Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction

From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphyxia by affecting the upper airway. Therefore, we assessed the morphological changes of the upper airway following maximal opening of the mouth. In 13 healthy adult volunteers, the sagittal diameter of the upper airway on lateral cephalogram was measured between the two conditions; closed mouth and maximally open mouth. The dyspnea in each state was evaluated by a visual analog scale. In one subject, a computed tomograph (CT) was taken to assess the three-dimensional changes in the upper airway. A significant difference was detected in the mean sagittal diameter of the upper airway following use of the prop (closed mouth: 18.5 ± 3.8 mm, maximally open mouth: 10.4 ± 3.0 mm). All subjects indicated upper airway constriction and significant dyspnea when their mouth was maximally open. Although a CT scan indicated upper airway constriction when the mouth was maximally open, muscular compensation was admitted. Our results further indicate that the maximal opening of the mouth narrows the upper airway diameter and leads to dyspnea. The use of a prop for the patient who has communication problems or poor neuromuscular function can lead to asphyxia. When the prop is used for patient refusal in dentistry, the respiratory condition should be monitored strictly, and it should be kept in mind that the “sniffing position” is effective for avoiding upper airway constriction. Practitioners should therefore consider applying not only systematic desensitization, but also general anesthesia to the patient who refuses treatment, because the safety of general anesthesia has advanced, and general anesthesia may be safer than the use of a prop and restraints

OSA-HCIM: On-The-Fly Saliency-Aware Hybrid SRAM CIM with Dynamic Precision Configuration

Computing-in-Memory (CIM) has shown great potential for enhancing efficiency and performance for deep neural networks (DNNs). However, the lack of flexibility in CIM leads to an unnecessary expenditure of computational resources on less critical operations, and a diminished Signal-to-Noise Ratio (SNR) when handling more complex tasks, significantly hindering the overall performance. Hence, we focus on the integration of CIM with Saliency-Aware Computing -- a paradigm that dynamically tailors computing precision based on the importance of each input. We propose On-the-fly Saliency-Aware Hybrid CIM (OSA-HCIM) offering three primary contributions: (1) On-the-fly Saliency-Aware (OSA) precision configuration scheme, which dynamically sets the precision of each MAC operation based on its saliency, (2) Hybrid CIM Array (HCIMA), which enables simultaneous operation of digital-domain CIM (DCIM) and analog-domain CIM (ACIM) via split-port 6T SRAM, and (3) an integrated framework combining OSA and HCIMA to fulfill diverse accuracy and power demands. Implemented on a 65nm CMOS process, OSA-HCIM demonstrates an exceptional balance between accuracy and resource utilization. Notably, it is the first CIM design to incorporate a dynamic digital-to-analog boundary, providing unprecedented flexibility for saliency-aware computing. OSA-HCIM achieves a 1.95x enhancement in energy efficiency, while maintaining minimal accuracy loss compared to DCIM when tested on CIFAR100 dataset

歯槽骨内における局所麻酔薬の注射位置の差異は麻酔薬の浸潤と作用に影響する

付着歯肉や歯槽粘膜に麻酔薬を注入した際の顎骨への麻酔作用を、ウサギを用いた実験で評価した。30羽の日本白色ウサギを5%セボフルランで全身麻酔して、動脈圧モニタリングのための大腿動脈カニューレ挿入と気管切開術を行い3%セボフルランで維持した。上顎第三大臼歯頬域の右側付着歯肉と左側歯槽粘膜に0.5mLの局所麻酔薬(1/80000アドレナリンを含む2%リドカイン)を注入し、5～30分後に両側歯槽骨を除去すると共に、動脈圧を測定した。局所麻酔薬注入から30分後における平均動脈圧の変化は付着歯肉で14.0mmHg、歯槽粘膜で40.0mmHgであり、その時点での歯槽骨内のHPLCで計測したリドカイン濃度は付着歯肉で131.8μg/g、歯槽粘膜で11.4μg/gであった。また浸潤性麻酔薬の平均注入圧は付着歯肉で450.4mmHg、歯槽粘膜で80.1mmHgであった。動脈圧の大きな変化は低いリドカイン骨内濃度と相関しており、付着歯肉への浸潤性麻酔薬注入は、たとえ注入圧力の観点から困難であっても、顎骨内のリドカインレベルが直ちに上昇して強い鎮痛作用が得られることが分かった

Incidence and Risk Factors of Hypomagnesemia in Head and Neck Cancer Patients Treated with Cetuximab

