350 research outputs found
Facial reanimation with masseter nerve–innervated free gracilis muscle transfer in established facial palsy patients
Background The masseter nerve is a useful donor nerve for reconstruction in patients with established facial palsy, with numerous advantages including low morbidity, a strong motor impulse, high reliability, and fast reinnervation. In this study, we assessed the results of masseter nerve–innervated free gracilis muscle transfer in established facial palsy patients. Methods Ten patients with facial palsy who received treatment from January 2015 to January 2017 were enrolled in this study. Three patients received masseter nerve–only free gracilis transfer, and seven received double-innervated free gracilis transfer (masseter nerve and a cross-face nerve graft). Patients were evaluated using the Facial Assessment by Computer Evaluation software (FACEgram) to quantify oral commissure excursion and symmetry at rest and when smiling after muscle transfer. Results The mean time between surgery and initial movement was roughly 167.7 days. A statistically significant increase in excursion at rest and when smiling was seen after muscle transfer. There was a significant increase in the distance of oral commissure excursion at rest and when smiling. A statistically significant increase was observed in symmetry when smiling. Terzis’ functional and aesthetic grading scores showed significant improvements postoperatively. Conclusions Masseter nerve innervation is a good option with many uses in in established facial palsy patients. For some conditions, it is the first-line treatment. Free gracilis muscle transfer using the masseter nerve has excellent results with good symmetry and an effective degree of recovery
High Extracellular Calcium Increased Expression of Ank, PC-1 andOsteopontin in Mouse Calvarial Cells
In the process of bone remodeling, mineral phase of bone
is dissolved by osteoclasts, resulting in elevation of calcium
concentration in micro-environment. This study was performed
to explore the effect of high extracellular calcium
(Ca
2+
e) on mineralized nodule formation and on the expression
of progressive ankylosis (Ank), plasma cell membrane
glycoprotein-1 (PC-1) and osteopontin by primary cultured
mouse calvarial cells. Osteoblastic differentiation and mineralized
nodule formation was induced by culture of mouse
calvarial cells in osteoblast differentiation medium containing
ascorbic acid and β-glycerophosphate. Although Ank, PC-1
and osteopontin are well known inhibitors of mineralization,
expression of these genes were induced at the later stage of
osteoblast differentiation during when expression of osteocalcin,
a late marker gene of osteoblast differentiation, was
induced and mineralization was actively progressing. High
Ca
2+
e (10 mM) treatment highly enhanced mRNA expression
of Ank, PC-1 and osteopontin in the late stage of osteoblast
differentiation but not in the early stage. Inhibition of p44/42
MAPK activation but not that of protein kinase C suppressed
high Ca
2+
e-induced expression of Ank, PC-1 and
osteopontin. When high Ca
2+
e (5 mM or 10 mM) was present
in culture medium during when mineral deposition was
actively progressing, matrix calcifiation was significantly
increased by high Ca
2+
e. This stimulatory effect was abolished
by pyrophosphate (5 mM) or levamisole (0.1-0.5 mM), an
alkaline phosphatase inhibitor. In addition, probenecid (2mM),
an inhibitor of Ank, suppressed matrix calcification in both
control and high Ca
2+
e-treated group, suggesting the possible
role of Ank in matrix calcification by osteoblasts. Taken
together, these results showed that high Ca
2+
e stimulates expression of Ank, PC-1 and osteopontin as well as matrix
calcification in late differentiation stage of osteoblasts and
that p44/42 MAPK activation is involved in high Ca
2+
e-
induced expression of Ank, PC-1 and osteopontin
Identification of genes modulated by high extracellular calcium in coculuture of mouse osteoblasts and bone marrow cells by oligo chip assay
Calcium concentration in the bone resorption lacunae is
high and is in the mM concentration range. Both osteoblast
and osteoclast have calcium sensing receptor in the cell
surface, suggesting the regulatory role of high extracellular
calcium in bone metabolism. In vitro, high extracellular
calcium stimulated osteoclastogenesis in coculture of mouse
osteoblasts and bone marrow cells. Therefore we examined
the genes that were commonly regulated by both high
extracellular calcium and 1,25(OH)2vitaminD3 (VD3) by
using mouse oligo 11 K gene chip. In the presence of 10 mM
[Ca2+]e or 10 nM VD3, mouse calvarial osteoblasts and bone
marrow cells were co-cultured for 4 days when tartrate
