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Limited information is currently available on methemoglobinemia caused by the administration of prilocaine in children undergoing dental procedures in Japan. This case report presents the development of methemoglobinemia due to prilocaine overdose. The patient was a female aged 5 years 8 months with Noonan syndrome who also had pulmonary valve stenosis and hypertrophic cardiomyopathy. She presented with severe dental caries affecting 12 total teeth and required general anesthesia due to a lack of cooperation during dental treatment. General anesthesia was performed, during which 3% prilocaine with 0.03 IU/mL felypressin was administered intraoperatively via infiltration. Her SpO2 gradually decreased after 30 minutes, and cyanosis was observed postoperatively. Several assessments including a 12-lead electrocardiogram, an anteroposterior chest radiograph, and venous blood gas analysis were performed to identify potential causes. However, there were no indications of acute respiratory or cardiovascular abnormalities. It was noted that a total of 192 mg prilocaine was administered during the procedure, and methemoglobinemia was suspected to have developed because of overdose. Further testing revealed an elevated serum methemoglobin of 6.9%, supporting methemoglobinemia as the cause of her decreased SpO2. In dental procedures that require the use of prilocaine to treat multiple teeth, particularly for pediatric patients, it is important to carefully manage prilocaine dosing, as an overdose may lead to methemoglobinemia.

Although sevoflurane is the most commonly used inhalational anesthetic agent, the popularity of desflurane is increasing to a similar level. The main beneficial property of desflurane is the relatively fast emergence of the patient from the anesthetic state after halting its supply compared with anesthesia using other anesthetic agents. However, there has been no comprehensive comparison of the effects of these two anesthetic agents on alterations in liver gene expression profiles in animals, including humans, to assess the levels of hepatotoxicity that is induced at least in some extent by inhalational anesthesia. Thus, we compared alterations in the global gene expression profiles in the livers of rats subjected to inhalational anesthesia by sevoflurane or desflurane by a next-generation sequencing method. Our data revealed that both anesthetic agents significantly activated a similar set of genes including those related to drug metabolism and circadian rhythm. Furthermore, many genes downregulated by sevoflurane were also downregulated by desflurane. However, many of the genes related to the cholesterol biosynthetic process were specifically repressed by sevoflurane, but not by desflurane.

To examine the effects of photobiomodulation (PBM) in healthy volunteers using photonic stimulation of acupuncture points on conditioned pain modulation (CPM), temporal summation of pain (TSP), and offset analgesia (OA), which reflect some aspects of endogenous pain modulation. We included 15 men and 15 women (age, 31.5 [27.3–37.0], body mass index, 25.7 [24.4–27.1], Fitzpatrick skin typing, II: 20, III: 8, IV: 2). CPM, TSP, and OA were evaluated after a sham procedure (control session) and after acupuncture point stimulation (LI4 and LI10 on the non-dominant forearm) using linear polarized near-infrared light irradiation (LPNILI; wavelengths peaked at approximately 1000 nm, output: 1.4 W/cm2, spot diameter: 10 mm, spot size: 1.02 cm2, maximum temperature: 40.5 °C, pulse width: 1 s, frequency: 0.2 Hz) (PBM session). Differences in CPM, TSP, and OA between the two sessions were evaluated by the paired t-test and Fisher’s exact test (statistical significance: p < 0.05). Values indicate median [interquartile range]. LPNILI significantly increased CPM in all participants (control session: 12.1 [−4.5–37.4], PBM session: 23.9 [8.3–44.8], p < 0.05) and women (control session: 16.7 [−3.4–36.6], PBM session: 38.7 [24.6–52.1], p < 0.05). The CPM effect increment was significantly higher in women than in men (p = 0.0253). LPNILI decreased TSP in participants with higher TSP ratios (p = 0.0219) and increased OA in participants with lower OA scores (p = 0.0021). LPNILI enhanced endogenous pain modulation in healthy volunteers, particularly in women, as evaluated using CPM. CPM, TSP, and OA evaluations are potentially useful for discriminating PBM responders from non-responders.

Acetaminophen (APAP) in humans has robust effects with a high therapeutic index in altering postoperative and inflammatory pain states in clinical and experimental pain paradigms with no known abuse potential. This review considers the literature reflecting the preclinical actions of acetaminophen in a variety of pain models. Significant observations arising from this review are as follows: 1) acetaminophen has little effect upon acute nociceptive thresholds; 2) acetaminophen robustly reduces facilitated states as generated by mechanical and thermal hyperalgesic end points in mouse and rat models of carrageenan and complete Freund’s adjuvant evoked inflammation; 3) an antihyperalgesic effect is observed in models of facilitated processing with minimal inflammation (eg, phase II intraplantar formalin); and 4) potent anti-hyperpathic effects on the thermal hyperalgesia, mechanical and cold allodynia, allodynic thresholds in rat and mouse models of polyneuropathy and mononeuropathies and bone cancer pain. These results reflect a surprisingly robust drug effect upon a variety of facilitated states that clearly translate into a wide range of efficacy in preclinical models and to important end points in human therapy. The specific systems upon which acetaminophen may act based on targeted delivery suggest both a spinal and a supraspinal action. Review of current targets for this molecule excludes a role of cyclooxygenase inhibitor but includes effects that may be mediated through metabolites acting on the TRPV1 channel, or by effect upon cannabinoid and serotonin signaling. These findings suggest that the mode of action of acetaminophen, a drug with a long therapeutic history of utilization, has surprisingly robust effects on a variety of pain states in clinical patients and in preclinical models with a good therapeutic index, but in spite of its extensive use, its mechanisms of action are yet poorly understood.

