Changes in Corrected QT Interval May Be Associated with Clinical Responses in Burning Mouth Syndrome

Backgrounds: Burning mouth syndrome (BMS) is characterized by a burning sensation of the oral mucosa in the absence of underlying dental causes. Only a minority of BMS patients will achieve satisfactory pain relief and little is known about clinical makers for the response. The objective of this study was to consider whether corrected QT interval (QTc) is a useful biomarker for clinical responses. Methods: We conducted a single-center retrospective observational study and evaluated 51 BMS patients treated with amitriptyline. We calculated QTc changes with amitriptyline and examined the relationship between changes in QTc and visual analogue scale (VAS). Results: Of 51 subjects, 13 (25.5%) were amitriptyline-responders and 38 (74.5%) were non-responders. The changes in QTc interval were significantly correlated with changes in VAS (Spearman's rank correlation coefficient r = 0.389, p = 0.006). Conclusions: Changes in QTc interval may be a non-invasive estimation of clinical responses in BMS patients

Pharmacotherapeutic outcomes in atypical odontalgia : determinants of pain relief

Objectives: There has been considerable research which has focused on clarifying the origin of pain in patients with atypical odontalgia (AO), also known as “idiopathic toothache”, and on identifying effective treatment, but there has been limited success so far. In this study, we assessed the outcomes of treatment and attempted to identify factors that could account for pain remission in patients with AO. Patients and methods: Data for 165 patients diagnosed with AO from June 2015 to August 2017 were retrospectively reviewed. The patients’ sex, age, duration of pain, and psychiatric history were collected, along with information on pain intensity, depressive status, and catastrophizing scores. Responses at 4 and 16 weeks from the start of treatment were observed. The associations between potentially associated factors and outcome were investigated using Bayesian model averaging. Results: A 30% reduction in pain was reported by 38 patients (46.3%) at 4 weeks and by 54 patients (65.9%) at 16 weeks. The pain intensity decreased as the depression and catastrophizing score improved; all of the changes were statistically significant (P<0.001). Four elements, that is, patient sex, depression score at baseline, pain score at 4 weeks, and change in the catastrophizing score, explained 52.5% of the variation in final outcome between individual patients. Conclusion: Our findings confirm the efficacy of tricyclic antidepressants (TCAs) as a treatment for AO and indicate that other medications, especially aripiprazole used in combination with a TCA, may be useful. A considerable number of patients, especially women, those with lower levels of depression at baseline, and those who responded to 4 weeks of treatment, achieved pain relief

Burning Mouth Syndrome and Atypical Odontalgia

Objective: This study aimed (1) to investigate the differences in clinical characteristics of patients between 2 groups, those who have atypical odontalgia (AO) only and those who have AO with burning mouth syndrome (BMS), and (2) to assess the influence of psychiatric comorbidity factors on patients' experiences. Method: Medical records and psychiatric referral forms of patients visiting the Psychosomatic Dentistry Clinic of Tokyo Medical and Dental University between 2013 and 2016 were reviewed. The final sample included 2 groups of 355 patients: those who have AO only (n = 272) and those who have AO with BMS (AO-BMS; n = 83). Clinicodemographic variables (gender, age, comorbid psychiatric disorders, and history of headache or sleep disturbances) and pain variables (duration of illness, pain intensity, and severity of accompanying depression) were collected. Initial pain assessment was done using the Short-Form McGill Pain Questionnaire, and depressive state was determined using the Zung Self-Rating Depression Scale. Results: The average age, female ratio, and sleep disturbance prevalence in the AO-only group were significantly lower than those in AO-BMS group. AO-BMS patients rated overall pain score and present pain intensity significantly higher than did the AO-only patients (P = 0.033 and P = 0.034, respectively), emphasizing sharp (P = 0.049), hot-burning (P = 0.000), and splitting (P = 0.003) characteristics of pain. Patients having comorbid psychiatric disorders had a higher proportion of sleep disturbance in both groups and a higher proportion of depressive state in the AO-only group. Conclusions: AO-BMS patients have different epidemiological characteristics, sleep quality, and pain experiences compared to AO-only patients. The presence of psychiatric comorbidities in both groups may exacerbate sleep quality. We suggest that BMS as a comorbid oral disorder in AO patients contributes to a more intensively painful experience

