Analysis of mandibular condylar and glenoid fossa fractures with computed tomography

Objectives

The purpose of this study was to investigate the prevalence of glenoid fossa and condylar fractures in patients with mandibular fractures using multidetector computed tomography (MDCT).

Methods

A prospective study was performed in 227 patients with mandibular fractures who underwent 64-MDCT. Mandibular fractures were classified into four types: median, paramedian, angle and condylar. Statistical analysis of the relationship between prevalence of condylar fractures and mandibular fracture locations was performed using χ² test with Fisher’s exact test. A P value less than 0.05 was considered statistically significant.

Results

The prevalence of condylar fracture was 64.8 % of all patients with mandibular fractures, 66.7 % of median type (P?=?0.667), 45.5 % of paramedian type (P?=?0.001) and 12.3 % of angle type (P?=?0.000), respectively. Furthermore, glenoid fossa fracture was seen in 1.4 % of patients with condylar fractures.

Conclusions

The results of the presented study suggest focusing also on incidental findings such as glenoid fossa fractures.

Key Points

? The prevalence of condylar fracture was 64.8 % in patients with mandibular fractures. ? Glenoid fossa fracture was seen in 1.4 % of patients with condylar fractures. ? The study suggests a focus on incidental findings such as glenoid fossa fractures.     

Subject independent facial expression recognition with robust face detection using a convolutional neural network.

Reliable detection of ordinary facial expressions (e.g. smile) despite the variability among individuals as well as face appearance is an important step toward the realization of perceptual user interface with autonomous perception of persons. We describe a rule-based algorithm for robust facial expression recognition combined with robust face detection using a convolutional neural network. In this study, we address the problem of subject independence as well as translation, rotation, and scale invariance in the recognition of facial expression. The result shows reliable detection of smiles with recognition rate of 97.6% for 5600 still images of more than 10 subjects. The proposed algorithm demonstrated the ability to discriminate smiling from talking based on the saliency score obtained from voting visual cues. To the best of our knowledge, it is the first facial expression recognition model with the property of subject independence combined with robustness to variability in facial appearance.     

Systemic Administration of Platelets Incorporating Inactivated Sendai Virus Eradicates Melanoma in Mice

Tumor microenvironments include a number of fibrin clots due to the microbleeding caused by cancer cell invasion into blood vessels, which suggests the potential utility of a platelet vector for systemic cancer treatment. We previously reported that inactivated Sendai virus (hemagglutinating virus of Japan; HVJ) envelope (HVJ-E) activates anti-tumor immunity and induces cancer cell-selective apoptosis. The hemagglutination activity that blocks the systemic administration of HVJ-E was dramatically attenuated by incorporation into platelets. Platelets incorporating HVJ-E (PH complex) were then injected into the tail veins of B16F10 melanoma-bearing mice. The PH complex primarily accumulated in tumor tissues and caused the significant accumulation of various immune cells in the tumor bed. Injections of the PH complex to the melanoma-bearing mouse significantly reduced the tumor size, and the tumor growth was ultimately arrested. Secretion of the chemokine regulated upon activation normal T-expressed and presumably secreted (RANTES) was upregulated following PH stimulation. The RANTES-depletion in melanoma-bearing mice significantly attenuated the cytotoxic T lymphocyte activity and led to a dramatic abrogation of the mouse melanoma suppression induced by the PH complex. Thus, a platelet vector incorporating viral particles, a Trojan horse for cancer treatment, will provide a new approach for cancer therapy using oncolytic viruses.     

Stenosis after use of the double-stapling technique for reconstruction after laparoscopy-assisted total gastrectomy

Background

The double-stapling technique (DST) for esophagojejunostomy using the transorally inserted anvil (OrVil; Covidien Japan, Tokyo, Japan) is one of the reconstruction methods used after laparoscopy-assisted total gastrectomy (LATG). This technique has potential advantages in terms of less invasive surgery without the need to create a complicated intraabdominal anastomosis.

Methods

From 2008 to 2011, 262 patients with gastric cancer underwent total gastrectomy and reconstruction with a Roux-en-Y anastomosis, and 52 patients underwent LATG with DST. A retrospective analysis then was performed comparing the patients who experienced postoperative stenosis after LATG-DST (positive group) and the patients who did not (negative group). A comparative analysis was performed among patients comparing conventional open total gastrectomy and LATG, and multivariate analysis was performed to evaluate risk factors for the development of anastomotic stenosis.

Results

A minor leak was found in 1 patient (1.9 %), and 11 patients experienced anastomotic stenosis (21 %) after LATG with DST. Among the patients with anastomotic stenosis, three (3/4, 75 %) anastomoses were performed with the 21-mm end-to-end anastomosis (EEA) stapler, and eight anastomoses were performed (8/47, 17 %) with the 25-mm EEA stapler. The median interval to the diagnosis of anastomotic stenosis was 43 days after surgery. The patients with stenosis needed endoscopic balloon dilation an average of four times, and the rate of perforation after dilation was 13 %. The clinical and operative characteristics did not differ between the two groups. Anastomotic stenosis after open total gastrectomy occurred in two cases (0.98 %). Multivariate analysis showed that the size of the EEA stapler and the use of DST were risk factors for anastomotic stenosis.

Conclusion

Esophagojejunostomy using DST with OrVil is useful in performing a minimally invasive procedure but carries a high risk of anastomotic stenosis.     