Background and objectives: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic cardiomyopathy characterized by potentially lethal ventricular tachycardia. Here we describe a patient with ARVC and an Implantable Cardioverter Defibrillator (ICD) in whom maxillary sinus surgery was performed under general anesthesia. Case report: The patient was a 59 year-old man who was scheduled to undergo maxillary sinus surgery under general anesthesia. He had been diagnosed as having ARVC 15 years earlier and had undergone implantation of an ICD in the same year. Electrocardiography showed an epsilon wave in leads II, aVR, and V1–V3. Cardiac function was within normal range on transthoracic echocardiography. The ICD was temporarily deactivated after the patient arrived in the operating room and an intravenous line was secured. An external defibrillator was kept on hand for immediate defibrillation if any electrocardiographic abnormality was detected. Remifentanil 0.3 μg/kg/min, fentanyl 0.1 mg, propofol 154 mg, and rocuronium 46 mg were administered for induction of anesthesia. Tracheal intubation was performed orally. Anesthesia was maintained oxygen 1.0 L.min−1, air 2.0 L.min−1, propofol 5.0–7.0 mg.kg−1.h−1, and remifentanil 0.1–0.25 μg.kg−1.min−1. The surgery was completed as scheduled and the ICD was reactivated. The patient was then extubated after administration of sugammadex 200 mg. Conclusion: We report the successful management of anesthesia without lethal arrhythmia in a patient with ARVC and an ICD. An adequate amount of analgesia should be administered during general anesthesia to maintain adequate anesthetic depth and to avoid stress and pain. Resumo: Introdução e objetivo: A Cardiomiopatia Arritmogênica do Ventrículo Direito (CAVD) é uma cardiomiopatia genética caracterizada por taquicardia ventricular potencialmente letal. Descrevemos um paciente com CAVD com Cardioversor Desfibrilador Implantável (CDI) submetido a anestesia geral para cirurgia de seio maxilar. Relato do caso: Paciente masculino, 59 anos, a ser submetido a anestesia geral para cirurgia de seio maxilar. O paciente foi diagnosticado com CAVD há 15 anos, momento em que foi submetido a implante de CDI. A eletrocardiografia mostrou onda épsilon nas derivações II, aVR e V1–V3. O ecocardiograma transtorácico revelou função cardíaca normal. Após a entrada do paciente na sala de cirurgia, o CDI foi temporariamente desativado e uma via intravenosa foi instalada. Um desfibrilador externo foi mantido próximo ao paciente caso fosse detectada alguma anormalidade eletrocardiográfica que indicasse desfibrilação do paciente. Foram administrados 0,3 mg/kg/min de remifentanil, 0,1 mg de fentanil, 154 mg de propofol e 46 mg de rocurônio para indução da anestesia. A intubação traqueal foi realizada por via oral. A anestesia foi mantida com 1 L/min de oxigênio, 2 L/min de ar, 5–7 mg/kg/h de propofol e 0,1–0,25 μg/kg/min de remifentanil. O procedimento cirúrgico proposto foi concluído e o CDI foi reativado. O tubo traqueal foi retirado após administração de 200 mg de sugamadex. Conclusão: Descrevemos técnica de anestesia bem sucedida sem arritmia letal em paciente com CAVD e CDI. Analgesia adequada deve ser administrada durante a anestesia geral para manter profundidade anestésica correta e evitar estresse e dor.

Summary Priming doses of non-depolarising neuromuscular blocking drugs given before administration of anaesthetic agents have been used to hasten the onset of neuromuscular blockade In the settings of coronavirus disease 2019 (COVID-19), this could be used to reduce the apnoeic, and potentially aerosol-generating, window To our knowledge, we report the first cases of tracheal intubation with rocuronium for COVID-19 using the priming principle Both patients needed their tracheas intubated for severe hypoxia using a rapid sequence induction technique with a priming dose of rocuronium Despite adequate pre-oxygenation a sudden, unexpected fall in arterial oxygen saturations was observed in both patients after administration of a priming dose of 2 mg of rocuronium Clinicians should consider this possible risk associated with priming doses of neuromuscular blocking drugs in the management of patients with respiratory failure due to COVID-19

Background: It is presently unclear whether the hemodynamic response to intubation is less marked with indirect laryngoscopy using the GlideScope (GlideScope) than with direct laryngoscopy using the Macintosh laryngoscope. Thus, the aim of this study was to determine whether using the GlideScope lowers the hemodynamic response to tracheal intubation more than using the Macintosh laryngoscope. Methods: We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim was to determine whether the heart rate (HR) and mean blood pressure (MBP) 60 s after tracheal intubation with the GlideScope were lower than after intubation with the Macintosh laryngoscope. We expressed pooled differences in HR and MBP between the devices as the weighted mean difference with 95% confidence interval and also performed trial sequential analysis (TSA). Second, we examined whether use of the GlideScope resulted in lower post-intubation hemodynamic responses at 120, 180, and 300 s compared with use of the Macintosh laryngoscope. For sensitivity analysis, we used a multivariate random effects model that accounted for within-study correlation of the longitudinal data. Results: The literature search identified 13 articles. HR and MBP at 60 seconds post-intubation was not significantly lower with the GlideScope than with the Macintosh (HR vs MBP: weighted mean difference = 0.22 vs 2.56; 95% confidence interval −3.43 to 3.88 vs −0.82 to 5.93; P = .90 vs 0.14; I2 = 77% vs 63%: Cochran Q, 52.7 vs 27.2). Use of the GlideScope was not associated with a significantly lower HR or MBP at 120, 180, or 300 s post-intubation. TSA indicated that the total sample size was over the futility boundary for HR and MBP. Sensitivity analysis indicated no significant association between use of the GlideScope and a lower HR or MBP at any measurement point. Conclusions: Compared with the Macintosh laryngoscope, the GlideScope did not lower the hemodynamic response after tracheal intubation. Sensitivity analysis results supported this finding, and the results of TSA suggest that the total sample size exceeded the TSA monitoring boundary for HR and MBP.

