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Introduction: This study aimed to evaluate and validate the educational effectiveness of a job shadowing class as a dental teaching programme for preclinical dental students through a questionnaire that assessed related student perceptions. Materials and Methods: A total of 124 preclinical (second year) dental students at Tokushima University participated in job shadowing placements from 2017 to 2019. Each student observed dental practice or surgery for 1 day in the university hospital. After shadowing, the students were requested to fill out a nine‐item questionnaire based on a five‐point scale. The first analysis was performed to calculate the correlation for each item. Furthermore, regression analysis for the categorical data was performed to show the relationship between eight questions (Items 1–8) and one question (Item 9: comprehensive evaluation). Next, factor analysis was performed to determine students' perceptions regarding the shadowing class. Results: Ninety‐eight students (response rate: 79%) completed the questionnaire. There was a strong relationship amongst Items 1, 8 and 9 ("interested in dentistry as a job," "learning motivation" and "comprehensive evaluation" respectively) based on the results of the correlation and regression analysis. The factor analysis led to three student perceptions as latent factors, namely, "Interesting," "Self‐awareness" and "Future Goal," which had a relatively close inter‐factor correlation (0.465–0.772). Conclusion: The finding suggests that job shadowing may increase a students' interest in a dentistry career at an early stage of their education and learning motivation, along with generating self‐awareness. This programme may present possible educational effectiveness in dental education. [ABSTRACT FROM AUTHOR]

Temporomandibular disorders (TMDs) are a multifactorial joint disease of the masticatory system. The possible etiological factors involved in the onset and progression of TMDs include oral parafunctional habits (OPFHs) and postural habits (PHs). However, little information is available on the association between OPFHs and PHs and a predisposition to TMDs. Thus, to investigate whether the presence of OPFH and PH predisposes individuals to TMDs, a survey-based cross-sectional cohort study of self-reported TMD was performed. A total of 2292 patients with TMD were recruited for the survey. Through one-to-one propensity score matching, 166 patients with and without sleep bruxism (SB) were selected. The SB group had a significantly higher risk of masticatory muscular pain or fatigue than the non-SB group (p = 0.018). Furthermore, the SB group without other OFPHs and PHs did not show a significantly higher risk of TMD symptoms than the non-SB group. Diurnal clenching and bad posture also affect the stomatognathic system, causing pain or fatigue; however, it did not result in TMDs in patients without any OPFHs and PHs. This implies that OPFHs and PHs may increase the risk of TMD symptoms in coexistence with other habits. [ABSTRACT FROM AUTHOR]

Background: Treatment of anastomotic leakage in reconstruction after esophagectomy remains challenging. This report presents a new endoscopic filling method for persistent fistula after failure of conservative treatment of leakage caused by anastomotic insufficiency.Methods: 10 of 14 patients, in whom post-esophagectomy leakage had failed to resolve after 2 weeks of conservative treatment, underwent endoscopic filling with polyglycolic acid (PGA) sheet and fibrin glue into the anastomotic leakage site, using a delivery tube and endoscopic catheter, respectively.Results: Each patient underwent jejunostomy, to secure nutrition. The leakage was resolved in all 10 patients. The mean number of PGA - fibrin glue procedures was 1.7. The mean period from the first application to the resumption of oral intake was 31.6 days, from the final application it was 14.7 days.Conclusions: The reported filling method offers a new endoscopic approach for persistent fistula after esophagectomy when conservative treatment of leakage has failed. [ABSTRACT FROM AUTHOR]

The palatal lift prosthesis is used to alleviate rhinopharyngeal closure dysfunction. It is generally problematical to use in edentulous patients, because the palatal lift prosthesis requires secure retention of the denture base and is difficult for the patient to retain while eating. This article describes the fabrication of a complete denture with a removable palatal lift prosthesis and a clinical evaluation of the denture's stability. A sprue pin and lube were uses as a connecting attachment between the removable palatal lift prosthesis and the denture base. The force required tor lifting the soft palate and the denture's stability were measured in the clinical evaluation. The prosthesis required an average retentive force of 0.26 N tor each 1 mm of soft palate lift. The force required to dislodge the denture was measured with and without the palatal lift prosthesis in place. The force required to dislodge the conventional complete dentures of five healthy individuals was also measured as a reference. The denture was 24.4% less stable when the palatal lift prosthesis was in place and was generally easier to dislodge than were conventional dentures. This denture with a removable palatal lift prosthesis is useful for patients with dysfunction of the soft palate involving hypernasal speech who have difficulty in retaining the prosthesis while eating. (Quintessence Int 2002;33: 675-678) [ABSTRACT FROM AUTHOR]

