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Brain abscesses most frequently occur because of bacterial dissemination from a primary lesion at a distant site or direct contiguous invasion from an adjacent site of infection. We examined serum and saliva cytokine levels in a brain abscess patient with severe periodontitis. A 66-year-old man with high-grade fever and right-sided paresis was hospitalized. Brain magnetic resonance imaging (MRI) revealed several nodules in his right parietal and occipital lobes. We also found increased leukocyte (10,532/ml) and cerebrospinal fluid white blood cell (235–7860 mm3) counts. Bacteriological examination of sputum showed Fusobacterium nucleatum and Prevotella. No ear, nose, throat, and gastrointestinal infections were observed. Severe periodontitis was noted. Bacteriological examination of the right maxilla showed Porphyromonas gingivalis, and we detected a high level of serum antibody to P. gingivalis. Broad-spectrum antimicrobial therapy, dental calculus removal, and intraoral remediation improved the patient’s general condition. Brain MRI at the time of discharge showed a decrease in the size of the nodules, and after three months, the level of serum antibody to P. gingivalis decreased. Elevated pro-inflammatory cytokines such as interleukin (IL)-1α and IL-1β and chemokines such as IL-8, macrophage chemoattractant protein-1 (MCP-1), granulocyte colony-stimulating factor (G-CSF), and vascular endothelial growth factor (VEGF) levels in the saliva significantly decreased after oral treatment. Similarly, elevated serum IL-1α, IL-1β, IL-8, MCP-1, eotaxin, regulated on activation, normal T-cell expressed and secreted (RANTES), VEGF, and tumor necrosis factor-alpha (TNF)-α levels decreased after oral treatment. These findings supported our hypothesis that periodontopathic bacteria produce inflammation cytokines, pro-inflammatory cytokines migrate from systemic circulation to the brain, and their expression increases, and transition of that response into an adaptive form might have been the etiology of brain abscess in our patient.

Objective Improvement of quality of life (QOL) by growth hormone (GH) therapy was not demonstrated in Japanese adult growth hormone deficiency (AGHD) patients by either the QOL Assessment of Growth Hormone Deficiency in Adults or the Questions on Life Satisfaction-Hypopituitarism, which are widely used to evaluate QOL in Western AGHD patients. We therefore evaluated QOL in Japanese AGHD patients receiving recombinant GH, Norditropin® (Novo Nordisk A/S, Denmark), using the newly developed Adult Hypopituitarism Questionnaire (AHQ). Design This multicenter, non-interventional, observational study in Japanese patients with severe AGHD was conducted from 1 October 2009 to 30 September 2014. Patients with severe AGHD already receiving somatropin and somatropin-naive patients were included. GH therapy (Norditropin®) was initiated as injections of 0.021 mg/kg/week divided into 6–7 doses/week, and was adjusted according to clinical responses. Demographic/clinical data were obtained from medical records or by patient recall. QOL was assessed using the AHQ at baseline; 3, 6, and 12 months; and annually up to 4 years. Results Of 387 registered patients, 161 were eligible for QOL analysis. AHQ scores significantly improved after 3 months of treatment. Improvements in the psycho-social and physical domains were statistically significant throughout the 4-year study period. Although the GH dose was increased in females such that insulin-like growth factor-1 levels reached those of males, QOL improvements in females did not reach those of males. Despite the greater GH dose in child-onset patients, limited QOL improvements were observed in child-onset vs adult-onset cases. Conclusions Four-year GH treatment in Japanese AGHD patients elicits sustained improvement in QOL as assessed by AHQ scores.

We aimed to evaluate the long-term safety and effectiveness of growth hormone (GH) therapy in Japanese patients with adult growth hormone deficiency (AGHD). In this observational, multicenter study, Norditropin® (Novo Nordisk A/S, Bagsvaerd, Denmark) was administered as injections of 0.021 mg/kg/week as a starting dose divided into 6-7 doses/week. The dose was increased according to clinical response. Patients' data were obtained from medical records. Measurements (lipids, glucose metabolism, and body composition) taken at baseline; 3, 6, and 12 months; and yearly until the end of the study were collected. Adverse drug reactions (ADRs), serious ADRs, and serious adverse events (SAEs) were evaluated. Of 387 registered patients, 334 were eligible for safety. After GH treatment initiation, a marked decrease in total cholesterol was observed earlier in the child-onset group than in the adult-onset group. LDL-cholesterol also decreased, but no significant differences in changes in LDL-cholesterol between adult-onset and child-onset groups were found. A significant increase in HDL-cholesterol starting 1 year after GH treatment initiation was found in the adult-onset group. There was no effect of GH treatment on glucose metabolism. Because of the small number of dual-energy X-ray absorptiometry data, the overall assessment of changes of body composition was difficult. Fifty-six (16.8%), 12 (3.6%), and 35 (10.5%) patients experienced ADRs, serious ADRs, and SAEs, respectively. This study demonstrated a favorable long-term safety and effectiveness profile of GH therapy in AGHD patients in the real-life Japanese clinical practice setting.

