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Purpose: Among previous reports on dental injuries associated with mandibular fractures, there are few investigating the conditions under which dental injuries commonly occur. The aim of this study was to determine specific characteristics of mandibular fractures accompanied by dental injuries.Methods: This retrospective cohort study included dentate patients with mandibular fractures treated at a tertiary trauma center between 2011 and 2019. The data were analyzed according to 2 outcome variables: patients with additional dental injuries and patients without. The predictor variables were patient age, sex, accident mechanism, number and location of mandibular fractures, and presence of submental lacerations. Odds ratios for the risk factors for dental injury were calculated in conjunction with descriptive statistics. Binary logistic regression analysis was also performed to identify the factors associated with dental injuries as dependent variables.Results: Of 252 patients who had only mandibular fractures, 95 (37.7%) had associated dental injuries. In the group with dental injuries, 55.8% of mandibular fractures were caused by a fall (P = .003). Condyle fractures (77.9%) with dislocation (67.6%) and bilateral involvement (41.9%) were more common than in the group without dental injuries (P < .001). In patients with dental injuries, the incidence of 3 or more fractures (29.5%) was significantly higher than in the group without dental injuries. Dental injuries were more likely to occur in patients with concomitant submental lacerations (confidence interval (CI) 1.135-4.983, P = .02), and the risk of dental injury was significantly lower in the presence of angle fractures (CI 0.113-0.999, P = .045).Conclusions: A frontal impact involving the anterior part of the mandible is often associated with condyle and multiple mandibular fractures. This seems to be the typical mechanism for concomitant dental injuries. Submental laceration can be considered a prime sign of associated dental injuries. [ABSTRACT FROM AUTHOR]

The aim was to determine changes in various parameters indicating physical conditions and nutritional status of patients during surgical and conservative treatment of mandibular fractures. A round by a nutrition support team was done once postoperatively for the surgical treatment group. For the conservative treatment group, three rounds were performed during the period of intermaxillary fixation. Data obtained from the rounds were compared between the groups. There were 29 patients surgically and 30 patients conservatively treated. A significant weight loss was observed in both groups postoperatively. The mean weight loss of the surgical treatment group measured at the postoperative round was 1.73 kg (SD ± 1.78) (P < 0.001) and that of the conservative treatment group at the third round was 2.74 kg (SD ± 2.35) (P < 0.001). During the entire treatment period, weight loss, body fat percentage, skeletal muscle percentage, grip strength and parameters indicating body composition and nutritional status of the conservative treatment group did not substantially differ from those of the surgical group. The influence of the conservative procedure on the nutritional condition of the patients seems to be limited and reversible at the end of the treatment. The weight loss observed here suggests that systematic nutrition support is necessary during both surgical and conservative treatment. [ABSTRACT FROM AUTHOR]

Summary Background This study was attempted to investigate whether lifestyle modifications supported by regional health nurses should improve cardio-metabolic factors—including adipocytokines, oxidative stress, and arterial stiffness—in subjects with metabolic syndrome. Methods Thirty-six subjects with metabolic syndrome were enrolled, 28 of whom completed the 6-month lifestyle modifications (male:female = 19:9). Blood and urine test results were examined in relation to metabolic factors before and after 6-month nutritional and physical activity modifications. In addition, oral glucose tolerance tests were performed and arterial stiffness was measured by brachial-ankle pulse wave velocity and radial augmentation index before and after them. Results Six-month lifestyle modifications significantly reduced body weight, homeostasis model assessment index, and low-density lipoprotein cholesterol (LDL-C). They significantly attenuated oxidative stress measured by the urinary 8-hydroxy-2-deoxyguanosine/creatinine ratio. They also lowered brachial and central systolic blood pressure. They tended to decrease waist circumferences and the levels of C-reactive protein. However they did not significantly change the levels of adipocytokines, including tumour necrosis factor, soluble tumour necrosis factor receptors, and interleukin 6, or arterial stiffness measured by brachial-ankle pulse wave velocity and radial augmentation index. Conclusions Six-month lifestyle modifications supported by regional health nurses lowered body weight, insulin resistance, LDL-C, oxidative stress, and peripheral and central blood pressure in subjects with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between frozen-thawed single blastocyst transfer (BT) and maternal and neonatal outcomes of pregnancy. Design: Retrospective analysis. Setting: Japanese nationwide registry of assisted reproductive technology (ART) with mandatory reporting for all ART clinics in Japan. Patient(s): Registered from 2008 through 2010 undergoing single embryo transfer cycles (n = 277,042). Intervention(s): None. Main Outcome Measure(s): Rates of preterm birth (PTB; <37 weeks' gestation), low birth weight (LBW; <2,500 g), small for gestational age (SGA), large for gestational age (LGA), placenta previa, placenta abruption, placenta accreta, and pregnancy-induced hypertension (PIH) after fresh/frozen-thawed and cleaved-embryo/blastocyst transfers were performed. Result(s): Frozen-thawed embryo transfer (FET) was associated with a significantly reduced occurrence of PTB, LBW, and SGA but increased rate of LGA. FET was also associated with a higher incidence of placenta accreta (odds ratio 3.16) and PIH (odds ratio 1.58). BT was associated with a significantly decreased rate of SGA and increased rate of LGA. There was no significant association between BT and maternal complications. Conclusion(s): Frozen-thawed BT is associated with improved general perinatal outcomes of pregnancy but significantly increased maternal risks of placenta accreta and PIH. This finding requires further investigation to assure maternal safety of patients undergoing ART treatment. [Copyright &y& Elsevier]