Purpose: Composite resin teeth are more widely used than porcelain or acrylic resin teeth in the fabrication of removable dentures because of their high fracture toughness and high abrasion resistance. The purpose of this study was to evaluate the shock absorbability of commercially available artificial posterior teeth by the free drop--ball test with an accelerometer and to evaluate the Vickers hardness at the surface. Materials and Methods: The tested artificial teeth included seven composite resin teeth, one acrylic resin tooth, and one porcelain tooth. Specimens were tested 50 hours after immersion in distilled water at 37°C. The impact value and Vickers hardness were measured. A one-way analysis of variance was used to analyzed the data (P = .05). Results: The composite resin teeth showed an intermediate impact value between that of the acrylic resin tooth and the porcelain tooth. Among the artificial teeth investigated, the porcelain tooth showed the highest impact value. A significant difference in the impact value was observed between the porcelain tooth and the composite resin and acrylic resin teeth. However, no significant difference was observed among the composite resin teeth tested. A significant correlation was found between the impact values and the Vickers hardness of the artificial teeth. Conclusion: The present findings suggest that composite resin teeth and acrylic resin teeth have a higher shock absorbability than porcelain teeth. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to estimate which occlusion offers the best conditions of pressure distribution on the supporting structure under a complete denture when crushing food. Materials and Methods: Simulated maxillary and mandibular complete dentures with three different posterior occlusal schemes—fully balanced occlusion, lingualized occlusion, and monoplane occlusion—were fabricated. Eight pressure transducers were placed in the basal surface of a mandibular denture. The pressure distribution on the mandibular edentucous mouth model with 1.5-mm-thick artificial tissue under a complete denture was recorded when crushing three different foods: soft food (kamaboko), peanuts, and carrot. The mean pressure values at each measurement point and the force required for each test were compared using one-way analysis of variance with P≤0.05 representing statistical significance. Results: The required force for crushing a soft food or carrot in the left molar region in monoplane occlusion was significantly larger than that required in fully balanced occlusion or lingualized occlusion. In crushing soft food, fully balanced occlusion showed significantly higher pressure values on the working side than in monoplane occlusion or lingualized occlusion. In crushing the carrot, the pressure values in fully balanced occlusion and in lingualized occlusion were significantly lower than those in monoplane occlusion. Conclusion: These results demonstrate that with fully balanced occlusion and lingualized occlusion a large occlusal force is not needed for crushing hard food, and the stress to the supporting tissues is smaller than with monoplane occlusion. [ABSTRACT FROM AUTHOR]

The indocyanine green test is a reliable liver function examination before major hepatectomy, and anaphylaxis is rarely a concern. A 65-year-old male patient without epigastralgia was diagnosed with a 2.2-cm intrahepatic cholangiocarcinoma. He had no history of allergic reactions. Some liver dysfunction was indicated by the laboratory data; however, there was no marked obstructive jaundice and the liver functional reserve was maintained by technetium-99m galactosyl serum albumin. The indocyanine green test was routinely performed, but the patient immediately demonstrated severe anaphylaxis due to indocyanine green administration. He had cardiorespiratory arrest, but recovered after immediate resuscitation. Although acute renal and respiratory failure was significant, the patient recovered at day 10 after the event, and his liver function and other organ functions were improved. Then, the scheduled left hepatectomy with caudate and extrahepatic duct resection was successfully performed without issues. The patient exhibited no allergic response against the administration of antibiotics or other drugs and the postoperative course was uneventful. The patient was discharged on day 17. The tumor was diagnosed as stage III intrahepatic cholangiocarcinoma and R0 resection was accomplished. Preoperative management, including the liver functional loading test, should be carefully carried out before major hepatectomy. [ABSTRACT FROM AUTHOR]

The bond strength of six commercial soft denture liners was evaluated by a two-phase tensile test. The soft denture liners investigated were VinaSoft, Prolastic, Flexor Molloplast-B Novus, and SuperSoft. The samples were fabricated by processing them (1) against polymerized poly(methyl methacrylate), and (2) against unpolymerized poly(methyl methacrylate). The soft denture liners were processed according to the manufacturers' recommendations. The samples were tested using an Instron Universal Testing Machine. The mode of failure, adhesive or cohesive, was also recorded. The bond strength when processed against unpolymerized poly(methyl methacrylate) ranged from 0.48 to 2.60 MPa, and when processed against polymerized poly(methyl methacrylate) the bond strength ranged from 0.94 to 2.56 MPa. A two-way analysis of variance (P = .05) revealed a significant increase in bond strength when the liners were processed against polymerized poly(methyl methacrylate), except for Novus, which had no change, and VinaSoft, which decreased. The Tukey interval between materials was .22 and between methods of polymerization was .08. Four of the six liners investigated demonstrated increased bond strength when processed against polymerized poly(methyl methacrylate). It was concluded that bonding can be influenced by the processing method. [ABSTRACT FROM AUTHOR]