We report a case experiencing repeated common iliac artery (CIA) occlusion due to an unexpected stent deformation. A 74-year-old man with intermittent claudication had undergone balloon-expandable stenting for the left CIA. Six years after his first stent implantation, his left CIA was totally occluded inside the stent. We performed revascularization for the left CIA and achieved sufficient balloon inflation and balloon-expandable stenting. Then, one and a half years later, his left CIA was re-occluded. CT angiography showed compression by the protruding hyperostotic lumbar vertebral body, such that both stents had become deformed into a crescent shape. We were told that he had been using a powerful massage machine to stretch and relieve his spondylotic back pain. We suspected that the external pressure of the hyperostotic spondylosis and massage might have caused the CIA compression and repeated crush of the stents.

水酸化カルシウム製剤は,根未完成歯のアペキシフィケーションに用いる薬剤である.我々は,8歳の男児が転倒時に顔面を殴打し,右側上顎中切歯が完全脱臼した症例を経験した.脱臼歯は早急に整復固定したものの失活歯となり,同時に歯肉腫脹も認めたため,根管治療(アペキシフィケーション)が必要と診断された.根管内の失活歯髄を除去した後,市販の水酸化カルシウム製剤を適応した後,症状は速やかに改善した.今後約2～3年の経過観察の後,最終根管充填処置を行う必要があると考えられる., Calcium hydroxide is a suitable reagent for apexification procedures in immature permanent teeth. We report on a case of root apexification in a patient (8-yr, male) with a traumatic extrusion of the maxillary right central incisor. After temporary fixation of the traumatically extruded maxillary right central incisor, tooth necrosis and gingival swelling was observed , thus it was diagnosed to require an apexification procedure. The apexification procedure was successfully performed using calcium hydroxide following endodontic treatment. None of the calcium hydroxide -treated tooth showed any clinical or radiographic pathology. Additional follow-up time (2-3 years) is required to determine the final outcome of root canal therapy applied in cases of traumatized maxillary permanent incisor teeth with incomplete root formation.

This report describes two cases of gingival overgrowth which occurred around the anterior teeth. Two adult patients visited the Department of Periodontics for investigation and treatment of their gingival overgrowth. Case 1 : A 73-year-old female was receiving amlodipine for treatment of hypertension. A remarkable inflammation and overgrowth in the periodontal tissues was observed around the upper and lower anterior teeth. Histochemically, the epithelium was elongated and inflammatory cells were ubiquitously infiltrated in the connective tissue. An increase of collagen fibers was observed with the accumulation of fibroblasts. The initial treatment was successfully carried out, followed by flap operation with osteoplasty. After completing all the treatments, no gingival overgrowth was seen. Case 2 : A 34-year-old female with no systemic disease had an esthetical problem in the gingival tissues around the upper left central incisor. The gingival overgrowth was seen in the gingiva ranging from distal to mesial interdental papilla. Histochemical findings showed its cell-rich fibrous connective tissue, but no inflammatory changes were seen in either epithelial or subepithelial tissues. The gingivectomy was performed and the overgrowth vanished. Fortunately, both patients recovered healthy periodontal tissues without gingival overgrowth. It should be noted that dentists are expected to understand and solve true worries behind the chief complaint from each patient.

The photoreaction of Kemp's imide-linked coumarin 1 and thymine 3 gave two crossadducts, cis-syn 4 cis-anti 5. The yield and ratio of 45 in benzene solution remarkably increased by factors of 4.2 and 10 than those in acetonitrile solution, respectively. On the other hand, the reaction of acetoxycoumarin 2 and 3 gave only the cis-anti crossadduct in each solution.

Pustulosis palmaris et plantaris (PPP) is a chronic, inflammatory, autoimmune-type disease characterized by sterile pustules of skin. The skin inflammation is influenced by several factors such as drugs, sunlight, metabolic and psychogenic factors as well as metal allergy. Here, we report a rare case that intensive periodontal treatment might have contributed to the improvement of skin inflammation.Skin inflammation regressed 1 month after intensive periodontal treatment. Both CD4/CD8 ratio and % of B cells in the blood sample were slightly decreased corresponding to the improvement of periodontal inflammation.Infection control of periodontal lesions might be one of attractive therapeutic targets in management of PPP.

