IABP is in wide clinical use as an effective adjunctive means for the management of seriously impaired cardiac function. Unfortunately, however, it is an undeniable fact that this specialized circulatory support technic has so far been used in severe heart disease cases in a desultory way, with no established criteria being available for indication of elective IABP for prophylactic purposes. Under such circumstances, it was felt worthwhile to analyze data on preoperative left ventricular function from a series of open heart surgery cases (25 treated with and 94 without IABP) encountered in our hospital since 1983 (when procedure for myocardial protection was virtually standardized) in an effort to formulate acceptable criteria for indication of elective IABP. Hemodynamic parameters studied were LVESVI, LVEF and LVEDP. The results led us to conclude that scheduled IABP can be regarded as indicated for use in each of the following valvular heart diseases if at least one of the respective criteria specified below is fulfilled: MR: LVESVI≥120ml/m², LVEF≤0.4, LVEDP≥21mmHg; AR: LVESVI≥135ml/m², LVEF≤0.4, LVEDP≥18mmHg; MS: LVESVI≥70ml/m², LVEF≤0.35, LVEDP≥23mmHg.

OBJECTIVE: The purpose of this study was to compare the treatment duration and dentoskeletal changes between two different anchorage systems used to treat maxillary dentoalveolar protrusion and to examine the effectiveness of en-masse retraction using two miniscrews placed in the midpalatal suture. METHODS: Fifty-seven patients (9 men, 48 women), who had undergone level anchorage system treatment at Aichi-Gakuin University Dental Hospital (Nagoya, Japan) were divided into two groups according to the method of maxillary posterior anchorage reinforcement: midpalatal miniscrews (25 patients, mean age 22 years) and conventional anchorage (32 patients, mean age 19 years). The en-masse retraction period, overall treatment duration, pre-treatment effective ANB angle, and change in the effective ANB angle were compared with an independent-samples t-test. RESULTS: Compared to the headgear group, the duration of en-masse retraction was longer by approximately 4 months in the miniscrew group (p < 0.001). However, we found no significant difference in the total treatment duration between the groups. Moreover, a greater change in the effective ANB angle was observed in patients treated with miniscrews than in those treated with the conventional method (p < 0.05). CONCLUSIONS: The level anchorage system treatment using miniscrews placed in the midpalatal area will allow orthodontists more time to control the anterior teeth during en-masse retraction, without increasing the total treatment duration. Furthermore, it achieves better dentoskeletal control than does the conventional anchorage method, thereby improving the quality of the treatment results.
Humans ; Male ; Sutures ; Tooth

Objective:Delayed gastric emptying (DGE) after pylorus-preserving pancreatoduodenectomy (PpPD) is a persistent and frustrating complication. To preserve pylorus ring with denervation and devascularization may be a risk factor of DGE after pancreaticoduodenectomy. We conducted this study to confirm the hypothesis that pylorus-resecting pancreatoduodenectomy (PrPD) reduces the incidence of DGE compared to PpPD. Moreover, long-term outcomes of PrPD and the adverse effect of postsurgical DGE on long-term outcomes have not been reported. Therefore, in addition, this study focused on long-term outcomes during 24 months after surgery between PrPD versus PpPD. Methods: Between October 2005 and March 2009, at Wakayama Medical University Hospital (WMUH), 130 patients with pancreatic or periampullary lesions were randomized to preservation of the pylorus ring (PpPD) or to resection of the pylorus ring (PrPD). In PpPD, the proximal duodenum was divided 3-4cm distal to the pylorus ring. In PrPD, the stomach was divided just adjacent the pylorus ring and the nearly total stomach more than 95% was preserved. Shortterm and long-term outcomes were evaluated between PpPD and PrPD. Primary endpoint is the incidence of DGE. DGE was defined according to a consensus definition and clinical grading about postoperative DGE proposed by the international study group of pancreatic surgery (ISGPS). This RCT was registered at Clinical Trials.Gov NCT00639314. Results: Of 130 patients who were enrolled in this study, 64 patients were randomized to PpPD and 66 to PrPD. The overall incidence of DGE in this RCT was 10.8% (14 of 130 patients); the overall incidence of DGE was significantly lower in PrPD (4.5%) than PpPD (17.2%) (P =0 .0244). DGE was classified into three categories proposed by the International Study Group of Pancreatic Surgery. The proposed clinical grading classified 11 cases of DGE in PpPD into grades A (n=6), B (n=5), and C (n=0), and one case in PrPD into each of the three grades. In long-term outcomes, weight loss > grade 2 (Common Terminology Criteria for Adverse Events, Ver. 4.0) at 24 months after surgery improved significantly in PrPD (16.2%) compared with PpPD (42.2%) (P = 0.011). Nutritional status and late postoperative complications were similar between PpPD and PrPD. The incidence of weight loss greater than Grade 2 at 24 months after surgery was 63.6% in patients with DGE group and 25.3% in patients without DGE group (P = 0.010). Tmax (the time to peak 13CO2 content in 13C-acetate breath test) at 24 months after surgery in patients with DGE was significantly delayed compared with those without DGE (27.9 ± 22.7min vs.16.5 ± 10.1min, P=0.023). Serum albumin at 24 months after surgery was higher in patients without DGE than those with DGE (3.7±0.6 g/dl vs. 4.1±0.4 g/dl, P=0.013). Conclusion: This study clarified that PrPD can lead to a significant reduction in the incidence of DGE compared with PpPD. Moreover, PrPD offers similar longterm outcomes with PpPD. DGE may be associated with weight loss and poor nutritional status in long-term outcomes.