The cushioning effect of soft denture liners was evaluated by using a free drop test with an accelerometer. Materials tested included SuperSoft (Coe Laboratories, Chicago, IL), Kurepeet-Dough (Kreha Chemical, Tokyo), Molteno Soft (Molten, Hiroshima, Japan) and Molloplast-B (Molloplast Regneri, Karlsruhe, Germany). All materials were found to reduce the impact force when compared to acrylic denture base resin. A 2.4-mm layer of soft denture material demonstrated good impact absorption, and Molloplast-B and Molteno had excellent impact absorption. When the soft denture liner was kept in an accelerated aging chamber for 900 hours, the damping effect recorded increased for all materials tested. Aging of all materials also affected the cushioning effect. [ABSTRACT FROM AUTHOR]

This study compared lingualized occlusion and completely balanced occlusion using a simulation device. Sixteen pressure transducers were placed in the simulated residual ridge area supporting the test dentures. Lingualized occlusion was found to transfer stresses from the occluding side to the opposite, nonworking side to stabilize the mandibular denture. [ABSTRACT FROM AUTHOR]

This study examined the effect of a soft denture liner on the distribution of stresses in the denture-supporting structures, Dentures without a liner and with three configurations of a soft liner were simulated by using a two-dimensional viscoelastic finite-element stress analysis. The stress intensity at functional force-bearing stress decreased when a soft denture liner was used. However, the stresses in the bone increased remarkably up to 3.0 seconds after leading Because of the time-dependent effect of stresses applied to soft denture liners, denture patients who clench or brux may not benefit as greatly from soft denture liners. The study indicates that viscoelastic finite-element analysis is helpful for evaluating soft denture liners. Soft denture liners appear to be useful for improving the stress distribution in the supporting structures under dentures. [ABSTRACT FROM AUTHOR]

The authors previously reported on the strengthening effect of a thin Ni-Cr plate on an acrylic resin test specimen in the three-point bending test. This study evaluated the reinforcement of acrylic resin denture bases by measuring the strain distribution in the palate of a maxillary complete denture. It was found that this reinforcing technique led to a uniform distribution of strain in the palatal area of the maxillary denture and a reduction of strain in the midpalatal area. [ABSTRACT FROM AUTHOR]

A pilot study was conducted to evaluate the strengthening effect of a Ni-Cr metal plate on an acrylic resin test specimen. Test specimens were retained using a mechanical method and adhesion with 4-META resin. Three positions of the metal plate were evaluated: on the compression surface, on the tension surface, and in the middle layer. A three-point bend test was used to compare physical properties of the specimens with metal-plate reinforcement to a resin specimen without reinforcement. No advantage was derived from placing the metal plate in the center of the resin. Both methods of retention produced improved physical properties when placed on either the compressive or tensile side, but the greatest advantages were gained when an adhesive-retained plate was placed on the side in tension. [ABSTRACT FROM AUTHOR]

Introduction Jejunogastric intussusception is a rare complication after gastric operation. Intussusception after gastric operation occurs mostly at the gastrojejunal anastomosis site and Braun anastomosis site of Billroth II reconstruction, and at the Y anastomosis site of Roux-en-Y reconstruction. However, jejunogastric intussusception after distal gastrectomy with Roux-en-Y reconstruction is very rare. We report a surgical case of jejunogastric intussusception after distal gastrectomy for gastric cancer treatment. Presentation of case An 82-year-old woman underwent laparoscopic distal gastrectomy for early gastric cancer treatment. Reconstruction was performed using Roux-en-Y anastomosis. Oral intake was started on postoperative day 4, however vomiting and high—grade fever occurred on postoperative day 12, after which oral intake became difficult. Discussion Anastomotic stenosis of the gastrojejunostomy was suspected, and various examinations were performed. Gastroendoscopy and computed tomography revealed an elevated lesion with ring-like folds protruding through the anastomosis site into the remnant stomach. Reoperation was performed on postoperative day 28 after a diagnosis of jejunogastric intussusception was made. It failed to reduce the intussusception, so partial resection of the gastrojejunal anastomosis was performed and Roux-en-Y reconstruction was repeated. Reconstruction was conducted after taking into consideration the recurrence of intussusception. Conclusion Jejunogastric intussusceptions after distal gastrectomy is a rare complication; however, when it occurs, early diagnosis and appropriate management are necessary. [ABSTRACT FROM AUTHOR]