This study was a prospective, multicentre, cohort study on 685 patients who had undergone oncologic surgery. The patients were divided into two groups according to the presence or absence of postoperative pneumonia. The two groups were compared with respect to their background, index operation, food eaten, oral condition, contents of oral care and dental treatment, laboratory data, and bacterial flora. All postoperative pneumonias occurred in six cases within four days postoperatively. The multivariable logistic regression analysis showed that preoperative serum C-reactive protein was the strongest predictor of postoperative pneumonia. In addition, decreased postoperative Candida albicans colonies was an effective predictor of postoperative pneumonia. For patients with predictors of postoperative pneumonia, perioperative strategies for its prevention should be considered in addition to professional oral health care. This study was approved by the National Hospital Organization’s Central Ethics Review Board and was also approved by the directors of the participating institutions.

Premolar extraction treatment with a multibracketed system and reinforced anchorage has been a common modality for correcting incisor crowding, Class II or Class III malocclusion in adult patients. The alternative distalization approach of the posterior teeth was difficult and perhaps unachievable after full eruption of the second molars. However, following development of the temporary anchorage devices (TADs), the clinical strategies for malocclusions have drastically changed in adult orthodontics. The Skeletal Anchorage System (SAS), which uses titanium miniplates, is one of the techniques used in TADs. The miniplates are always positioned away from the dentition, so that it never disturbs the distalization of the molars. This chapter addresses how the nonextraction treatment using SAS biomechanics should be performed for correction of bimaxillary anterior crowding in adults.

Study objective The McGrath laryngoscope is a novel self-contained videolaryngoscope with a single-use blade. There are several anecdotal reports that the McGrath is superior to the Macintosh laryngoscope for tracheal intubation. However this remains controversial. Design Meta-analysis and systematic review. Setting Operating room or intensive care unit. Measurements A comprehensive literature search was conducted to identify clinical trials that met our inclusion criteria. To qualify, studies had to be prospective randomized trials comparing tracheal intubation between the McGrath and the Macintosh in an adult population. We extracted data on success rate, glottic visualization during intubation, and intubation time from the studies identified. In subgroup analysis, we assessed the influence on each of these parameters which included airway condition (normal or difficult) and operator (novice or experienced). We then conducted a trial sequential analysis (TSA). Main results Fourteen articles met our inclusion criteria. The McGrath offered better glottic visualization than the Macintosh (risk ratio, 1.34; 95% confidence interval (CI), 1.25–1.45). However, the McGrath required longer intubation time (mean difference, 10.1 s; CI, 2.74–17.5) and demonstrated similar success rate of tracheal intubation (risk ratio, 1.00; CI, 0.95–1.05) compared to the Macintosh. TSA showed that total sample size reached the required information size (RIS) in glottic visualization and success rate. However, only 15.1% of the RIS was achieved in intubation time. In the subgroup analysis for airway condition and operator experience level, there were no subgroup differences in both glottic visualization and intubation time. Conclusions Our meta-analysis suggests that the McGrath is superior to the Macintosh in terms of glottic visualization (GRADE: moderate). However, it significantly extends intubation time (GRADE: very low) and its success rate (GRADE: very low) for tracheal intubation is not excellent. TSA suggests that further studies are necessary to confirm the results of intubation time.

Akira Nishioka,1 Maiko Kimura,1 Eriko Sakamoto,1 Hiroshi Nagasaka,2 Toshiharu Azma1,2 1Department of Anesthesiology & Pain Medicine, Kohondai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba 272-8516, Japan; 2Department of Anesthesiology, Saitama Medical University Hospital, Iruma, Saitama 350-0495, JapanCorrespondence: Toshiharu AzmaDepartment of Anesthesiology & Pain Medicine, Kohondai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba 272-8516, JapanEmail azma@hospk.ncgm.go.jpBackground: The application of pulsed radiofrequency (PRF) current to peripheral nerves with conditions related to neuropathic pain is considered to be clinically safe, while it has been reported that the destruction of mitochondria after PRF application was observed by electron microscopy. If it occurs reproducibly, PRF applied to peripheral nerves should provoke neurolysis because the impairment of mitochondria is known as the primary cause of apoptosis.Methods: Human monocytic cells THP-1 loaded with 100 nM tetramethylrhodamine methyl ester (TMRM), a fluorescent dye that proves the mitochondrial membrane potential (MMP), were exposed to the electric field of continuous radiofrequency (CRF) or PRF current. The TMRM-related fluorescence from THP-1 cells was measured by flow cytometry.Results: The exposure of THP-1 cells to a PRF electric field generated by NeuroTherm NT500 for 15 min with maximum power did not decrease MMP in these cells, nor did it cause the induction of apoptosis. By contrast, the application of CRF current at 70 °C for 3 min significantly decreased MMP and induced apoptosis within 10 min after CRF application.Conclusion: We conclude from these findings that PRF application does not provoke mitochondrial injury in various types of mammalian cells because the size and the subcellular structure of the plasma membrane or mitochondria are similar among those. However, the present results cannot address the effect of PRF current on organic structure around the nervous system. Further study is required to solve the question of whether PRF current causes neurolysis or not.Keywords: pulsed radiofrequency current, human monocytic cells, THP-1, mitochondrial membrane potential, apoptosis