Objective:Delayed gastric emptying (DGE) after pylorus-preservingpancreatoduodenectomy (PpPD) is a persistent and frustrating complication. Topreserve pylorus ring with denervation and devascularization may be a risk factorof DGE after pancreaticoduodenectomy. We conducted this study to confirm thehypothesis that pylorus-resecting pancreatoduodenectomy (PrPD) reduces theincidence of DGE compared to PpPD. Moreover, long-term outcomes of PrPDand the adverse effect of postsurgical DGE on long-term outcomes have not beenreported. Therefore, in addition, this study focused on long-term outcomes during24 months after surgery between PrPD versus PpPD.Methods: Between October 2005 and March 2009, at Wakayama MedicalUniversity Hospital (WMUH), 130 patients with pancreatic or periampullarylesions were randomized to preservation of the pylorus ring (PpPD) or to resectionof the pylorus ring (PrPD). In PpPD, the proximal duodenum was divided 3-4cmdistal to the pylorus ring. In PrPD, the stomach was divided just adjacent thepylorus ring and the nearly total stomach more than 95% was preserved. Shorttermand long-term outcomes were evaluated between PpPD and PrPD. Primaryendpoint is the incidence of DGE. DGE was defined according to a consensusdefinition and clinical grading about postoperative DGE proposed by theinternational study group of pancreatic surgery (ISGPS). This RCT was registeredat Clinical Trials.Gov NCT00639314.Results: Of 130 patients who were enrolled in this study, 64 patients wererandomized to PpPD and 66 to PrPD. The overall incidence of DGE in this RCTwas 10.8% (14 of 130 patients); the overall incidence of DGE was significantlylower in PrPD (4.5%) than PpPD (17.2%) (P =0 .0244). DGE was classified intothree categories proposed by the International Study Group of Pancreatic Surgery.The proposed clinical grading classified 11 cases of DGE in PpPD into grades A(n=6), B (n=5), and C (n=0), and one case in PrPD into each of the three grades.In long-term outcomes, weight loss > grade 2 (Common Terminology Criteriafor Adverse Events, Ver. 4.0) at 24 months after surgery improved significantlyin PrPD (16.2%) compared with PpPD (42.2%) (P = 0.011). Nutritional statusand late postoperative complications were similar between PpPD and PrPD. Theincidence of weight loss greater than Grade 2 at 24 months after surgery was63.6% in patients with DGE group and 25.3% in patients without DGE group (P= 0.010). Tmax (the time to peak 13CO2 content in 13C-acetate breath test) at24 months after surgery in patients with DGE was significantly delayed comparedwith those without DGE (27.9 ± 22.7min vs.16.5 ± 10.1min, P=0.023). Serumalbumin at 24 months after surgery was higher in patients without DGE than thosewith DGE (3.7±0.6 g/dl vs. 4.1±0.4 g/dl, P=0.013).Conclusion: This study clarified that PrPD can lead to a significant reduction inthe incidence of DGE compared with PpPD. Moreover, PrPD offers similar longtermoutcomes with PpPD. DGE may be associated with weight loss and poornutritional status in long-term outcomes.

OBJECTIVES: An animal experiment clarified that insertion of an orthodontic apparatus activated the trigeminal neurons of the medulla oblongata. Orthodontic tooth movement is known to be associated with the sympathetic nervous system and controlled by the nucleus of the hypothalamus. However, the transmission of both has not been demonstrated in humans. The purpose of this study were to examine the activated cerebral areas using brain functional magnetic resonance imaging (MRI), when orthodontic tooth separators were inserted, and to confirm the possibility of the transmission route from the medulla oblongata to the hypothalamus. METHODS: Two types of alternative orthodontic tooth separators (brass contact gauge and floss) were inserted into the right upper premolars of 10 healthy volunteers. Brain functional T2*-weighted images and anatomical T1-weighted images were taken. RESULTS: The blood oxygenation level dependent (BOLD) signals following insertion of a brass contact gauge and floss significantly increased in the somatosensory association cortex and hypothalamic area. CONCLUSION Our findings suggest the possibility of a transmission route from the medulla oblongata to the hypothalamus.
Brain Mapping ; methods ; Healthy Volunteers ; Humans ; Hypothalamus ; diagnostic imaging ; Magnetic Resonance Imaging ; methods ; Medulla Oblongata ; diagnostic imaging ; Tooth Movement Techniques ; instrumentation