Introduction An esophagorespiratory fistula (ERF) can cause severe pneumonia or a lung abscess which progresses to life-threatening sepsis. A case of a patient with esophageal cancer and an esophagopulmonary fistula (EPF) who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and was promptly started on definitive chemoradiotherapy (CRT) is reported. Presentation of case A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, the patient was transferred to our hospital. CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer. Due to the EPF, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy and enterostomy. Definitive CRT for the esophageal cancer was started from postoperative day 25. At six-month follow-up, the patient achieved relapse-free survival. Discussion Separation surgery with a DRESS esophagostomy provides good control of inflammation because of division of the respiratory tract from the alimentary tract, which allows prompt initiation of CRT. Alternatively, a DRESS esophagostomy allows patients to be free from any tube trouble. Conclusion Separation surgery with a DRESS esophagostomy for an ERF is a promising method to improve patient quality of life that is less invasive, controls inflammation, and facilitates subsequent definitive CRT. [ABSTRACT FROM AUTHOR]

Introduction The present case reports demonstrated the accompanying surgical support from hepato-biliary-pancreas (HBP) surgeons for urological surgery to secure operative safety because HBP surgeons are well experienced in dissecting techniques for mobilization of the liver or pancreas. We experienced 9 consecutive patients who underwent nephrectomy, adrenectomy or resection of retroperitoneal tumors by urological surgeons. Cardiovascular intervention was also required in cases of long tumor thrombus into the vena cava. Cases All patients had no severe co-existing diseases except the main tumor. Reverse T-shape incision was performed in 7 cases and thoracolaparotomy in two. Dissection and mobilization at the site of severe compression by the urinary tumors were performed in three cases. Partial liver resection was performed for testicular liver metastases in two, and right hepatectomy for right renal cancer was performed in one. Encircling the vena cava and preparation of transection for tumor thrombi were performed in three, and among these, cardiovascular intervention was necessary in two because of extension into the right atrium. During admission, all patient outcomes were uneventful without severe complications. We herein showed the representative two cases of combined surgery. Discussion and conclusion The point of this case report is the coordination between each surgeon and anesthesiologist under precise perioperative planning or management. The role of HBP surgeons is to provide information as a specialist on the operative field for urological or cardiovascular surgery to achieve operative safety. [ABSTRACT FROM AUTHOR]

Introduction This case report is intended to inform acute care surgeons about treating rare horizontal laceration of the pancreas head caused by blunt trauma. Case presentation A 57-year-old woman who sustained blunt abdominal trauma during a car crash was transported to the emergency center of our hospital with unstable vital signs due to hemorrhagic shock. Computed tomography showed transection of the pancreas head and massive intra-abdominal hemorrhage. She was referred for emergency surgery because of a transient response. Laparotomy at five hours after the accident initially revealed consistent massive bleeding from branches of the superior mesenteric artery and vein, which we resolved by suturing the vessels without damaging the main trunks. A horizontal laceration and complete transection of the pancreatic head were then confirmed but the main pancreatic duct remained intact. The lower part of the pancreatic head including the uncus with the attached part of the duodenum was resected, and the pancreatic stump remaining after transection was fixed by suturing. The jejunal limb was attached to the remnant duodenum by side-to-side functional anastomosis. Although gastric emptying was delayed for one month after surgery, the postoperative course was good and the patient recovered at three months thereafter. The embryonic border of pancreas head accompanied with pancreatic divisum was considered for this laceration without disruption of the main pancreatic duct. Discussion Blunt pancreatic trauma usually causes vertical transection and thus, horizontal transection is considered rare. The embryological anatomical border between the ventral and dorsal pancreas due to pancreatic divisum was supposed to be transected and therefore the main pancreatic duct was not damaged. Conclusion Hemorrhagic shock and rare pancreatic head trauma were treated by appropriate intraoperative management. [ABSTRACT FROM AUTHOR]

Introduction Venous tumor thrombus of thyroid cancer that extend to the great vein is rare, and management criteria for venous thrombus have not been established yet. We report a surgical case of thyroid carcinoma with extensive tumor thrombus in the superior vena cava (SVC) and consider the appropriate treatment strategy for venous thrombus. Presentation of case A 75-year-old woman consulted our hospital because of thyroid carcinoma with an extensive tumor thrombus. Computed tomography (CT) revealed a solitary thyroid mass with extensive continuous tumor thrombus in the left internal jugular vein, innominate vein, and SVC. We planned complete tumor resection. During operation, the tumor thrombus in the SVC disappeared, suggesting that pulmonary embolism occurred. Therefore, she underwent total thyroidectomy with extensive phlebectomy (the innominate and internal jugular veins). Although she had some morbidities during her postoperative course, she was followed up for 6 months without progression of thyroid cancer. Discussion and conclusion Intravascular tumor extension of thyroid carcinoma is rare, but is a life-threatening complication. For patients with thyroid tumor with venous tumor thrombus, segmental resection and thrombectomy should be considered if radical operation is possible. Therefore, preoperative correct imaging evaluation and operative planning are necessary to perform safe and effective operations. We suggest a management criteria for patients with thyroid carcinoma with venous tumor thrombus. [ABSTRACT FROM AUTHOR]

