (n=19) and 89.0+/-13.6% (n=3), respectively. The inhibitory effect continued for conditioning-test intervals of up to 500ms. Effective sites for conditioning stimulation were concentrated in the lateral side of the IC. These findings suggest that modulation of nociceptive transmission by IC stimulation occurs at second-order neurons via a presynaptic phenomenon by corticofugal fibers in the IC.     

In vitro study of a mandibular implant overdenture retained with ball,magnet, or bar attachments: comparison of load transfer and denture stability

PURPOSE: When implants are used to support a removable overdenture, the optimal stress distribution to minimize both forces on the implants and denture movement is desirable. This study compared the stress patterns generated around implants and denture movement among three retention systems. MATERIALS AND METHODS: Two root-form implants were anchored in a mandibular model made of resin, and a removable overdenture on which all experiments were performed was fabricated. The surface of the model was covered with a layer of impression material to simulate oral mucosa. Ball/ O-ring, bar/clip, and magnetic attachments were used. A vertical force was applied to the left first molar and gradually increased from 0 to 50 N in 5-N steps. The resultant stress distribution and denture movement were evaluated. RESULTS: The ball/O-ring attachment transferred the least stress to both implants and produced less bending moment than the bar/clip attachment. Vertical force applied to the bar/clip attachment created immediate stress patterns of greater magnitude and concentration on both implants. CONCLUSION: This in vitro study suggested that the use of the ball/O-ring attachment could be advantageous for implant-supported overdentures with regard to optimizing stress and minimizing denture movement.     

Plaque accumulation on Teflon-coated metal

This study demonstrated that plaque accumulation was reduced and plaque removal facilitated by the TFE coating. These findings suggest that the TFE coating has a practical application for pontics and the proximal and cervical surfaces of crowns. These inaccessible surfaces are not easily cleaned by brushing.     

En bloc resection of the primary tumour and cervical lymph nodes through the parapharyngeal space in patients with squamous cell carcinoma of the maxilla: a preliminary study

We retrospectively studied 72 patients with maxillary carcinoma (48 of the gingiva, 22 of the antrum, and one each of the hard palate and maxillary bone). The 5-year survival was 73% for those with gingival carcinoma, and 45% for those with antral carcinoma. Nine patients died of local recurrence, three of cervical metastases, six of distant metastases, and five died of metastases in lateral retropharyngeal nodes despite successful control of local and regional disease. We have recently done en bloc resections of the maxilla and cervical lymph nodes through the parapharyngeal space for patients with posteriorly invasive maxillary cancer accompanied by lymph node metastases in the upper jugular region.