Cyclosporin A (CsA) is an immunosuppressant with side effects including gingival hyperplasia. Sarcoidosis is a systemic disease characterized by granulomas. Here, we report on a rare case of sarcoidosis with gingival hyperplasia to clarify whether clinical observation corresponds to in vitro results.Gingival fibroblasts (HGFs) were isolated from healthy gingiva and cultured with CsA. Total RNA was collected and expression of mRNAs examined using semi-quantitative RT-PCR analysis. Cathepsin B, D, and L expression in overgrown gingiva of the patient was examined by immunohistochemistry.Cathepsin D, L, and vascular endothelial growth factor (VEGF)165 mRNA were markedly suppressed in CsA-treated HGFs, whereas cathepsin B, matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) mRNA were not reduced. Next, the decrease of cathepsin B and L expression in enlarged gingiva was observed, whereas an increase of cathepsin D expression was observed. Clinically, the enlarged gingival lesions were fully resolved by performing oral infection control.Cathepsins regulation might be an important factor in the development of CsA-mediated gingival hyperplasia.

We performed several techniques for chronic total occlusion (CTO) lesions in peripheral arterial disease (PAD). We evaluated the cases using the metal tip catheter (MT). We performed peripheral endovascular therapy (EVT) using MT in 31 cases 32 lesions of PAD from March 2007 to March 2011. Twenty-nine cases were CTO lesions using MT for back up of guidewire or MT alone in order to penetrate like a bougie with the blunt tip of MT. Two cases were acute arterial thrombosis for thrombectomy. Seven cases were CTO of the iliac artery (IA) and 25 cases were of the femoral artery (FA). Seven cases were in-stent restenosis. All 7 cases of IA were successfully treated with the initial techniques. We were unable to penetrate by MT(MT-) in 7 cases of FA, and in 2 cases out of the 7, we were even unable to cross the guidewire. Mean lesion length was 80 ± 42 mm in IA and 188 ± 88 mm in SFA. Among them, MT- was 164 ± 67 mm with no significant differences. Procedure time of EVT for CTO using MT was significantly shorter than other strategies. We had no complications such as perforation by using MT. MT provides high initial success rate by spectacular penetration performance and pushability. MT is a safe and effective device for CTO in PAD.

The radial artery approach is becoming more popular for diagnostic cardiac catheterization and interventional procedures because of its lower incidence of access site complications and decreased patient discomfort after the procedure. However, Allen's test reveals inadequate blood supply through the ulnar artery to the hand, and therefore the approach does not seem to be suitable in 10%-30% of patients. Here we demonstrated a new percutaneous ulnar artery approach for coronary angiography in nine patients. We succeeded in obtaining an entry site into the left ulnar artery in seven patients. The average time for cannulation and that for catheterization procedure were comparable with those of the radial approach previously reported from other laboratories. Complications such as bleeding, loss of an ulnar pulse, ulnar nerve injury, and the formation of an aneurysm or fistula were not observed in any patient. The ulnar approach may be another technique that decreases patient discomfort and risk, while preserving the radial artery as a potential coronary bypass graft for surgical myocardial revascularization. Cathet Cardiovasc Intervent 2001;53:410-414.

A 28-year-old Filipina with complete atrio-ventricular block took a pacemaker implantation at Philippine in August, 1995. Her pacemaker was once exchanged due to loss of battery in July, 2002. In October, 2009, Filipino physician in charge pointed out less than 6 months of the lifetime of her pacemaker battery. In February, 2010, she consulted to our hospital. We checked the pacemaker, which model was Medtronic Sigma SS103. This pacemaker model was not approval in Japan, and there were some difficulties to understand the condition of pacemaker. We should know several pacemaker models in the world, which were not approval in Japan.

Oxidative cleavage of anispinacolone (An3C·CO·An, An=p-methoxyphenyl) with diaroyl peroxides proceeds by electron-transfer mechanism, which starts with rate-determining decomposition of the peroxide, unimolecular for dibenzoyl and bimolecular for bis(3,5-dinitrobenzoyl) peroxide.