The article presents a clinical study on evaluating the shock absorbability between high-abrasion-resistance-posterior resin teeth and commercial porcelain teeth in Japan. A free drop-ball test with an accelerometer was used to test the shock absorbability of commercially available posterior teeth. Several results include the maximum acceleration of porcelain teeth than resin teeth, porcelain teeth shows the shortest duration, and resin teeth shows excellent resistance impact force.

The article discusses a study conducted by several Japanese researchers which examines the impact of surface treatments on the shear bond strength between abrasion resistance plastic teeth and photo-cured dental resin. Findings reveal that the bond strength of dried corrasion-resistant synthetic teeth to photo-cured resin was better than water concentrated one. It also notes that the treatment with silane couping agent, bonding agent and methylene chloride did not increase shear bond strength.

The article presents a study conducted in Japan which investigated the influence of the buccal interocclusal distance in lingualized occlusion on the pressure distribution. Three different foods including kamaboko, carrot and peanuts were crushed and the pressure distribution under a complete denture and the required force were recorded. Several results were revealed which include the decreases required force for crushing all test foods as the buccal interocclusal distance increases.

The article focuses on a study conducted in Japan which clarifies the aging of swallowing by observing tongue pressure on the palate during swallowing. It compares young dentitions and elderly complete denture wearers wherein the tongue pressure and electromyography (EMG) of the suprahyoid were observed by recording. The study reveals several results including the higher maximum tongue pressure of young dentate persons than elderly denture wearer.

The article presents a study which examines the impact of electrolyzed water (EW) on in vitro biofilm of bacteria Candida albicans. Researchers treat biofilms with different kinds of Ews and analyze the effectiveness of using EW in denture cleaning. Results of the study show the potential use of EW as denture cleaners because of its bacteriocidal effects.

The article presents a study on the use of three-dimensional finite element model for the implant connection on mandibular flexure in jaw movement. It discusses the linear static stress analysis of the three-dimensional finite element model with six titanium implants in the right half of mandible. The study suggests that implant connection hardly affects the implant and the surrounding bone during mandibular flexure in the jaw movements.

Background: This study aimed to assess the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position for patients with esophageal cancer from the perspective of short-term outcomes, including operation time, blood loss, and morbidity.Materials and Methods: The initial 44 consecutive patients with esophageal cancer who underwent minimally invasive esophagectomy were statistically analyzed retrospectively. Thoracic cage area was measured from preoperative computed tomography as a factor affecting the surgical difficulty of minimally invasive esophagectomy, as well as other patient characteristics. Correlations with short-term outcomes including chest operation time, blood loss, and morbidity rate were then examined.Results: In univariate analyses, smaller area of the upper thoracic cage width correlated with prolonged thoracic procedure time (p = 0.0119) and greater blood loss during thoracic procedures (p = 0.0283), but area of the lower thoracic cage showed no correlations. History of respiratory disease was associated with thoracic procedure time (p < 0.0001), but not blood loss. In multivariate analysis, small area of the upper thoracic cage was independently associated with prolonged thoracic procedure time (p = 0.0253). Small upper thoracic cage area was not directly correlated with morbidity rate, but prolonged thoracic procedure time was associated with increased blood loss (p < 0.0001) and morbidity rate (p = 0.0204). Empirical time reduction (p = 0.0065), but not blood loss, was associated with thoracic procedure time. However, area of the upper thoracic cage did not correlate with empirical case number. In multivariate analysis, area of the upper thoracic cage (p = 0.0317) and empirical case number (p = 0.0193) correlated independently with thoracic procedure time.Conclusion: A small area of the upper thoracic cage correlated significantly with prolonged thoracic procedure time and increased thoracic blood loss for minimally invasive esophagectomy in the left lateral decubitus position, suggesting the surgical difficulty of minimally invasive esophagectomy in the left lateral decubitus position. [ABSTRACT FROM AUTHOR]