Study objective To investigate whether Airtraq® attenuate the hemodynamic responses to tracheal intubation using single-lumen tubes in adults as compared with the Macintosh laryngoscope. Design Meta-analysis. Setting Operating room. Measurements The primary outcome of this meta-analysis was to determine whether laryngoscopy using the Airtraq® reduced hemodynamic responses—heart rate (HR) and mean blood pressure (MBP)—at 60 s (s) after tracheal intubation compared to laryngoscopy with the Macintosh laryngoscope. Pooled differences in these hemodynamic responses between the two devices were expressed as weighted mean difference with 95% confidence intervals. We then conducted trial sequential analysis (TSA). The secondary outcome was to investigate whether the Airtraq® reduce the hemodynamic response at 120 s, 180 s, and 300 s after tracheal intubation compared to the Macintosh laryngoscope. We also conducted sensitivity analysis of the hemodynamic responses to tracheal intubation with the laryngoscopes using a multivariate random effects model accounting for within-study correlation of the longitudinal data. Main results From electronic databases, we selected 11 randomized controlled trials for studies that enrolled subjects satisfying our inclusion criteria. Compared with the Macintosh laryngoscope, the Airtraq® significantly reduced both HR and MBP at 60 s after tracheal intubation. In secondary outcome, the Airtraq® significantly reduced both HR and MBP at all measurement points, excluding HR at 300 s after tracheal intubation. TSA showed that total sample size reached the required information size for both HR and MBP. The sensitivity analysis revealed that the Airtraq® reduced both HR and MBP at all measurement points, excluding HR at 300 s after tracheal intubation. Conclusions The Airtraq® attenuates the hemodynamic response at 60 s after tracheal intubation compared with the Macintosh laryngoscope. (GRADE: Low) These results were supported by the sensitivity analysis. TSA suggested that the total sample size was exceeded TSA monitoring boundary both HR and MBP.

The McGrath laryngoscope is a novel self-contained videolaryngoscope with a single-use blade. There are several anecdotal reports that the McGrath is superior to the Macintosh laryngoscope for tracheal intubation. However this remains controversial.Meta-analysis and systematic review.Operating room or intensive care unit.A comprehensive literature search was conducted to identify clinical trials that met our inclusion criteria. To qualify, studies had to be prospective randomized trials comparing tracheal intubation between the McGrath and the Macintosh in an adult population. We extracted data on success rate, glottic visualization during intubation, and intubation time from the studies identified. In subgroup analysis, we assessed the influence on each of these parameters which included airway condition (normal or difficult) and operator (novice or experienced). We then conducted a trial sequential analysis (TSA).Fourteen articles met our inclusion criteria. The McGrath offered better glottic visualization than the Macintosh (risk ratio, 1.34; 95% confidence interval (CI), 1.25-1.45). However, the McGrath required longer intubation time (mean difference, 10.1s; CI, 2.74-17.5) and demonstrated similar success rate of tracheal intubation (risk ratio, 1.00; CI, 0.95-1.05) compared to the Macintosh. TSA showed that total sample size reached the required information size (RIS) in glottic visualization and success rate. However, only 15.1% of the RIS was achieved in intubation time. In the subgroup analysis for airway condition and operator experience level, there were no subgroup differences in both glottic visualization and intubation time.Our meta-analysis suggests that the McGrath is superior to the Macintosh in terms of glottic visualization (GRADE: moderate). However, it significantly extends intubation time (GRADE: very low) and its success rate (GRADE: very low) for tracheal intubation is not excellent. TSA suggests that further studies are necessary to confirm the results of intubation time.

Current Surgery First (SF) approaches can be classified into two rather different styles. One is the orthodontic-driven style. In this style, skeletal problems are solved by surgery, and dental problems are fixed orthodontically. The other is the surgery-driven style. In this approach, the aim is to solve both skeletal and dental problems by orthognathic surgery (OGS) as much as possible. The concept of SF that we practice is the orthodontic-driven style, referred to as Sendai SF (SSF). This approach was made possible by the application of the Skeletal Anchorage System (SAS) which enables predictable control of the entire dentition, including the three-dimensional control of the bimaxillary molars. With SAS in combination with the multi-bracketed system, the extent of surgical intervention is significantly reduced, and complex orthodontic problems in post-surgical orthodontics can be solved. In this article, the SAS biomechanics of the post-surgical orthodontics in SSF is described.

Rationale: With Duchenne muscular dystrophy (DMD) being the most common and most severe type of muscular dystrophy, DMD patients are at risk for complications from general anesthesia due to impaired cardiac and respiratory functions as the pathological condition progresses. In recent years, advances in multidisciplinary treatment have improved the prognosis of DMD patients, and the number of patients requiring surgery has increased. Remimazolam is a benzodiazepine derivative similar to midazolam. Its circulatory stability and the fact that it has an antagonist make it superior to propofol. There are no reports of pediatric patients with DMD undergoing total intravenous anesthesia with remimazolam. Patient concerns: A 4-year boy was scheduled for single-incision laparoscopic percutaneous extraperitoneal closure for inguinal hernia under general anesthesia, but the surgery was postponed because his serum creatine phosphokinase level was extremely high. Diagnosis: He was diagnosed with DMD. According to the results of the genetic test, exon deletion of the DMD gene was detected using multiplex ligation-dependent probe amplification, although he had no symptoms of DMD except for elevated serum levels of creatine phosphokinase, etc. Intervention: He was admitted for the same surgical purpose. Anesthesia was induced with 3 mg of intravenously administered remimazolam. He lost the ability to respond to verbal commands. After the intravenous administration of 100 μg of fentanyl, a continuous infusion of remifentanil (1.0 μg/kg/min) and remimazolam (15 mg/h) was started, and the endotracheal tube was inserted smoothly after the administration of 10 mg of rocuronium with which the muscle twitches disappeared in train-of-four monitoring. At the end of the surgery, 15 mg of flurbiprofen was administered intravenously. After surgery, we injected 40 mg of sugammadex to confirm a train-of-four count of 100%. Outcomes: Although the dose of remimazolam was reduced to 5 mg/h 30 minutes before the end of the surgery, it took 20 minutes after the discontinuation of remimazolam for the patient to open his eyes upon verbal command. On postoperative Day 2, he was discharged from the hospital without any complications. Lessons: Remimazolam was shown to be safe to use for general anesthesia in a pediatric patient with DMD.