resistant acid phosphatase-positive multinucleated cells
start to appear. Of 11,000 genes examined, the genes
commonly regulated both by high extracellular calcium and
by VD3 were as follows; 1) the expression of genes which
were osteoclast differentiation markers or were associated
with osteoclastogenesis were up-regulated both by high
extracellular calcium and by VD3; trap, mmp9, car2, ctsk,
ckb, atp6b2, tm7sf4, rab7, 2) several chemokine and
chemokine receptor genes such as sdf1, scya2, scyb5, scya6,
scya8, scya9, and ccr1 were up-regulated both by high
extracellular calcium and by VD3, 3) the genes such as
mmp1b, mmp3 and c3 which possibly stimulate bone
resorption by osteoclast, were commonly up-regulated, 4)
the gene such as c1q and msr2 which were related with
macrophage function, were commonly down-regulated, 5)
the genes which possibly stimulate osteoblast differentiation and/or mineralization of extracellular matrix, were
commonly down-regulated; slc8a1, admr, plod2, lox, fosb, 6)
the genes which possibly suppress osteoblast differentiation
and/or mineralization of extracellular matrix, were commonly
up-regulated; s100a4, npr3, mme, 7) the genes such
as calponin 1 and tgfbi which possibly suppress osteoblast
differentiation and/or mineralization of extracellular matrix,
were up-regulated by high extracellular calcium but were
down-regulated by VD3. These results suggest that in
coculture condition, both high extracellular calcium and
VD3 commonly induce osteoclastogenesis but suppress
osteoblast differentiation/mineralization by regulating the
expression of related genes.본 연구는 보건복지부 보건의료기술진흥사업의 지원에
의하여 이루어진 것임(03-PJ1-PG3-20500-0013)
The Expression of Matrix Metalloprotease 20 is Stimulated by Wild Type but not by 4 bp- or 2 bp- Deletion Mutant DLX3
Mutations in DLX3 are associated with both autosomal
dominant hypoplastic hypomaturation amelogenesis
imperfecta (ADHHAI) and tricho-dento-osseous (TDO)
syndrome. ADHHAI is caused by a c.561_562delCT (2bpdel
DLX3) mutation whereas TDO syndrome is associated
with a c.571_574delGGGG (4bp-del DLX3) mutation.
However, although the causal relationships between DLX3
and an enamel phenotype have been established, the
pathophysiological role of DLX3 mutations in enamel
development has not yet been clarified. In our current study,
we prepared expression vectors for wild type and deletion
mutant DLX3 products (4bp-del DLX3, 2bp-del DLX3) and
examined the effects of their overexpression on the
expression of the enamel matrix proteins and proteases.
Wild type DLX3 enhanced the expression of matrix
metalloprotease 20 (MMP20) mRNA and protein in murine
ameloblast-like cells. However, neither a 4bp-del nor 2bpdel
DLX3 increased MMP20 expression. Wild type DLX3,
but not the above DLX3 mutants, also increased the activity
of reporters containing 1.5 kb or 0.5 kb of the MMP20
promoter. An examination of protein stability showed that
the half-life of wild type DLX3 protein was less than 12 h
whilst that of both deletion mutants was longer than 24 h.
Endogenous Dlx3 was also found to be continuously
expressed during ameloblast differentiation. Since
inactivating mutations in the gene encoding MMP20 are
associated with amelogenesis imperfecta, the inability of
4bp-del or 2bp-del DLX3 to induce MMP20 expression
suggests a possible involvement of such mutations in the enamel phenotype associated with TDO syndrome or
ADHHAI
Tricho-dento-osseous Syndrome Mutant Dlx3 Shows Lower Transactivation Potential but Has Longer Half-life than Wild-type Dlx3
Dlx3 is a homeodomain protein and is known to play a role
in development and differentiation of many tissues. Deletion
of four base pairs in DLX3 (NT3198) is causally related to
tricho-dento-osseous (TDO) syndrome (OMIM #190320), a
genetic disorder manifested by taurodontism, hair abnormalities,
and increased bone density in the cranium. The
molecular mechanisms that explain the phenotypic characteristics
of TDO syndrome have not been clearly determined.
In this study, we examined phenotypic characteristics of
wild type DLX3 (wtDlx3) and 4-BP DEL DLX3 (TDO mtDlx3)
in C2C12 cells. To investigate how wtDlx3 and TDO mtDlx3
differentially regulate osteoblastic differentiation, reporter
assays were performed by using luciferase reporters containing
the promoters of alkaline phosphatase, bone sialoprotein or
osteocalcin. Both wtDlx3 and TDO mtDlx3 enhanced
significantly all the reporter activities but the effect of
mtDlx3 was much weaker than that of wtDlx3. In spite of
these differences in reporter activity, electrophoretic mobility
shift assay showed that both wtDlx3 and TDO mtDlx3
formed similar amounts of DNA binding complexes with
Dlx3 binding consensus sequence or with ALP promoter
oligonucleotide bearing the Dlx3 binding core sequence.