Background Thoracoscopic esophagectomy (TE) was reported that increased morbidity in the National Clinical Data analysis in Japan and technical proficiency is required as the esophageal surgery team. The aim of this study is to assess the degree of surgical difficulty from operation time and to applicate for esophageal surgery team-building and the education of next-generation. Methods Consecutive initial 33 cases by the same operator was statistically examined concerning the correlation between chest operation time and the empirical effect of the time shortening, BMI, obstructive pulmonary disorders, Rib cage area, tumor progression, preoperative treatment as an indicator of the degree of surgical difficulty. Rib cage area measured in the preoperative CT Imaging. Results As the factors affecting the extension of operating time, the narrower upper rib cage area correlated with the prolonged operation time in the univariate (P  = 0.0279) and multivariate (P  = 0.0125) analysis. Empirical time reduction (P  = 0.0429) also was correlated with chest operation time. In addition, there was a significant correlation between chest operation time and blood loss (P  = 0.0007). Conclusion In the training of TE, operating surgeon or first assistant should start from the patient with broad upper rib cage area in chest CT. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Recurrent laryngeal nerve paralysis in esophagectomy is one of the most concerned complications. In recent years, intraoperative neurostimulation monitoring system (IONM) in thyroid surgery have been widespread for identification of recurrent laryngeal nerve and assessment of soundness. Therefore, IONM is often used during esophagectomy in Japan. In this study, we examined the efficacy of IONM in the patients undergoing esophagectomy. Methods Of 66 patients underwent esophagectomy since April 2015 until December 2017, IONM used in 27 patients in the surgery for the examination of recurrent nerve paralysis. We retrospectively reviewed these cases for intraoperative findings, neurostimulation monitoring findings and their outcomes. Results Of 27 patients, 25 were male and two were female, and the median age at operation was 66 years old. Although IONM was used in cervical lymph node dissection, there were no vocal cord responses in 5 patients (left side in 4 and right side in 1) with stimulation of the vagus nerve. Because all patients had no vocal cord paralysis due to stimulation of the cervical recurrent laryngeal nerve, it was diagnosed that there was the recurrent laryngeal nerve injury due to thoracic para recurrent nerve lymph node dissection. IONM was able to facilitate the identification and preservation of cervical recurrent nerve in all patients. Three out of 5 patients with no vocal cord response by IONM were confirmed recurrent laryngeal nerve paralysis in postoperative endoscope. In patients with vocal cord paralysis by IONM, it was possible to carefully performed postoperative management. On the other hand, in patients without paralysis, extubation on the operation day seemed possible without the concern for aspiration. Conclusion By using IONM in esophagectomy, we were able to evaluate the damage of the recurrent laryngeal nerve in real-time. Confirming the intraoperative recurrent nerve injuries is important for postoperative management or prediction of postoperative aspiration pneumonia. IONM in esophagectomy was useful not only in terms of surgical procedures but also in the evaluation of postoperative management. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Esophagorespiratory fistulas including esophagopulmonary fistulas occur in 5–10% patients with esophageal cancer with invasion to adjacent organs. With an esophagorespiratory fistula, saliva and food flow into the respiratory tract through the fistula and severe pneumonia or lung abscess can develop. Alternatively, whether chemoradiotherapy can be performed for patients with esophagorespiratory fistulas affects the further outcomes of treatment in these patients. An esophageal cancer patient with an esophagopulmonary fistula who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and whose inflammation from the esophagorespiratory fistula could be effectively controlled, which facilitated the prompt administration of definitive chemoradiotherapy, is reported. Methods Case report: A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, urgent CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer, infiltrative shadows in the peripheral lung field, and a pleural effusion. Due to the esophagopulmonary fistula, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy on the right and left supraclavicular region and enterostomy (drainage tube-less esophageal separation surgery). Results Antibiotic drug therapy for pneumonia and lung abscess achieved a favorable outcome. Definitive chemoradiotherapy for the esophageal cancer was started from postoperative day 25. Radiotherapy could not be completed because of sepsis due to aspiration pneumonia, though the aspiration pneumonia improved with intensive treatment. At six-month follow-up, the patient had achieved relapse-free survival and is currently symptom-free. Conclusion Separation surgery with a drainage tube-less (DRESS) esophagostomy is the less invasive operative procedure, which allows prompt initiation of chemoradiotherapy. In many cases of esophageal surgeries, an external esophagostomy is made with a drainage tube, and drainage tubes sometimes cause trouble and affect the quality of life of patients after surgery. However, our drainage tube-less (DRESS) esophagostomy might improve patient's quality of life. In addition, evaluation of esophageal cancer by endoscopic examination through the esophagocutaneostomy can be easily performed. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Treatment of anastomotic leakage in the reconstruction after esophagectomy remains a challenge. Secure treatment method has been established and there is very few clinical studies. Although internal drainage using nasogastric tube has been reported recently. In this report, the authors present endoscopic filling method (EFM) for anastomotic leakage. Methods Six patients (five males and one female) with anastomotic leakage whose ages ranged from 54 to 77 were includes in this study. The patients underwent EFM and the anastomotic leakage was filled with polyglycolic acid sheets and fibrin glue endoscopically. Initially, tube drainage was performed, and this treatment was performed as the secondary treatment, when the improvement was not made by tube drainerge. Results Every patient had a jejunostomy, with any concern for nutrition. Abscess was present in all patients, but external drainerge was not required. EFM was required once to five times until the fistulas cured. There was no motality. There are no cases of relapse after discharge from the hospital. Three of them cured in the first treatment, it takes average 26 days from esophagectomy to starting oral intake. This method allows us to repair for all fistula with regardless of inflammation or infection. Conclusion In conclusion, the patients with reflactly esophagogastric anastomotic leakage after esophagectomy would be better served by EFM. Further study is required larger series of patients and a longer follow-up period to examine the safety and effectiveness of EFM. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Bruxism, the parafunctional habit of nocturnal grinding of the teeth and clenching, is associated with the onset of joint degeneration. Especially prolonged clenching is suggested to cause functional overloading in the temporomandibular joint (TMJ). In this study, the distributions of stresses in the cartilaginous TMJ disc and articular cartilage, were analysed during prolonged clenching. The purpose of this study was to examine if joint degradation due to prolonged clenching can be attributed to changes in stress concentration in the cartilaginous tissues. Design: Finite element model was developed on the basis of magnetic resonance images from a healthy volunteer. Condylar movements recorded during prolonged clenching were used as the loading condition for stress analysis. Results: At the onset of clenching (time=0s), the highest von Mises stresses were located in the middle and posterior areas (6.18MPa) of the inferior disc surface facing the condylar cartilage. The largest magnitude of the minimum principal stress (−6.72MPa) was found in the condylar cartilage. The stress concentrations were relieved towards the superior disc surface facing the temporal cartilage. On the surfaces of the temporal cartilage, relatively lower stresses were found. After 5-min clenching, both stress values induced in the TMJ components were reduced to 50–80% of the stress values at the onset of clenching, although the concomitant strains increased slightly during this period. Conclusions: It is suggested that both the condylar and temporal cartilage layers along with the TMJ disc, play an important role in stress distribution and transmission during prolonged clenching due to tissue expansion. Furthermore, our study suggests that a development of stress concentrations in the TMJ during prolonged clenching and risk factors for the initiation of TMJ degeneration could not be confirmed. [ABSTRACT FROM AUTHOR]