Objective: To evaluate the implications of assisted reproductive technologies (ART) on neonatal birth weight. Design: A retrospective study using analysis of covariance and multiple logistic regression analysis of the Japanese ART registry. Setting: Japanese institutions providing ART treatment. Patient(s): A total of 25,777 singleton neonates reaching term gestation following ART during the years 2007–2008, with 11,374 achieved through fresh embryo transfers (fresh ET) and 14,403 achieved through frozen-thawed embryo transfers (FET). Intervention(s): None. Main Outcome Measure(s): Birth weight. Result(s): The mean birth weight after FET was significantly higher compared with fresh ET and all Japanese births (3,100.7 ± 387.2 g, 3,009.8 ± 376.8 g, and 3,059.6 ± 369.6 g, respectively). The risk for low birth weight in FET was significantly lower compared with fresh ET. In fresh ET, ovarian stimulations were associated with about twofold risk of low birth weight compared with natural cycle. Regarding to the duration of embryonic culture, the risks resulting from a shorter culturing time were significantly higher compared with a longer culturing time in fresh ET. Conclusion(s): The best method of embryo transfer for fetal growth was FET after extended culturing until blastocyst stage. However, further investigations should be performed to understand the safety of ART treatment. [ABSTRACT FROM AUTHOR]

Although single-balloon enteroscopy (SBE)-assisted or short-type SBE (short SBE)-assisted ERCP has been reported as useful in patients with surgically altered anatomy, most studies had small sample sizes or single-center designs. This study aimed to evaluate the efficacy and factors affecting the procedure results of short SBE–assisted ERCP in patients with surgically altered anatomy. This multicenter, retrospective study was conducted at 8 tertiary referral care centers in Japan. The data of patients who underwent ERCP-related procedures using short SBE between September 2011 and August 2019 at each facility were analyzed. Overall, 1318 patients were included in this analysis. The enteroscopy (reaching the target site), cannulation, and total procedural success rates were 87.9% (95% confidence interval [CI], 86.1%-89.6%), 87.0% (95% CI, 84.9%-88.8%), and 74.9% (95% CI, 72.5%-77.2%), respectively. Adverse events occurred in 7.7% of patients (95% CI, 6.4%-9.3%). Multiple logistic regression analysis indicated that age (≥75 years), Roux-en-Y reconstruction, pancreatic indication, and malignancy were factors affecting the total procedural failure. This large-scale study proved that short SBE–assisted ERCP in patients with surgically altered anatomy was effective. Moreover, it clarified factors affecting procedure results. Proficiency with alternative treatment techniques is required in difficult cases. (Clinical trial registration number: UMIN00004045.) [ABSTRACT FROM AUTHOR]

Objective: Early hematoma expansion is a known cause of morbidity and mortality in patients with intracerebral hemorrhage (ICH). The goal of this study was to identify clinical predictors of ICH growth in the acute stage. Materials and methods: We studied 201 patients with acute (<6 h) deep ganglionic ICH. Patients underwent CT scan at baseline and hematoma expansion (>33% or >12.5 ml increase) was determined on the second scan performed within 24 h. Fourteen clinical and neuroimaging variables (age, gender, GCS at admission, hypertension, diabetes mellitus, kidney disease, stroke, hemorrhagic, antiplatelet use, anticoagulant use, hematoma density heterogeneity, hematoma shape irregularity, hematoma volume and presence of IVH) were registered. Additionally, blood pressure was registered at initial systolic BP (i-SBP) and systolic BP 1.5 h after admission (1.5 h-SBP). The discriminant value of the hematoma volume and 1.5 h-SBP for hematoma expansion were determined by the receiver operating characteristic (ROC) curves. Factors associated with hematoma expansion were analyzed with multiple logistic regression. Results: Early hematoma expansion occurred in 15 patients (7.0%). The cut-off value of hematoma volume and 1.5 h-SBP were determined to be 16 ml and 160 mmHg, respectively. Hematoma volume above 16 ml (HV > 16) ([OR] = 5.05, 95% CI 1.32--21.36, p = 0.018), hematoma heterogeneity (HH) ([OR] = 7.81, 95% CI 1.91-40.23, p = 0.004) and 1.5 h-SBP above 160 mmHg (1.5 h-SBP > 160) ([OR] = 8.77, 95% CI 2.33-44.56, p = 0.001) independently predicted ICH expansion. If those three factors were present, the probability was estimated to be 59%. Conclusions: The presented model (HV > 16, HH, 1.5 h-SBP > 160) can be a practical tool for prediction of ICH growth in the acute stage. Further prospective studies are warranted to validate the ability of this model to predict clinical outcome. [ABSTRACT FROM AUTHOR]

Background: The arterial oxygen saturation of infants requiring resuscitation can be monitored using a pulse oximeter. However, the device cannot provide information about cerebral oxygenation. Thus, we used a new portable near-infrared spectroscopy (NIRS) device that can monitor regional cerebral tissue oxygen saturation (crSO2) with a probe attached to the examiner's finger.Aim: To identify the reference ranges for crSO2 within the first 10 min after birth in term infants who did not receive any medical intervention in the delivery room.Results: crSO2 in the left frontoparietal area of the forebrain was measured within the first 10 min of life in 127 healthy term infants. The median gestational age and birth weight were 37.6 weeks and 2742 g, respectively, and 85% of the infants were delivered via a scheduled cesarean section. The 3rd-97th percentile values for crSO2 ranged from 33.1% to 56.7% at 1 min, from 33.2% to 59.5% at 2 min, and from 38.7% to 66.6% at 5 min after birth. A median of 3.5 min was required to achieve a crSO2 > 50%.Conclusions: This study showed the reference ranges for crSO2 measured with the new portable NIRS device within the first 10 min after birth in term infants. [ABSTRACT FROM AUTHOR]