(Ti, Al)N films were deposited inside 1 mm scale small holes from a Ti 0.33 Al 0.67 alloy target by high-power impulse magnetron sputtering (HiPIMS). To investigate the transport behavior of sputtered and gas species of ternary nitride into the small hole structure and its effect on the chemical and phase compositions of the films grown on the inner side walls, the deposition was performed under inert working gas pressures of 0.5, 1, and 2 Pa with a fixed pulse length of 50 μs and a frequency of 1 kHz. Optical emission spectra revealed the pressure dependence of the ion-to-neutral fraction for titanium, showing an increasing fraction at a higher working pressure. The highest fraction of Al/(Al + Ti) was obtained at 0.5 Pa, while the lowest value was obtained at 1 Pa. This pressure dependence is discussed by considering the degree of thermalization from the viewpoint of mass differences between Al, Ti and the gas species. Under ballistic transport at 0.5 Pa, the high degree of ionization of the HiPIMS discharge further enhances the film coverage at a greater depth, resulting with an aspect ratio of 2.7, and a higher Al fraction was obtained even at a greater depth of 2 mm. The films deposited at 0.5 Pa had a high Al content with mixed cubic and wurtzite phases of (Ti, Al)N and exhibited a hardness of 35 GPa even on the inner walls of the small holes. The influence of the degrees of ionization and thermalization of the sputtered species in the growth of ternary nitride films on a high aspect ratio geometry was demonstrated.

Background/aim Although adrenergic agonists have been used in dental treatments and oral surgery for general anesthesia, their cytotoxicity against human oral malignant and non-malignant cell has not been well- understood. The present study was undertaken to investigate the cytotoxicity of five adrenergic agonists against human oral squamous cell carcinoma (OSCC), glioblastoma, promyelocytic leukemia, and normal oral mesenchymal cells (gingival fibroblast, pulp cell, periodontal ligament fibroblast) and normal epidermal keratinocytes. Materials and methods Tumor-specificity (TS) was calculated by the ratio between the mean 50% cytotoxic concentration against normal cells to that of tumor cells. Internucleosomal DNA fragmentation was detected using agarose gel electrophoresis. Caspase-3 activity was measured by substrate cleavage. Results Both cytotoxicity and tumor-specificity of adrenergic agonists against OSCC cell lines was in the order of isoprenaline>dexmedetomidine> adrenaline>clonidine and phenylephrine. Isoprenaline and dexmedetomidine did not induce apoptosis markers, such as internucleosomal DNA fragmentation and caspase-3 activation, but induced a smear pattern of DNA fragmentation in OSCC cell lines. Their cytotoxicity was not reduced by pretreatment with autophagy inhibitors, or by adrenoceptors antagonists. Addition of superoxide dismutase and catalase significantly reduced the cytotoxicity of isoprenaline, but not that of dexmedetomidine. Conclusion Isoprenaline and dexmedetomidine induce non-apoptotic cell death by different mechanisms.

Purpose: Pain catastrophizing scale (PCS) is useful to predict anxiety of patients before medical treatment. The aim of the study was to investigate the relationship between pre-operative PCS and the period of acute post-operative pain after orthognathic surgery.Methods: This study was conducted in accordance with the Declaration of Helsinki, approved by the Ethics Committee of Meikai University (A1624), and registered with the University Hospital Medical Information Network (UMIN) clinical trials registry (number UMIN 000026719). Nineteen patients scheduled for orthognathic surgery (5 men and 14 women, age 27.8 ± 9.1 (mean ± SD) years) participated and performed Japanese version of PCS assessments prior to the surgery. All patients received a routine post-operative pain management protocol, consisting of acetaminophen 3000 mg per day (every 8 hours). Patients were offered additional analgesia upon request. The period of consumption for post-operative analgesics was recorded. The relationships between PCS-total score, PCS-rumination, PCS-magnification, PCS-helplessness and the period of consumption for post-operative analgesics were analyzed with Pearson correlation coefficient.Results: PCS-total score, PCS-rumination, PCS-magnification, and PCS-helplessness were 21.05 ± 10.79, 11.10 ± 4.95, 4.26 ± 3.19, and 5.68 ± 3.69, respectively (mean ± SD). The period of consumption for post-operative analgesics was 8.2 [5.8 - 9.3] days (median [interquartile range]). A significant positive correlation was detected between PCS-magnification and the period of consumption for post-operative analgesics (R=0.49, p=0.022).Conclusions: Pre-operative PCS-magnification correlates the period of acute post-operative pain in orthognathic surgery. Further studies in larger cohorts are needed to substantiate the present findings. Purpose: Pain catastrophizing scale (PCS) is useful to predict anxiety of patients before medical treatment. The aim of the study was to investigate the relationship between pre-operative PCS and the period of acute post-operative pain after orthognathic surgery.Methods: This study was conducted in accordance with the Declaration of Helsinki, approved by the Ethics Committee of Meikai University (A1624), and registered with the University Hospital Medical Information Network (UMIN) clinical trials registry (number UMIN 000026719). Nineteen patients scheduled for orthognathic surgery (5 men and 14 women, age 27.8 ± 9.1 (mean ± SD) years) participated and performed Japanese version of PCS assessments prior to the surgery. All patients received a routine post-operative pain management protocol, consisting of acetaminophen 3000 mg per day (every 8 hours). Patients were offered additional analgesia upon request. The period of consumption for post-operative analgesics was recorded. The relationships between PCS-total score, PCS-rumination, PCS-magnification, PCS-helplessness and the period of consumption for post-operative analgesics were analyzed with Pearson correlation coefficient.Results: PCS-total score, PCS-rumination, PCS-magnification, and PCS-helplessness were 21.05 ± 10.79, 11.10 ± 4.95, 4.26 ± 3.19, and 5.68 ± 3.69, respectively (mean ± SD). The period of consumption for post-operative analgesics was 8.2 [5.8 - 9.3] days (median [interquartile range]). A significant positive correlation was detected between PCS-magnification and the period of consumption for post-operative analgesics (R=0.49, p=0.022).Conclusions: Pre-operative PCS-magnification correlates the period of acute post-operative pain in orthognathic surgery. Further studies in larger cohorts are needed to substantiate the present findings.