Clinical outcomes after tracheoplasty in patients with congenital tracheal stenosis in 1997–2014

Background

Mortality and morbidity of congenital tracheal stenosis (CTS) remain high. The aim of this study was to determine the factors predicting 12-month survival and 2-month successful extubation after tracheoplasty in patients with CTS.

Early postoperative mobilization with walking at 4 hours after lobectomy in lung cancer patients

Objectives The aim of this study was to determine whether walking at 4 h after surgery as a more aggressive way to proceed with early mobilization could be a safe approach compared with the patients who walked the day after surgery. Methods We encouraged patients who had lobectomy for non-small-cell lung cancer at Kansai Medical University Hospital to walk at 4 h after surgery and start pulmonary rehabilitation between January 2003 and June 2005. A group of 36 patients walked at 4 h after surgery. We retrospectively reviewed the postoperative courses of the patients and compared them with 50 patients who walked the next day during the same period. Results No patient had major trouble with chest drainage tube, and no patients fell when walking at 4 h. Amount of drainage, changing rates of the heart load during the walking, and pain scores after walking did not show significant differences in patients walking at 4 h and those walking the next day. Although four patients who walked the next day had an arterial oxygen partial pressure/inspired oxygen concentration ratio of <300 on day 3, none in the patients walking at 4 h had a ratio below this level. Among the patients walking at 4 h, 24 (67%) needed oxygenation for less than 2 days compared with 17 (34%) of the patients walking the next day. Conclusion Walking at 4 h after lobectomy in patients with non-small-cell lung cancers is a safe approach to starting pulmonary rehabilitation after surgery.     

Comparative population pharmacokinetics of fentanyl using non-linear mixed effect modeling: Burns vs. non-burns

Objective

Fentanyl is a commonly used analgesic and sedative for the burned in the operating theater as well as the burn care units. The aim of this study was to characterize fentanyl population pharmacokinetics in burns and to identify clinically significant covariates.

Method

Twenty adults, aged 37 ± 3 years, with 49 ± 4% (mean ± S.E.) total body surface area burn, were enrolled at 17 ± 3 days after the injury. Twenty non-burn adults served as controls. After an intravenous bolus of 200 mcg fentanyl, the plasma concentrations were sequentially determined up to 4.5 h. Concentration–time profiles were subjected to non-linear mixed effect modeling. Cardiac indices were estimated with esophageal Doppler monitor.

Results

Burned patients have higher cardiac index than the non-burned. Three-compartment model was the best fit. The volumes of distribution were considerably expanded in all three compartments (27.9 L vs. 63.4 L, 64.7 L vs. 92.9 L, 153 L vs. 301 L, respectively) compared to the non-burned. BURN was the single most important covariate significantly improving the model.

Conclusion

The primary effect of burn trauma on fentanyl pharmacokinetics is substantially expanded volumes of distribution, i.e., dilutional. Difference in simulation, however, was insufficient to explain the augmented resistance to fentanyl, implying the importance of titrating analgesics to the clinical effect.     

Neuronal differentiation elicited by glial cell line-derived neurotrophic factor and ciliary neurotrophic factor in adrenal chromaffin cell line tsAM5D immortalized with temperature-sensitive SV40 T-antigen

To understand the characteristics of tsAM5D cells immortalized with the temperature-sensitive simian virus 40 large T-antigen, we first examined the responsiveness of the cells to ligands of the glial cell line-derived neurotrophic factor (GDNF) family. tsAM5D cells proliferated at the permissive temperature of 33 degrees C in response to either GDNF or neurturin, but not persephin or artemin. At the nonpermissive temperature of 39 degrees C, GDNF or neurturin caused tsAM5D cells to differentiate into neuron-like cells; however, the differentiated cells died in a time-dependent manner. Interestingly, ciliary neurotrophic factor (CNTF) did not affect the GDNF-mediated cell proliferation at 33 degrees C but promoted the survival and differentiation of GDNF-treated cells at 39 degrees C. In the presence of GDNF plus CNTF, the morphological change induced by the temperature shift was associated with up-regulated expression of various neuronal marker genes, indicating that the cells had undergone neuronal differentiation. In addition, tsAM5D cells caused to differentiate by GDNF plus CNTF at 39 degrees C became dependent solely on nerve growth factor (NGF) for their survival and neurite outgrowth. Moreover, upon treatment with GDNF plus CNTF, the dopaminergic phenotype was suppressed by the temperature shift. Thus, we demonstrated that tsAM5D cells had the capacity to differentiate terminally into neuron-like cells in response to GDNF plus CNTF when the oncogene was inactivated by the temperature shift. This cell line provides a useful model system for studying the role of a variety of signaling molecules for GDNF/CNTF-induced neuronal differentiation.     

Association between monoamine oxidase A (MAOA) and personality traits in Japanese individuals

It has been reported that personality traits are related to several neurotransmitters. However, the association between personality traits and the central nervous system remains unclear. In the present study, we investigated the relationships between a polymorphism involving a variable number of tandem repeats in the promoter of the monoamine oxidase A (MAOA-VNTR) gene and personality traits, as assessed by the Temperament and Character Inventory (TCI). Promoter VNTRs in the MAOA were genotyped in 558 healthy Japanese individuals. Females homozygous for high-activity allele (4/4) had significantly higher persistence scores than those homozygous for the low-activity allele (3/3) (p=0.012, ANOVA). Meanwhile no difference in persistence was found between 3 and 4 allele in males. There were no differences between other scores of TCI subscales and MAOA-VNTR polymorphism. Our results suggest a gender-specific contribution of MAOA-VNTR polymorphism to persistence scores.