The one-electron reduction of tropylium fluoroborate with Cr(II) was carried out in aqueous solution containing various anions (Cl−, Br−, SO42−, HSO4−, BF4− and ClO4−) which were added as proton acids or as sodium salts, and the reaction rate at 25°C was measured by the use of the flow method. It was found that Cl−, Br−, and SO42− exhibit the characteristic rate-accelerating effect, whereas BF4− and ClO4− show a slight rate-retarding effect. From the extrapolation of the anion concentration to zero, it was indicated that this reaction can proceed even in the absence of added anions. From these findings, together with the results of chemical and spectrophotometrical analyses of the Cr(III) species, it was concluded that the reduction of the tropylium ion with Cr(II) proceeds through an electron-transfer step where the anion (Cl−, Br−, or SO42−) or the water molecule acts as a weakly interacting electron-transfer bridge. This mechanism is essentially analogous to the “inner-sphere mechanism” known in the fi...

In order to make clear the effects of difference in planting time of sugar beet varieties on the bolting tirne, root weight and sucrose percentage, several experiments were carried out, the results being as follows. 1. Most of the easy-bolting varieties planted six times from August 10 to October 20 in Kagawa Prefecture, bolted in the middle of April. But non-bolting varieties as Klein-AA bolted on April 21 and Cesena NSA bolted on May 5. They were planted on September 4. The latter were they planted, the less often they bolted. When those two varieties were planted on October 20, there was found no bolter. 2. In the warm region of Japan as Kagawa Prefecture, cultivation of sugar beet in winter may be successful by using non-bolting varieties as Klein-AA and Cesena NSA and by seeding in September and harvesting before the rainny season of June. Considering from the bolting tendency of these non-bolting varieties the adequate time for harvest should be from the end of April to mid-May. It is very clear that the Italian type of sugar beet cultivation is very difficult to be practised, because of the excess rainfall in June and low temperature in winter in our country.

The one-electron reduction of the unsubstituted, methyl-, ethyl-, isopropyl-, t-butyl-, triphenylmethyl-, and phenyltropylium ions with Cr(II) in a 10% HCl solution gives, quantitatively, the dimer of the corresponding substituted tropyl radical. The measurements of the reaction rate at 25°C exhibit this order of reactivity: t-butyltropylium (k2=7.98 l/g·ion·sec), isopropyltropylium (8.22), ethyltropylium (10.3), methyltropylium (11.1), tropylium (74.0), phenyltropylium (144), and triphenylmethyltropylium (567) ions. The values of log k2 have a linear correlation with the transition energies of the charge-transfer bands observed for these carbonium ions with pyrene, and also with the polarographic half-wave potentials of the respective cations. These correlations indicate that the reactivity of the carbonium ion in the reduction with Cr(II) is determined mainly by the electron affinity inherent in the respective cations. The values of log k2 also have a good linear correlation with the pKR+ values, implyi...

The acid-induced oxidative cleavage of anispinacolone [1,2,2,2-tetrakis-(p-methoxyphenyl)ethanone] with diaroyl peroxides in 1,2-dichloroethane–trifluoroacetic acid (TFA) has been investigated. The principal two products after work-up are tris-(p-methoxyphenyl)methanol and p-methoxybenzoic acid; the latter was found as anhydrides in the reaction mixture. Free-radical formation in the course of the cleavage was verified by polymerization of added acrylonitrile in the oxidation by bis-(3,5-dinitrobenzoyl) peroxide. When the oxidation of [1,2-13C2]anispinacolone (90%13C) by dibenzoyl peroxide was carried out in a 13C n.m.r. probe, an emission peak, assigned to p-methoxybenzoic trifluoroacetic anhydride, was observed. The logarithms of the rate constants for oxidation of p-substituted benzpinacolones by dibenzoyl peroxide were linearly correlated with the oxidation potentials of the benzpinacolones. These results are consistent with a single-electron transfer (s.e.t.) pathway from benzpinacolones to dibenzoyl peroxide. The oxidation is first-order in each reactant and is promoted by TFA. The effect of TFA is accounted for by two factors, (i) assisted O–O bond cleavage of the peroxide radical anion by TFA, and (ii) the formation of protonated peroxide, a more powerful oxidizing species. The former factor is dominant at lower TFA concentrations (