(Ti,Al)N films were deposited from a Ti 0.33 Al 0.67 alloy target with a high Al content at a substrate temperature of less than 150 °C using high power impulse magnetron sputtering (HIPIMS) plasma. The pulse duration was varied from 60 to 300 μs with a low frequency of 333 Hz to investigate the effects on the dynamic variation of the substrate temperature, microstructural grain growth and the resulting mechanical properties. The chemical composition, surface morphology and phase composition of the films were analyzed by energy dispersive spectroscopy, scanning electron microscopy and X-ray diffraction, respectively. Mechanical properties were additionally measured by using a nanoindentation tester. A shorter pulse duration resulted in a lower rate of increase in the substrate temperature with an exponentially higher peak target current. The obtained films had a high Al content of 70–73 at.% with a mixed highly (0002) textured wurtzite phase and a secondary phase of cubic (220) grains. Even with the wurtzite phase and the relatively high Al contents of more than 70 at.%, the films exhibited a high hardness of more than 30 GPa with a relatively smooth surface of less than 2 nm root-mean-square roughness. The hardest and smoothest surfaces were obtained for pulses with an intermediate duration of 150 μs. The differences between the obtained film properties under different pulse durations are discussed on the basis of the grain growth process observed by transmission electron microscopy. The feasibility of the low-temperature synthesis of AlN rich wurtzite phase (Ti,Al)N films with superior hardness by HIPIMS plasma duration was demonstrated.

Study objective Videolaryngoscopy has become more common since the 2000s. Despite several anecdotal reports in the literature, it remains unclear whether videolaryngoscopy is superior to direct Macintosh laryngoscopy for tracheal intubation in adults with obesity. This systematic review and meta-analysis focused on prospective randomised trials comparing videolaryngoscopes with the Macintosh laryngoscope for tracheal intubation in adults with obesity. Design Systematic review, Meta-analysis Setting Operating room, Obesity patients Measurements Data on success rate, intubation time, and glottic visualisation during tracheal intubation were extracted from the identified studies. In a subgroup analysis, we also compared the parameters for videolaryngoscopes with a tracheal tube guide channel and those without a tracheal tube guide channel. Data from individual trials were combined, and the DerSimonian and Laird random-effect model was used to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) as well as the corresponding 95% confidence intervals (CI). Main results Eleven articles describing 13 trials met the inclusion criteria. The performance of videolaryngoscopes was superior to that of the Macintosh laryngoscope for all outcomes. (Success rate; RR=1.11, 95% CI 1.04 to 1.18, p=0.001, I 2 =63%, Intubation time; WMD=−16.1, 95% CI −31.1 to −1.10, p=0.04, I 2 =97%, Glottic visualisation; RR=1.19, 95% CI 1.09 to 1.30, p 2 =76%) In the subgroup analysis, the performance of both types of videolaryngoscopes (with and without a tracheal tube guide channel) was superior to that of the Macintosh laryngoscope, except for intubation time with the videolaryngoscopes without a tracheal tube guide channel. Conclusions Videolaryngoscopes were superior to the Macintosh laryngoscope for tracheal intubation in adults with obesity. (GRADE score: low or very low.)

It is known that a variety of sized procoagulant vesicles that express tissue factor are released from several types of cells including monocytes by mechanisms related to the induction of apoptosis, while it has not yet been evaluated whether superoxide is involved in the production of such vesicles. Here, we report that a local anesthetic bupivacaine induces apoptosis in human monocytic cells THP-1 within a short observation period, where the shedding of procoagulant vesicles is associated. The property as procoagulant vesicles was evaluated using flow cytometry by the binding of FITC-conjugated fibrinogen to vesicles in the presence of fresh frozen plasma and the suppression of this binding by heparin. Bupivacaine (1 mg/ml) increased the apoptotic cells and procoagulant vesicles. LY294002 (100 µM), that inhibits the recruiting of intracellular component of NADPH oxidase to construct the activated form of this enzyme complex, or superoxide dismutase (1500 unit/ml) suppressed bupivacaine-provoked induction of apoptosis and the increase of procoagulant vesicles. We suggest that this simple experimental system is useful to explore the molecular mechanisms of action of superoxide in the shedding of procoagulant vesicles from human monocytic cells.

