The objective of this study was to assess the possibility of developing a clinical minimally invasive and standardized method to evaluate the relationship between the microstructure of the jaw bone and systemic bone turnover. For this purpose, we performed standardized bone biopsy of the alveolar bone, and compared the 3D bone microstructure using micro-computed tomography (micro-CT) with bone mineral density (BMD) of the lumbar spine and biochemical markers of bone turnover. We evaluated a total of 9 samples taken from 6 patients by standardized biopsy using a trephine bur. BMD was evaluated using dual energy X-ray absorptiometry (DXA). Regarding the biochemical markers of bone turnover, serum bone-specific alkaline phosphatase (BAP) and serum osteocalcin (OC) were used as bone formation markers, and urinary cross-linked N-telopeptides of type I collagen (NTx) and urinary deoxypyridinoline (DPD) were selected as bone resorption markers. We scanned micro-CT images of these samples. Bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular spacing (Tb.Spac), fractal dimension, trabecular bone pattern factor (TBPf) and node-strut (Nd.Nd/TV, TSL/TV) were measured. Regarding the correlations between the parameters of bone microstructures, TB/TV, Tb.N, fractal dimension, and node-strut seemed to be positively correlated and Tb.Spac and TBPf seemed to be negatively correlated with each other, but Tb.Th seemed to have a low correlation with other parameters. OC and/or BAP showed a significantly high correlation with many structural parameters (p<0.05%). In conclusion, some microstructural parameters may change according to the systemic bone turnover.

Concerning the bone structures of the mandible reconstructed by particular cellular bone and marrow (PCBM), platelet rich plasma (PRP) and tray, we have examined the possibility of implant insertion by clarifying the morphological conditions in each compact and cancellous bone on computed tomography (CT), and by observing the differences in their CT values.Using the computer software program Sim Plant (Materialize Dental, Leuven, Belgium), we morphologically observed 6 cases of implant inserted area after mandibular reconstruction and 11 cases of native bone, and examined the differences in their CT values. The osseointegration rate of each inserted implant was also evaluated.Compared with the native bone group, the PCBM reconstruction group had generally thin compact bone. In the over-3cm-length PCBM reconstruction group, the average CT value was 259.7 ± 94.4 HU (n = 3) in the cancellous bone, whereas in the native bone group, the average CT value was 528.9 ± 140.1 HU (n = 10). Therefore, the PCBM reconstruction group showed significantly lower CT value than the native bone group. However, in the under-3cm-length group, the PCBM reconstruction group showed no significant difference compared with the native bone group. The osseointegration rate of the inserted implants almost 6 months after insertion was 100% in the PCBM reconstruction group and 94.1% in the native bone group.Although the PCBM reconstructed bone had thinner cortical bone and showed lower CT value compared with the native bone, implant insertion was possible.

Two cases who underwent emergency operation for papillary muscle rupture complicating acute myocardial infarction were presented. The first case was a 75-year-old female who had suffered myocardial infarction 26 days previously. Operation was performed on the 2nd day after onset of mitral insufficiency. The posterior papillary muscle was partially ruptured and the mitral valve was replaced with a mechanical prosthesis (SJM 25mm). The second case was a 76-year-old female who had suffered myocardial infarction 10 days previously. Emergency operation was performed on the 4th day after onset of mitral insufficiency. The posterior papillary muscle was completely ruptured. Mitral valve replacement with a mechanical prosthesis (Omnicarbon 25mm) was performed. In both cases, recovery from cardiogenic shock was not possible preoperatively even with pharmacologic and circulatory support, but the postoperative courses were uneventful in both cases. We recommend immediate surgical intervention for mitral insufficiency in patients with severe grade regurgitation and cardiogenic shock following acute myocardial infarction.

Background: Ameloblastic carcinoma is a malignant form of ameloblastoma and a very rare odontogenic tumor. We report a case of ameloblastic carcinoma that occurred after removal of a right-sided mandibular dental implant.Case presentation A 72-year-old female patient visited her family dentist with a complaint of pain around a lower right implant placed 37 years previously. Although the dental implant was removed with the diagnosis of periimplantitis, the patient experienced dullness of sensation in the lower lip and was followed up by her dentist, but after no improvement. She was referred to a highly specialized institution where she was diagnosed with osteomyelitis and treated the patient with medication; however, there was no improvement. In addition, granulation was observed in the same area leading to a suspicion of malignancy, and the patient was referred to our oral cancer center. The diagnosis of squamous cell carcinoma was made after a biopsy at our hospital. Under general anesthesia, the patient underwent mandibulectomy, right-sided neck dissection, free flap reconstruction with an anterolateral thigh flap, immediate reconstruction with a metal plate, and tracheostomy. Histological analysis of the resected specimen on hematoxylin and eosin staining showed structures reminiscent of enamel pulp and squamous epithelium in the center of the tumor. The tumor cells were highly atypical, with nuclear staining, hypertrophy, irregular nuclear size, and irregular nuclear shape, all of which were suggestive of cancer. Immunohistochemical analysis showed that Ki-67 was expressed in more than 80% of the targeted area, and the final diagnosis was primary ameloblastic carcinoma. Conclusion After reconstructive flap transplantation, occlusion was re-established using a maxillofacial prosthesis.The patient remained disease-free at the 1-year 3-month follow-up.

We have previously reported on a predictive model for deficiency-excess pattern diagnosis that was unable to predict the medium pattern. In this study, we aimed to develop predictive models for deficiency, medium,and excess pattern diagnosis, and to confirm whether cutoff values for diagnosis differed between the clinics. We collected data from patients' first visit to one of six Kampo clinics in Japan from January 2012 to February 2015. Exclusion criteria included unwillingness to participate in the study, missing data, duplicate data, under 20 years old, 20 or less subjective symptoms, and irrelevant patterns. In total, 1,068 participants were included. Participants were surveyed using a 153-item questionnaire. We constructed a predictive model for deficiency, medium, and excess pattern diagnosis using a random forest algorithm from training data, and extracted the most important items. We calculated predictive values for each participant by applying their data to the predictive model, and created receiver operating characteristic (ROC) curves with excess-medium and medium-deficiency patterns. Furthermore, we calculated the cutoff value for these patterns in each clinic using ROC curves, and compared them. Body mass index and blood pressure were the most important items. In all clinics, the cutoff values for diagnosis of excess-medium and medium-deficiency patterns was > 0.5 and < 0.5, respectively. We created a predictive model for deficiency, medium, and excess pattern diagnosis from the data of six Kampo clinics in Japan. The cutoff values for these patterns fell within a narrow range in the six clinics.