Purpose: To increase the number of medical students or residents who want to become surgeons, we must evaluate our program that recruits new young surgeons., Methods: We planned surgical training programs for medical students and residents that we named the MANGOU (Miyazaki Advanced New General surgery Of University) training project in the Department of Surgery, Miyazaki University, Japan. From January 2016 through December 2022, we asked trainees who attended this training to complete questionnaires to evaluate their interest in surgery, confidence in surgical skills, and training. Scoring of the questionnaire responses was based on a 5-point Likert scale, and we evaluated this training prospectively., Results: Among the 109 trainees participating in this training, 61 answered the questionnaires. Two participants found the training boring, but 59 (96.7%) enjoyed it. All of them answered "Yes" to wanting to participate in the next training. Respective pre- and post-training scores were as follows: confidence in surgical skills, 2.2 ± 1.0 and 3.0 ± 1.0 (p < 0.0001); interest in surgery, 4.2 ± 0.8 and 4.4 ± 0.5 (p = 0.0011); and willingness to become surgeons, 3.9 ± 0.7 and 4.1 ± 0.6 (p = 0.0011). All scores rose after MANGOU training., Conclusion: We planned MANGOU surgical wet lab training for medical students and residents that aimed to educate and recruit new surgeons. After joining the MANGOU training, the trainees' anxiety about surgery was reduced, their confidence in performing surgical procedures improved, they showed more interest in surgery, and they increased their motivation to become surgeons., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Research Ethics Committee Faculty of Medicine, University of Miyazaki issued approval O-0007. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Hiyoshi et al.)