Study Objective To evaluate the efficacy of intravenous nitroglycerin (TNG) in preventing intraoperative myocardial ischemia (MI) under general anesthesia. Moreover, we analyzed the hemodynamic changes in heart rate (HR), mean blood pressure (MBP), and pulmonary capillary wedge pressure (PCWP) associated with TNG administration both before and after the induction of anesthesia. Design Meta-analysis. Setting Operating room, cardiac surgery or non-cardiac surgery, all surgeries were elective measurements. We performed a computerized search of articles on PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Meta-analysis was performed using Review Manager. The data from the individual trials were combined using a random-effects model to calculate either the pooled relative risk (RR) or the weighted mean difference (WMD) with 95% confidence interval (CI). We conducted trial sequential analysis (TSA). The primary outcome was the incidence of MI and the secondary outcomes were hemodynamic changes (HR, MBP, and PCWP). Main Results Using electronic databases, we selected 10 trials with a total of 353 patients for our review. Prophylactic intravenous TNG did not significantly decrease the incidence of MI (RR=0.61; CI, 0.33 to 1.13; P=0.12; I 2 =55). TSA corrected the CI to 0.05 to 7.39 and showed that 9.5% of the required information size was achieved. In terms of hemodynamic changes, intravenous TNG significantly reduced MBP in comparison with the placebo (MBP pre-induction: WMD=−7.27; 95% CI −14.2 to −0.33; P=0.04; I 2 =97%; MBP post-induction: WMD=−5.13; 95% CI −9.17 to −1.09; P=0.01; I 2 =73%). Conclusions Our analyses showed that prophylactic intravenous TNG does not reduce the incidence of intraoperative MI. Moreover, TSA suggests that further studies are necessary to confirm the results (GRADE: very low). Prophylactic doses of intravenous TNG significantly reduced the MBP both pre and post anesthesia induction (GRADE: very low).

For further enhancement of the tool life in microforming process, a high power impulse magnetron sputtering (HIPIMS) deposition technique, which has well-known advantageous features, such as dense and smooth surface, and three-dimensional uniformity on complex-shaped substrates, was applied to microforming die in this report. In view of the process tribology in sheet metal forming, the present study particularly focused on the thin film properties on the inner wall surface of the sub-millimeter scale tiny hole structure as micro-dies. TiAlN films were deposited by both HIPIMS and conventional direct current magnetron sputtering (dcMS) on the micro-hole structure, and its inner wall film properties were investigated in detail. Cross-sectional scanning electron microscopy (SEM) analysis, surface topographical analysis using atomic force microscopy, and micro-Vickers hardness test of TiAlN films deposited by HIPIMS demonstrated the highly dense microstructure with fine smooth surface (Rmax: 126 nm) and relatively high hardness (2288 Hv) even at the inner wall of micro-holes. Additionally, high wear resistivity and adhesion strength on the substrates were also shown via ball-on-disk tribology test and scratch test, respectively. The applicability of these advantageous features of HIPIMS deposition films to the practical forming behavior is further studied with micro-circular drawing test. Anti-adhesive performance of HIPIMS deposited micro-die leads to the better micro-formability than that deposited by the conventional dcMS process.

The patient was a 22-year-old Japanese woman who complained of a gummy smile. She had several other orthodontic problems, including crowding of the maxillary anterior teeth, retroclination of the maxillary central incisors, excessive maxillary incisor display, a deep overbite, Class II dental relationships, a Class II profile, and a long face. Two options for the correction of these problems were proposed. The first option was to extract the maxillary first premolars to correct the Class II relationship and implant a miniscrew to correct the gingival display; the second option was to place 2 miniplates for distalization of the maxillary molars and a miniscrew to correct the gingival smile without premolar extractions. The patient chose the second option. After placing a preadjusted bracketed system, 2 miniplates were placed in the zygomatic buttresses bilaterally with monocortical screws, and 1 miniscrew was fixed between the root apices of the maxillary central incisors. Distalization and intrusion of the maxillary molars and intrusion of the maxillary incisors were simultaneously started with those temporary skeletal anchorage devices functioning as absolute orthodontic anchors. The total treatment period was approximately 22 months. Her orthodontic problems were corrected. According to the cephalometric evaluation, the entire maxillary dentition was significantly distalized, and her maxillary incisors were successfully intruded, with the mandible showing a slight counterclockwise rotation. Thanks to the temporary anchorage devices combined with miniplates and a miniscrew, we were able to predictably achieve her treatment goals without premolar extractions, orthognathic surgery, and the need for patient compliance.

Supplemental Digital Content is available in the text, Accumulation of the literature has suggested an inverse association between healthcare provider volume and mortality for a wide variety of surgical procedures. This study aimed to perform meta-analysis of meta-analyses (umbrella review) of observational studies and to summarize existing evidence for associations of healthcare provider volume with mortality in major operations. We searched MEDLINE, SCOPUS, and Cochrane Library, and screening of references. Meta-analyses of observational studies examining the association of hospital and surgeon volume with mortality following major operations. The primary outcome is all-cause short-term morality after surgery. Meta-analyses of observational studies of hospital/surgeon volume and mortality were included. Overall level of evidence was classified as convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV), and non-significant (class V) based on the significance of the random-effects summary odds ratio (OR), number of cases, small-study effects, excess significance bias, prediction intervals, and heterogeneity. Twenty meta-analyses including 4,520,720 patients were included, with 19 types of surgical procedures for hospital volume and 11 types of surgical procedures for surgeon volume. Nominally significant reductions were found in odds ratio in 82% to 84% of surgical procedures in both hospital and surgeon volume-mortality associations. To summarize the overall level of evidence, however, only one surgical procedure (pancreaticoduodenectomy) fulfilled the criteria of class I and II for both hospital and surgeon volume and mortality relationships, with a decrease in OR for hospital (0.42, 95% confidence interval[CI] [0.35–0.51]) and for surgeon (0.38, 95% CI [0.30–0.49]), respectively. In contrast, most of the procedures appeared to be weak or “non-significant.” Only a very few surgical procedures such as pancreaticoduodenectomy appeared to have convincing evidence on the inverse surgeon volume-mortality associations, and yet most surgical procedures resulted in having weak or “non-significant” evidence. Therefore, healthcare professionals and policy makers might be required to steer their centralization policy more carefully unless more robust, higher-quality evidence emerges, particularly for procedures considered as having a weak or non-significant evidence level including total knee replacement, thyroidectomy, bariatric surgery, radical cystectomy, and rectal and colorectal cancer resections.