Psychiatric comorbidities in patients with Atypical Odontalgia

Objective: Atypical Odontalgia (AO) is a condition characterized by tooth pain with no apparent cause. Although psychiatric comorbidity seems to be very common, it has rarely been studied. To clarify the influence of psychiatric comorbidity on the clinical features in patients with AO, we retrospectively evaluated their examination records. Methods: Clinical features and psychiatric diagnoses of 383 patients with AO were investigated by reviewing patients' medical records and referral letters. Psychiatric diagnoses were categorized according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). We also analyzed visual analogue scale (VAS), self-rating depression scale (SDS), and the short-form McGill pain questionnaire (SF-MPQ) scores. Results: Of the 383 patients with AO, 177 (46.2%) had comorbid psychiatric disorders. The most common were depressive disorders (15.4%) and anxiety disorders (10.1%). Serious psychotic disorders such as bipolar disorder (3.0%) and schizophrenia (1.8%) were rare. Dental trigger of AO was reported in 217 (56.7%) patients. There were no significant correlations between psychiatric comorbidities and most of the demographic features. Higher VAS and SDS scores, higher frequency of sleep disturbance, and higher ratings of “Fearful” and “Punishing-cruel” descriptors of the SF-MPQ were found in patients with psychiatric comorbidity. Conclusions: About half of AO patients had comorbid psychiatric disorders. Dental procedures are not necessarily causative factors of AO. In AO patients with comorbid psychiatric disorders, pain might have a larger emotional component than a sensory one. VAS, SDS, and SF-MPQ scores might aid in the noticing of underlying comorbid psychiatric disorders in AO patients

Comorbid depressive disorders and left-side dominant occlusal discomfort in patients with phantom bite syndrome

Background: Phantom bite syndrome (PBS) is characterised by occlusal discomfort without corresponding dental abnormalities. Despite repeated, failed dental treatments, patients with PBS persist in seeking bite correction. PBS has been regarded as a mental disorder. However, we have reported that PBS patients with a dental trigger tend to have less psychiatric history than those without. Hence, the symptoms of PBS cannot be explained by a mental disorder alone, and it is unclear if mental disorders affect occlusal sensation. Objective: To elucidate the pathophysiology of PBS, we analysed the dental history, PBS symptom laterality and psychiatric history of patients. Methods: In this retrospective study, we reviewed outpatients with PBS who presented at our clinic between April 2012 and March 2017. Their medical records were reviewed for demographic data, medical history and laterality of occlusal discomfort. Results: Approximately half of the 199 enrolled patients had bilateral occlusal discomfort. In the others, the side with occlusal discomfort generally tended to be the one that had received dental treatment. There was no significant relationship between the side chiefly affected by occlusal discomfort and whether dental treatment had been received; however, the affected side differed depending on whether the patient had comorbid psychiatric disorders (P = .041). Conclusions: The distributions of the side with symptoms of PBS were different between those with and without comorbid psychiatric disorders, suggesting that psychiatric disorders might affect occlusal sensation due to a subtle dysfunction in brain areas central to sensory integration. Central dysfunction might play an important role in PBS

Retrospective chart review of oral somatic delusions

Objective: Oral cenesthopathy is characterized by foreign body sensations without medical and dental evidence for them. It is thought to be a rare disease in psychiatry, but many patients are visiting dental clinics seeking treatment to remove a foreign body. Even though the features of oral cenesthopathy might be different between a psychiatric clinic and a dental clinic, there has been no clinico-statistical study from dentists. In this study, we report a clinico-statistical study of patients with oral cenesthopathy in dentistry. Methods: This is a retrospective chart review of 606 outpatients with oral cenesthopathy in Tokyo Medical and Dental University from April 2010 through to March 2015. Results: A total of 159 male and 447 female patients were included in this study. The mean age was 62.08 years, and female patients were older than male patients. The trigger of the dental treatment and the acute phase of depression at the onset were significantly related (p=0.037). Only 128 patients (36%) had clinically significant improvement after 6 months of pharmacotherapy. No history of psychiatric disorders (odds ratio [OR] 0.479 [95% confidence interval {CI}: 0.262–0.875], p=0.017) and longer duration of illness (>18 months) (OR 2.626 [95% CI: 1.437–4.799], p=0.002) were significant factors for clinical outcomes. Conclusion: Patients with oral cenesthopathy in our clinic were predominantly elderly female patients. Dental treatment in the acute phase of depression might be a risk factor for oral cenesthopathy. Therefore, comprehending the situation of psychiatric disorder and obtaining adequate informed consent might be required to prevent the trouble concerning oral cenesthopathy

Effect of Heart Failure on Long‐Term Clinical Outcomes After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Severe Coronary Artery Disease