Purpose: To assess (1) whether an occlusal splint (OS) or mandibular advancement splint (MAS) allowed better sleep quality and was more comfortable in individuals with sleep bruxism (SB); and (2) the relationship between sleep quality, comfort, and reduction in RMMA related to SB., Materials and Methods: Polysomnographic data from 21 SB subjects (mean ± SD age 25.6 ± 4.5 years) collected in two previous studies were compared. Morning self-reports on sleep quality and comfort of the oral device, polysomnographic data, and RMMA index data from no-device nights were compared to nights using an OS or MAS. The reduction ratio of the RMMA index was calculated for both devices. A responder to the oral device was identified when the RMMA index was less than 2 and when it showed a reduction of at least 50% from the no-device control night., Results: Self-reports for sleep quality and comfort of the oral device showed a mild advantage of the OS when compared to the MAS (r 2 = 0.47, r 2 = 0.32; P ≤ .01). In responders, the MAS induced a greater reduction in the RMMA index ( P = .03) than the OS., Conclusions: In the short term, the comfort of the oral device seemed to influence sleep quality in SB individuals. However, despite the slightly higher degree of comfort offered by the OS, the MAS induced a greater effect on the RMMA index. Int J Prosthodont 2022;36:138-147. doi: 10.11607/ijp.7525.

CAD/CAM resin composite crowns are inexpensive tooth-colored prostheses that have been widely used. However, bonding between CAD/CAM resin composites and resin cements could be difficult since the resin composite is highly cross-linked. There is limited existing data on the resin cements' bond strength with different monomers to CAD/CAM resin composites. In this study, CAD/CAM resin composite was bonded to an SUS rod with three different resin cements following treatment of the bonding surface using the manufacturer's recommended primer. After storing the specimens in water at 37 °C for 24 h, half of them were tested immediately and half were thermocycled for 10,000 cycles in water for a dwell time of 20 s at 5 and 55 °C. The means of the tensile bond strength and standard deviations were determined for each resin cement and testing condition. The data were compared using two-way ANOVA and Bonferroni's multiple comparison tests at 95% confidence level., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that have or could be perceived to have influenced the work reported in this article., (© 2021 The Authors. Published by Elsevier Inc.)

The purpose of this study is to investigate the precision and trueness of the occlusal contact record obtained with a dental CAD/CAM device (ARCTICA). Sandblasted spherical steel balls with diameters of 10-20 mm were measured using ARCTICA and a three-dimensional measurement device (FN503). The radius of each steel ball was calculated from the measured value and the difference between the measured and nominal values was obtained. Upper/lower dental arch casts were measured and processed for occlusal contact image creation using both devices. The graphical images of the occlusal contacts at the intercuspal position obtained from both systems and an occlusal analysis device (BE-1) were compared with the occlusal contact area. Excellent correlation was observed between the measurement results of ARCTICA and FN503 (p<0.001, R 2 : 0.99). The occlusal contact areas were 186.0 mm 2 (ARCTICA), 192.8 mm 2 (FN503), and 196.1 mm 2 (BE-1). This study showed that ARCTICA is capable of conducting highly accurate measurements and generating a graphical image of occlusal contacts with good reliability.

Summary: A 54-year-old woman was referred to our hospital with a cervical tumor. CT revealed a cervical tumor extending to the upper mediastinum, tracheal deviation and tumor infiltration in the cervical vessels. She was followed-up because no diagnosis of malignancy was made by cytology. However, 2 months later, a CT scan showed enlargement of the tumor and tracheal stenosis, and a surgical biopsy was performed and she was diagnosed with anaplastic thyroid cancer (ATC). The tracheal tube with tracheal stenosis could not be removed due to the rapid growth of the tumor, necessitating management by mechanical ventilation. Due to the difficulty of surgical resection, she was treated with lenvatinib. A lenvatinib solution was made and administered via a nasogastric tube. After lenvatinib treatment, the tumor volume decreased and the tracheal stenosis improved. The tracheal tube was removed and oral intake became possible. She was discharged and received ambulatory lenvatinib therapy. The tumor was significantly reduced in size, but gradually grew and was exposed through the cervical wound 6 months later. Esophageal perforation occurred 10 months after the start of treatment. Lenvatinib was re-administered via a nasogastric tube. Eleven months later, the patient died of massive bleeding from the exposed cervical tumor. Patients with advanced ATC may require management with mechanical ventilation for airway stenosis or with a nasogastric tube for esophageal stenosis and perforation. We experienced a case in which lenvatinib was safely administered via a nasogastric tube while performing mechanical ventilation., Learning Points: An anaplastic thyroid cancer patient under mechanical ventilator management was treated with lenvatinib via a nasogastric tube. The lenvatinib solution can easily be prepared and administered via a nasogastric tube. The lenvatinib solution was effective for a patient with difficulty in oral intake. Lenvatinib could also improve the prognosis of an anaplastic thyroid cancer patient with severe airway and esophageal trouble.