Obesity and Craniofacial Abnormalities are Independent Causal Factors for Obstructive Sleep Apnea-Hypopnea Syndrome

OBJECTIVES:Obstructive sleep apnea-hypopnea syndrome is characterised by recurrent episodes offunctional pharyngeal airway obstruction during sleep. Here, we examined the craniofacial characteristicsand body mass index of patients with obstructive sleep apnea-hypopnea syndrome and healthy counterparts,and investigated the relationship between these factors and onset of obstructive sleep apnea-hypopneasyndrome.MATERIAL AND METHODS:Sixty non-edentulous male with obstructive sleep apnea-hypopnea syndromediagnosed by conventional polysomnography were divided into two groups according to their bodymass index, which was used as an index of obesity( <25 kg/m2:non-obese, &#8805; 25 kg/m2:obese). Craniofacialcharacteristics were analysed by cephalogram using Ricketts\u27 method and the Downs-Northwesternmethod.RESULTS:The mean body mass index was greater in patients with obstructive sleep apnea-hypopneasyndrome compared with their healthy counterparts. As for the craniofacial characteristics of patients withobstructive sleep apnea-hypopnea syndrome, the mandible was relatively small and located posteriorly, andthe hyoid bone was at a lower position. However, in patients with obstructive sleep apnea-hypopnea syndrome,there was no significant difference in any of the cephalometric measurements between non-obeseand obese patients.CONCLUSION:Obesity and craniofacial skeletal abnormalities are non-reciprocal, independent causalfactors for obstructive sleep apnea-hypopnea syndrome

ゼツヘンペイジョウヒガン ニ オケル センチネル リンパセツ セイケン ニ カン スル ケンキュウ : OSNA ホウ ニ ヨル イデンシ カイセキ ノ ユウヨウ セイ ニ ツ イテ

癌においてリンパ節転移は,重要な予後因子であることより,正確な診断が必要となる.そこで,より正確なリンパ節転移診断を行う方法として,センチネルリンパ節(sentinel lymph node:SLN) 生検が導入され,また,さらなる診断精度の向上を図るために遺伝子解析による転移診断が応用され,その有用性が報告されている.しかしながら,口腔癌のSLN 生検における遺伝子解析は,従来の病理組織学的診断に比べ精度が高いとする報告がある一方,ほぼ同等とする報告もあり,なお一定の見解が得られていない.本研究では,舌扁平上皮癌に対するSLN 生検における遺伝子解析の有用性について検討を行った.対象は,SLN 生検を施行した舌扁平上皮癌StageI,II症例28 例で,病理組織学的診断ならびにone-step nucleic acid amplification(OSNA) 法による遺伝子解析を用いてSLN における転移診断を行い,それぞれを比較検討し,さらに治療成績について,SLN 生検導入前のStage I,II症例23 例と比較検討した.その結果,病理組織学的診断にてリンパ節転移陽性と診断された症例は28 例中5 例(17.9%)で,そのうちの1 例は,当初病理組織学的診断では転移陰性であったが,遺伝子解析にて転移陽性と診断されたため,亜連続切片にて再度検索を行い,病理学的にも転移陽性と診断されたものであった.OSNA 法による遺伝子解析では28 例中6 例(21.4%) が転移陽性で,病理組織診断との一致率は,27 例(96.4%)であった.5 年累積生存率は,SLN 生検施行群94.4%,SLN 生検未施行群86.7%で,有意差はないもののSLN 生検施行群に高い傾向を示した.後発転移は,SLN 生検施行群にはなかったが,SLN 生検未施行群では23 例中3 例(13.0%) に認められ,有意に多かった.以上の結果より,舌扁平上皮癌においてもSLN 生検は有用で,OSNA 法による遺伝子解析は,その診断精度を高めると思われた.Background:Metastasis of cervical lymph node is the most important prognostic factor in oral cancer. In this study, we evaluated the efficacy of one-step nucleic acid amplification (OSNA) assay for intraoperative diagnosis of sentinel lymph node (SLN) metastasis compared with conventional examination in patients with carcinoma of the tongue. The aim of this study was to investigate availability of the genetic diagnosis in carcinoma of the tongue.Patients and Methods:We investigated patients with T1 and T2 squamous cell carcinoma of the tongue with a clinical diagnosis of N0 who underwent SLN biopsy (SLN group;n=28) in comparison with those who did not undergo SLN biopsy (non-SLN group;n=23). SLN biopsy consisted of not only intraoperative pathological examination, but also genetic analysis using the OSNA method.Results:Lymph node metastasis was detected in five of 28 patients in the SLN group( 17.9%). One discordant case was observed between pathological examination and OSNA assay. This case was positive metastatic lymph node according OSNA assay, but negative lymph node at pathological examination. Subsequent cervical lymph node metastasis was not seen in the SLN group, it was seen three patients in the non-SLN group( 13.0%). Five-year survival rate was higher in the SLN group (94.4 %) than the non-SLN group( 86.7%), but this difference was not significant.Conclusion:These results suggest that in early oral cancer, SLN biopsy is highly useful for detecting lymph node metastasis. The high accurate OSNA method can be used in intraoperative diagnosis as a tool for detecting metastasis in the sentinel lymph nodes of tongue carcinoma