TDO mtDlx3 exhibits a longer half-life than wtDlx3 and it
corresponds to PESTfind analysis result showing that
potential PEST sequence was missed in carboxy terminal of
TDO mtDlx3. In addition, co-immunoprecipitation demonstrated
that TDO mtDlx3 binds to Msx2 more strongly than
wtDlx3. Taken together, though TDO mtDlx3 acted as a
weaker transcriptional activator than wtDlx3 in osteoblastic cells, there is possibility that during in vivo osteoblast
differentiation TDO mtDlx3 may antagonize transcriptional
repressor activity of Msx2 more effectively and for longer
period than wtDlx3, resulting in enhancement of osteoblast
differentiation
Two cases of female hydrocele of the canal of nuck
The processus vaginalis within the inguinal canal forms the canal of Nuck, which is a homolog of the processus vaginalis in women. Incomplete obliteration of the processus vaginalis causes indirect inguinal hernia or hydrocele of the canal of Nuck, a very rare condition in women. Here, we report 2 cases of hydrocele of the canal of Nuck that were diagnosed with ultrasonography in both cases and magnetic resonance imaging in 1 case to confirm the sonographic diagnosis. High ligation and hydrocelectomy were conducted in both patients. In 1 patient, 14 months later, the occurrence of contralateral inguinal hernia was suspected, but did not require surgery. The other patient had a history of surgery for left inguinal hernia 11 months before the occurrence of right hydrocele of the canal of Nuck. In both cases, the occurrence of an inguinal hernia on the contralateral side was noted
Endoscopic Thyroidectomy via an Axillo-Breast Approach without Gas Insufflation for Benign Thyroid Nodules and Micropapillary Carcinomas: Preliminary Results
PURPOSE: To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo- breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas.
MATERIALS AND METHODS: The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups.
RESULTS: In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group).
CONCLUSION: ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.ope
CASS (CyanoAcrylate closure versus Surgical Stripping for incompetent saphenous veins) study: a randomized controlled trial comparing clinical outcomes after cyanoacrylate closure and surgical stripping for the treatment of incompetent saphenous veins
Background
Several modalities are used for the treatment of varicose veins. Open surgical treatment with ligation and stripping of the saphenous vein has been the standard of care for many years. Endovenous thermal ablation has been shown to be a safe and effective alternative with high, long-term, target-vein closure rates. Despite this, there is the possibility of thermal injury to surrounding structures. The recently introduced cyanoacrylate closure is also considered to be a good alternative and the risk of injury to surrounding structures is minimal. The purpose of this study is to demonstrate the non-inferiority of cyanoacrylate closure with the VenaSeal™ closure system compared to surgical stripping in terms of clinical outcomes for the treatment of incompetent great saphenous veins.
Methods/design
This is an open-label, multicenter, prospective, randomized controlled trial evaluating the non-inferior clinical outcomes of cyanoacrylate closure compared to surgical stripping for the treatment of incompetent saphenous veins. After baseline measurements, participants will be randomly allocated into either the cyanoacrylate closure group or the surgical-stripping group. The primary endpoint of the study is the complete closure rate of the target vein in the cyanoacrylate closure group, and the absence of venous reflux or residual venous tissue after surgical stripping in the surgical-stripping group. These endpoints will be measured by Doppler ultrasound performed by qualified vascular technologists or investigators at 3 months after treatment. Secondary outcomes include perioperative pain, postoperative ecchymosis, clinical assessment (including general and disease-specific quality of life evaluations), complete closure rate, and absence of venous reflux or residual venous tissue at the 12- and 24-month follow-ups, as well as all adverse event rates during the 24-month follow-up period.
Discussion
This multicenter randomized controlled trial is designed to show non-inferiority in terms of complete closure rate of cyanoacrylate compared to surgical stripping for the treatment of incompetent saphenous veins.
Trial registration
Clinical Research Information Service (CRIS), ID: KCT0003203. Registered on 20 September 2018.This is an investigator-sponsored study supported by a grant from Medtronic Korea Co., Ltd
Additional Effects of Back-Shu Electroacupuncture and Moxibustion in Cardioprotection of Rat Ischemia-Reperfusion Injury
Many preclinical studies show that electroacupuncture (EA) on PC6 and ST36 can reduce infarct size after ischemia-reperfusion (IR) injury. Yet studies to enhance the treatment effect size are limited. The purpose of this study was to explore whether EA has additional myocardial protective effects on an ischemia-reperfusion (IR) injury rat model when back-shu EA and moxibustion are added. SD rats were divided into several groups and treated with either EA only, EA + back-shu EA (B), or EA + B + moxibustion (M) for 5 consecutive days. Transthoracic echocardiography and molecular and immunohistochemical evaluations were performed. It was found that although myocardial infarct areas were significantly lower and cardiac function was also significantly preserved in the three treatment groups compared to the placebo group, there were no additional differences between the three treatment groups. In addition, HSP20 and HSP27 were expressed significantly more in the treatment groups. The results suggest that adding several treatments does not necessarily increase protection. Our study corroborates previous findings that more treatment, such as prolonging EA duration or increasing EA intensity, does not always lead to better results. Other methods of increasing treatment effect size should be explored
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