1,2,2,2-Tetrakis-(p-methoxyphenyl)ethanone (anispinacolone)(1) is cleaved by dibenzoyl peroxide (2) or bis-(3,5-dinitrobenzoyl) peroxide (3), affording tris-(p-methoxyphenyl)methyl benzoate (or 3,5-dinitrobenzoate) and benzoic (or 3,5-dinitrobenzoic)p-methoxybenzoic anhydride as the principal cleavage products. 13C N.m.r. CIDNP studies by use of labelled anispinacolone (An3*C·*CO·An; *C 90%13C) indicated that p-methoxybenzoyl radical is formed, presumably by way of the radical cation [anispinacolone]+˙ which is produced by a single-electron transfer (s.e.t.) mechanism. The formation of the p-methoxybenzoyl radical was also indicated by spin-trapping experiments. The decomposition rates of (2) at 50.0°C are unaltered on addition of (1) in nonpolar solvents such as dichloromethane, chloroform, carbon tetrachloride, 1,2-dichloroethane, and benzene, whereas those of (3) are markedly accelerated. The cleavage of (1) by (2) is suppressed by added 3,4-dichlorostyrene by a factor of 6.7, whereas that of (1) by (3) is almost unaffected. These results suggest that in the case of dibenzoyl peroxide (2) the thermally produced benzoyloxyl radical works as a one-electron acceptor (or oxidant) upon (1), whereas when bis-(3,5-dinitrobenzoyl) peroxide (3) is used the peroxide molecular oxidizes (1), probably by way of an s.e.t. mechanism even in such nonpolar solvents. On the other hand, in polar solvents such as (CF3)2CHOH, tetramethylene sulphone, and acetonitrile the decomposition of (2) is accelerated by added anispinacolone, suggesting that the intermolecular s.e.t. reaction is partially involved in such polar solvents. Consequently, the oxidative cleavage of anispinacolone (1) by diaroyl peroxide provides the first example of dichotomy in the s.e.t. reaction of diaroyl peroxides, which can be considered a counterpart of the SN1–SN2 dichotomy in nucleophilic substitution, as far as the molecularity of the peroxide is concerned.

The acid-induced oxidative cleavage of anispinacolone [1,2,2,2-tetrakis-(p-methoxyphenyl)ethanone] with diaroyl peroxides in 1,2-dichloroethane–trifluoroacetic acid (TFA) has been investigated. The principal two products after work-up are tris-(p-methoxyphenyl)methanol and p-methoxybenzoic acid; the latter was found as anhydrides in the reaction mixture. Free-radical formation in the course of the cleavage was verified by polymerization of added acrylonitrile in the oxidation by bis-(3,5-dinitrobenzoyl) peroxide. When the oxidation of [1,2-13C2]anispinacolone (90%13C) by dibenzoyl peroxide was carried out in a 13C n.m.r. probe, an emission peak, assigned to p-methoxybenzoic trifluoroacetic anhydride, was observed. The logarithms of the rate constants for oxidation of p-substituted benzpinacolones by dibenzoyl peroxide were linearly correlated with the oxidation potentials of the benzpinacolones. These results are consistent with a single-electron transfer (s.e.t.) pathway from benzpinacolones to dibenzoyl peroxide. The oxidation is first-order in each reactant and is promoted by TFA. The effect of TFA is accounted for by two factors, (i) assisted O–O bond cleavage of the peroxide radical anion by TFA, and (ii) the formation of protonated peroxide, a more powerful oxidizing species. The former factor is dominant at lower TFA concentrations (

The stoicheiometry and kinetics of the CeIV oxidation of 1,2,2,2-tetrakis-(p-methoxyphenyl)ethanone (1a) have been investigated at 25.0 °C in acetic acid as solvent by the use of cerium(IV) ammonium nitrate as oxidant. The reaction occurs with the stoicheiometry 2 CeIV+ An3C·CO·An → 2 CeIII+ An3C++ An·CO+(An =p-methoxyphenyl), affording tris-(p-methoxyphenyl)methanol and anisic acid after work-up. The kinetics were monitored by u.v.–visible spectrophotometry of the tris-(p-methoxyphenyl)methyl cation, showing that the rate-determining step is first order in each reactant. Evidence was found for the formation of p-methoxybenzoyl radical by means of spin-trapping with 2,3,5,6-tetrakis(trideuteriomethyl)nitrosobenzene. The rate constants at 25.0 °C, the oxidation potential, as measured by cyclic voltammetry, and the charge transfer energy with tetracyanoethylene have been measured for five para-substituted benzpinacolones (substituents MeO, Me, and Cl), including (1a). A good correlation of the logarithms of the rates with the oxidation potentials or with the charge transfer energies was found, indicating that a single electron-transfer step between the substrate and CeIV is rate determining. The formation of a radical cation of the benzpinacolone in the rate-determining step and subsequent rapid cleavage into the triarylmethyl cation and the aroyl radical are proposed as a possible mechanism.