Background Hypomagnesemia is a common adverse event during cetuximab (Cmab) treatment. However, few reports have investigated the incidence and risk factors of hypomagnesemia in head and neck cancer patients treated with Cmab. Methods We retrospectively reviewed 131 head and neck cancer patients who received Cmab-containing therapy. Main eligibility criteria were ≥3 Cmab administrations, no prior EGFR-directed therapy, and no prophylactic Mg supplementation.Results Median baseline serum Mg level and number of Cmab administrations were 2.2 mg/dl and eight, respectively. Overall incidence of hypomagnesemia was 50.4% (grade 1, 46.6%; grade 2, 3.1%; grade 3, 0%; grade 4, 0.8%) and differed between patients treated with palliative chemotherapy and bioradiation (Cmab and radiation) (63% vs. 24%; p<0.01). Independent risk factors were low baseline serum Mg [Odds ratio (OR) 161.988, 95% confidence interval (CI) 9.436-2780.895], ≥7 Cmab administrations (OR 3.56, 95% CI 1.16-13.98), and concurrent administration of platinum (cisplatin; OR 23.695, 95% CI 5.219-107.574, carboplatin; OR 5.487, 95% CI 1.831-16.439). Respective incidence of hypomagnesemia in patients in high- (concurrent platinum and ≥7 Cmab administrations) and low-risk (no concurrent platinum and <7 Cmab administrations) groups was 66.0% and 6.6% (P<0.001, OR 28.0). Conclusion Cmab is associated with a significant risk of hypomagnesemia in patients with head and neck cancer with longer term administration and concurrent platinum therapy. High-risk patients should be treated with particular care

Effects of Microstructure and Hardness on Fatigue Limit

博士（学術）琉球大

Availability of a remote online hemodynamic monitoring system during treatment in a private dental office for medically high-risk patients

The importance of systemic management to prevent accidents is increasing in dentistry because co-morbid illnesses in an aging society and invasive surgical procedures are increasing. In this prefecture, a new medical system called the remote online hemodynamic monitoring system (ROHMs) was started in 2001. Eight private dental offices participated in this trial. When dental practitioners feel the risk of a dental procedure, they can contact via ROHMs to this hospital. Then, the hemodynamic data (blood pressure, heart rate, ECG, SpO2, and RPP) of the patient in the clinic can be transmitted here via the internet, and the images and the voice can be transmitted as well. The availability of this system was assessed in 66 patients (98 cases). The most frequent complications were hypertension, heart disease, and diabetes mellitus. Systemic management included monitoring during the dental procedure (71.4%), checking vital signs after an interview (15.3%), and monitoring under sedation (13.3%). There were 35.7% of all cases where an unscheduled procedure was necessary for the systemic management. Based on a questionnaire, the majority of the patients felt relieved and safe. This system creates a situation where a specialist is almost present during the procedure. This system will provide significant assistance for future medical cooperation for risk management

Advantage of Insulin Glulisine Over Regular Insulin in Patients With Type 2 Diabetes and Severe Renal Insufficiency

ObjectivesTo compare the efficacy and safety of insulin glulisine over regular insulin in patients with type 2 diabetes and severe renal insufficiency.SubjectsOur study included 18 patients with type 2 diabetes and a mean (range) estimated glomerular filtration rate of 13.2 mL/minute/1.73 m2 (5.8-27.6), which corresponds to stage 4-5 chronic kidney disease.DesignAfter titration of doses, regular insulin was administered thrice daily on Day 1, along with continuous glucose monitoring for 24 h starting at 7 am. Exactly equal doses of insulin glulisine were administered on Day 2. Area under the curve (AUC) for blood glucose level variation after breakfast (AUC-B 0-4), lunch (AUC-L 0-6), and dinner (AUC-D 0-6) were evaluated.ResultsAUC-B 0-4 and AUC-D 0-6 were significantly lower with insulin glulisine than with regular insulin (AUC-B 0-4: 3.3 ± 4.7 vs. 6.2 ± 5.4 × 102 mmol/L·minute, respectively, P = .028; AUC-D 0-6: 1.8 ± 7.3 vs. 6.5 ± 6.2 × 102 mmol/L·minute, respectively, P = .023). In contrast, AUC-L 0-6 was higher with insulin glulisine than with regular insulin (AUC-L 0-6: 7.6 ± 6.4 vs. 4.2 ± 8.7 × 102 mmol/L·minute, respectively, P = .099), suggesting a prolonged hypoglycemic action of regular insulin after lunch.ConclusionsInsulin glulisine effectively suppressed postprandial hyperglycemia, whereas regular insulin caused a prolonged hypoglycemic action. These findings support the effectiveness and safety of insulin glulisine in patients with type 2 diabetes and severe renal insufficiency