[Background] Heart failure might be an important determinant in choosing coronary revascularization modalities. There was no previous study evaluating the effect of heart failure on long‐term clinical outcomes after percutaneous coronary intervention (PCI) relative to coronary artery bypass grafting (CABG). [Methods and Results] Among 14 867 consecutive patients undergoing first coronary revascularization with PCI or isolated CABG between January 2011 and December 2013 in the CREDO‐Kyoto PCI/CABG registry Cohort‐3, we identified the current study population of 3380 patients with three‐vessel or left main coronary artery disease, and compared clinical outcomes between PCI and CABG stratified by the subgroup based on the status of heart failure. There were 827 patients with heart failure (PCI: N=511, and CABG: N=316), and 2553 patients without heart failure (PCI: N=1619, and CABG: N=934). In patients with heart failure, the PCI group compared with the CABG group more often had advanced age, severe frailty, acute and severe heart failure, and elevated inflammatory markers. During a median 5.9 years of follow‐up, there was a significant interaction between heart failure and the mortality risk of PCI relative to CABG (interaction P=0.009), with excess mortality risk of PCI relative to CABG in patients with heart failure (HR, 1.75; 95% CI, 1.28–2.42; P<0.001) and no excess mortality risk in patients without heart failure (HR, 1.04; 95% CI, 0.80–1.34; P=0.77). [Conclusions] There was a significant interaction between heart failure and the mortality risk of PCI relative to CABG with excess risk in patients with heart failure and neutral risk in patients without heart failure

Preliminary report of marine macrofauna of Nishinoshima Island

2021年7月に西之島周囲の海洋環境および海洋生物相調査を行った。西之島の西側の海域では噴火の影響と思われる変色域が確認され、北側の海底は火山灰で覆われており、3m以上の溶岩様の岩や噴石と思われる尖った岩石が点在していた。本調査では、14門253種以上が主に西之島北側の海岸および海域より確認された。底生生物の多様性は低く、大型の海藻類やサンゴ類は確認されなかった。海底の岩石上に特に付着数が多かったものはヒドロ虫類とコケムシ類であった。これらは海底の裸地における群集形成の初期に加入する分類群であることから、今回観察した西之島周辺の海底環境は、群集の再生初期の状態であると考えられる。また、プランクトンの生物量が非常に少なく、貧栄養状態であり、底生生物の幼生はプランクトン全体の1.5%にすぎなかった。以上から、西之島への底生生物の加入と定着については時間がかかると思われる。しかしその一方で、2020年7月の大規模噴火後においても、西之島周辺の水深の深い場所には、元の生物群集が残っている可能性があり、そこからの幼生加入があれば、より早く生物の遷移がすすむと思われる。本調査では、海洋島における生態系の一次遷移の初期段階を記録できた。今後は、西之島周辺の深海域および、周辺の海流の状況や各生物種の繁殖シーズンなども考慮に入れ、海洋島である西之島の一次遷移のモニタリングを定期的に行うことが必要と思われる。The environment and marine macrofauna around Nishinoshima Island were investigated in July 2021. Muddy seawater was observed west of the island, probably due to the volcanic eruption. The seabed off the island's north was covered by volcanic ash and lava over 3 m, and pointed rocks that looked like volcanic bombs dotted the area. During this survey, over 253 species in 14 phyla were observed, mainly on the northern beach and in the northern sea. The biodiversity of benthic animals was low; therefore, macroalgae and corals were not observed. Hydrozoa and Bryozoa were abundant on the seabed rocks. Since they advance on the bare seabed when the marine benthic ecosystem recovers, this indicates that the benthic fauna around Nishinosima is in the early conveyed status of recovery. The plankton biomass was very low due to the poor nutrient content, and larvae of benthic animals were only 1.5 % of all plankton. From the above, it will take time for new benthic animals to occupy the area and gain a foothold in the marine ecosystem around Nishinoshima. It is possible that the benthic fauna will remain in the deep sea near the island after the eruption in July 2020. If benthic animal larvae move in from the deep sea, the primary succession will advance faster. In this study, the primary succession status of the marine ecosystem around Nishinoshima was confirmed. Future studies should monitor the primary succession around oceanic island Nishinoshima regularly, concerning the deep sea, the current around it, and the breeding season of each species.departmental bulletin pape

Reading the Fine Print: Ultra-Microstructures of Foraminiferal Calcification Revealed Using Focused Ion Beam Microscopy

The elemental composition of calcite is of critical value in paleoceanographic reconstructions, yet little is known about biological processes underlying elemental uptake by foraminifers during calcification. Especially crucial in the understanding of elemental composition and distribution is the involvement of organic templates separating different layers of calcite forming the wall of a foraminiferal chamber. In this study, we applied the focused ion beam (FIB) scanning electron microscopy (SEM) technique to the site of calcification (SOC) in a newly growing chamber of Ammonia “beccarii”, a benthic foraminifer, to reveal the ultra- and microstructure during calcification. This allowed cross-sections of both soft and hard tissues, allowing detailed observation of the SOC across a series of calcification stages. For the first time, we show that numerous voids of calcareous layers and internal organic structures are present within the SOC during the calcification process. The series of SEM observations suggest that organic layers are actively involved in calcite precipitation. We provide the first evidence that the SOC is isolated from surrounding seawater during calcification. Our findings improve the understanding of foraminiferal biomineralization and characterize key conditions under which element partitioning and isotope fractionation occur