カンセン セイ シンナイマクエン ハッショウ ニ オケル コウクウ ナイ サイキン ノ カンヨ

本研究では感染性心内膜炎(infective endocarditis:IE)発症における口腔内細菌の関与について検索した.IE 患者47 名の血中から検出された細菌の87.1%は口腔細菌であり,61.7%の患者が口腔内感染巣を有するか,抗菌薬予防投与なしで口腔内観血処置が施行されていた.また,IE 患者あるいはIE 発症リスク患者の27 名の口腔細菌(連鎖球菌とブドウ球菌)の薬剤感受性を検索したところ,92.3%はペニシリン系薬剤に対して感受性を示した.さらに,I E 患者9 名において血中細菌と口腔細菌の16S rRNA の遺伝子配列を決定することにより細菌種の同定を行った.その結果,血中から検出・同定された細菌は全て口腔に存在するStaphylococcus epidermidis とStreptococcus mitis group であった.また,血中細菌と口腔細菌の遺伝子配列は1 症例で100%一致し, 3 症例においては遺伝子配列の100%の一致は見られなかったが,細菌種グループまでは一致した.以上の結果より,IE 発症には口腔内の連鎖球菌とブドウ球菌が原因菌として重要であることが明らかとなった.また,IE 発症の予防には,口腔内感染巣の除去と日々の口腔ケアならびに口腔内の観血処置時には大量のペニシリン系薬剤の予防投与は有用であることが確認できた.In this study, we attempted to clarify the implication of the oral bacteria on the onset of infective endocarditis( IE). In the first experiment, oral bacteria could be found in the blood from 27 of the 47 patients( 57.4%) with IE. Furthermore, 29 of the patients( 61.7%) showed possible oral bacterial foci causing the bacteremia, and 8 of the patients (17.0 %) received the oral surgery or the dental treatment accompanying bleeding. In the second experiment, we isolated the oral bacteria( Staphylococci and Streptococci) from the 27 patients with IE or with high risk for the onset of IE, and determined the susceptibility for several anti-biotics. Ninety two point three percent of the bacteria showed susceptibility against penicillin G and its derivatives. In the third experiment, we identified the bacterial species isolated from oral cavity and blood in nine patients with IE by determining the DNA sequence of the 16S rRNA. The bacterial species isolated from blood in the patients with IE were Staphylococcus epidermidis or Streptococcus mitis group, which usually existed in the oral cavity. DNA sequence of the 16S rRNA in the bacteria( Staphylococcus epidermidis) from blood in one patient was completely identical to that from oral cavity. In three patients, although DNA sequence from blood was not completely identical to that from oral cavity, the species( Streptococcus mitis group) of the bacteria from blood and oral cavity were identical. These results suggest that oral Staphylococci and Streptococci play a crucial role on the onset of IE. Moreover, complete removal of the oral bacterial foci, daily oral care, and the administration of the large amount of penicillin before the oral surgery or the dental treatment accompanying bleeding might be effective to prevent the onset of IE

Three-dimensional Analysis the Mode of Invasion in Oral Squamous Cell Carcinoma and the Correlation Between its Results and the Expression of Matrix Metalloproteinases( MMPs)

われわれは口腔扁平上皮癌の浸潤様式に対してはじめて三次元解析による検討を行ない,その有用性について報告してきた.今回は,癌の浸潤・転移において重要な役割を担う細胞外マトリックス分解酵素のうち,Matrix metalloproteinase-2 (MMP-2),MMP-9 およびMembrane type 1 matrix metalloproteinase(MT1-MMP)の発現と三次元解析による浸潤様式との関係について検討を行ったので報告する.対象は獨協医科大学病院口腔外科で加療した口腔扁平上皮癌一次症例175 例のうち,三次元解析が可能であった根治的手術症例31 例を用いた.MMP-2,MMP-9 およびMT1-MMP のそれぞれの発現陽性率は38.7%,67.7%,100%であった.非連続型は連続型に比較し,MMPs の発現頻度は高く,また発現部位は腫瘍細胞だけでなく,間質の細胞にも発現していた.非連続型はMMPs が単独で,あるいは相互に作用しあい,び慢性に浸潤することが示唆された.今回の検討により,MMPs の発現と三次元解析による浸潤様式は密接に関連し,両者とも口腔癌の治療法の決定や予後予測に有用であることが示された.We studied the mode of invasion of oral squamous cell carcinoma( OSCC) by three-dimensional( 3-D) analysis for the first time and reported its clinical usefulness. The purpose of this study is to discuss the relationship between the expression of matrix metalloproteinase (MMP)-2, MMP-9and membrane type 1-metalloproteinase( MT1-MMP) and the mode of invasion of OSCC by 3-D analysis. In this present31 of 175 patients with OSCC treated with curative surgery at first were able to be examined. The expression ofMMP-2, MMP-9 and MT1-MMP was examined by immunohistochemical techniques. The rate of MMP-2 expressionwas 38.7%, MMP-9 67.7 % and MT1-MMP 100 % . The rates of the expression of MMPs were significantly higher in discontinuous type than in continuous type. The positive expression of MMPs were detected not only in tumor cells but also in stromal cells in discontinuous type. These results indicate that MMPs contribute to the diffused invasion of OSCC with discontinuous type independently or mutually.In conclusion, the mode of invasion of OSCC by 3-Danalysis is closely related with the expression of MMPs and they can be useful to planning therapeutic strategy and predicting prognosis of the patient with OSCC