Polycrystalline diamond (PCD) films prepared by chemical vapor deposition (CVD) can improve surface properties of hard materials. In this study, the growth rates of PCD film prepared by hot-filament CVD have been investigated on the influence of CH 4 concentration. Tribological properties of PCD films on sintered SiC substrates were investigated for application on the mechanical seals of pumps. The critical sealing pressure for friction and wear resistance properties of PCD films paired with PCD films were investigated under practical ring on ring sliding test conditions, and compared with conventional materials of mechanical seals. The results show that friction and wear resistance properties of PCD films are superior to that of conventional materials for high sealing pressure.

Although there have been a large number of reports on the effects of opioids on the bispectral index (BIS) during anesthesia, the effects of pentazocine on the BIS have not been reported. In this study, 60 patients scheduled for elective oral surgery [30 females, 30 males; all American Society of Anesthesiologists Physical Status (ASA PS) category 1] were enrolled in the trials. Maintaining gender parity, we randomly assigned the patients to one of three groups: pentazocine group (0.3 mg/kg; n = 20), fentanyl group (1 μg/kg; n = 20), or saline group (n = 20); these opioids were administered intravenously 15 min after the intubation. Anesthesia was induced with thiopental and vecuronium bromide and maintained with nitrous oxide (4 l/min)–oxygen (2 l/min)–sevoflurane (1%). At 15 min after the intubation, mean arterial blood pressure (MAP), heart rate (HR), and BIS index were recorded as baseline values. MAP, HR, and BIS values were measured at 2.5-min after the intubation up to 30 min. All data were expressed as the mean ± standard deviation. Differences in BIS values, MAP, and HR among the three groups throughout the experiment were analyzed using two-way repeated-measures analysis of variance (ANOVA), and demographic data among the three groups were analyzed using one-way ANOVA. Post hoc comparisons were performed using Fisher’s protected least significant difference test. A P value of

Kennedy's disease (KD), also known as spinal and bulbar muscular atrophy, is a rare, X-linked recessive, neurodegenerative disorder of the lower motor neurons characterized by progressive bulbar and appendicle muscular atrophy. Here we report a case of a 62-year-old male patient with KD, weighing 70 kg and 173 cm tall, was scheduled for frontal sinusectomy due to sinusitis. General anesthesia was induced through propofol 80 mg, remifentanil 0.25 μg/kg/min and 40 mg rocuronium. We were successfully able to use a sugammadex on a patient suffering from KD in order to reverse rocuronium-induced neuromuscular blockade.

Congenital fusion of the mandible to maxilla can involve soft tissue (synechiae) or bone (syngnathia). Congenital synechiae has been widely reported, whereas congenital syngnathia is rare. Syngnathia severely limits mouth opening. To improve airway control and prevent feeding handicaps, surgical division of the bony fusion or breakdown of the adhesions is recommended within the first few days of life. We described an 8-year-old girl who had unilateral syngnathia with micromandible, reactive coronoid process hyperplasia, cleft palate and congenital corneal opacity. She first underwent surgical treatment to improve jaw function at the age of 8 years. Delayed surgery slightly improved restricted mouth opening.

Slurry wear with sand particles in rivers is a serious problem for pump operation. Therefore, a technique to predict wear volume loss is required for selecting wear resistant materials and determining specifications for the maintenance period. This paper reports a method for predicting the wear depth distribution on the blade of an impeller. Slurry wear tests of an aluminum pump impeller were conducted. Prediction results of wear depth distribution approximately correspond with the results of slurry wear tests. This technique is useful for industrial application.

A rare case of benign cementoblastoma involving multiple deciduous and permanent teeth is presented with a review of the literature. A 12-year-old boy was admitted for a swelling in the right maxillary premolar-molar region. A radiologic examination revealed a well-defined, round, radiopaque mass extending from the right maxillary first premolar to the second permanent molar. The tumor was removed with all associated teeth. A histologic examination of the surgical specimen revealed a well-circumscribed tumor composed of cementum-like tissue surrounded by a fibrous capsule. The tumor was attached to the roots of the second deciduous molar, first premolar, and the first and second permanent molars and embedded in the crown and root of the right maxillary second premolar, suggesting that the lesion had arisen from the second deciduous molar. There has been no recurrence of the lesion more than 18 months after the surgical procedure.

For fluid machinery used in seawater, the overlaying technique is an effective means for the resistance to corrosion, erosion and abrasive wear in terms of cost, performance and repair. Therefore, we had attempted to combine the manufacturing technique of anti-wear resistant Co based KV powder and Crevelloy alloy with excellent crevice corrosion resistance. As the results, the overlayer containing 15%massVC, 35%massCr, and 15%massMo shows high hardness and excellent anti-corrosion property. High hardness of overlayer is mainly caused by matrix phase with lamellar structure consisting Ni-Cr-Mo-Fe alloy phase and carbide phase. Corrosion property was evaluated by cyclic potentiodynamic anodic polarization curve measurement in 3.0%NaCl aq. at 25°C, pitting potential measurement in 3.5%NaCl aq. at 80°C and 6-months immersion test in seawater. Erosion property was evaluated by slurry jet test and vibratory cavitation erosion test. From the evaluation results, developed material VCRMO is recommended as overlaied alloy for seawater applications.