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Background/purpose: Tooth extraction has been avoided in patients receiving antiresorptive agent (ARA) therapy. This study aimed to investigate dental findings associated with medication-related osteonecrosis of the jaw (MRONJ) development in patients. Materials and methods: First, in patients treated with high-dose ARAs, the relationship between dental findings and MRONJ development was examined. Next, in patients with MRONJ undergoing surgery, the relationship between dental findings and MRONJ occurring at a site distant from the initial site was examined. Results: MRONJ occurred in 13 of 172 patients (80 of 3725 teeth) during observation. Multiple tooth loss, periodontal ligament space enlargement, alveolar bone loss, periapical osteosclerosis, and local infection symptoms were associated with MRONJ development. Tooth extraction significantly reduced MRONJ development. Regarding other-site recurrence, new MRONJ developed at other sites in 54 of 357 patients with MRONJ (171 of 5038 teeth). Multiple tooth loss, apical lesions, periodontal ligament space enlargement, and periapical osteosclerosis were significantly associated with MRONJ development. In patients with malignant tumors, tooth extraction significantly reduced the subsequent incidence of MRONJ, while in patients with osteoporosis, there was no difference in the incidence of MRONJ between patients with and without tooth extraction. Conclusion: MRONJ was more likely to develop from teeth with local infections. Extraction of teeth with local infection in patients with malignancy may be more effective than tooth preservation in preventing MRONJ.

Background /purpose: The standard treatment for medication-related osteonecrosis of the jaw (MRONJ) is surgery. However, reports on the appropriate extent of bone resection are few. We aimed to examine the relationship between the extent of bone resection and postoperative outcomes in patients with mandibular MRONJ. Materials and methods: The clinical and imaging findings and treatment outcomes of 206 patients (258 surgeries) with mandibular MRONJ undergoing surgery were reviewed. Imaging findings were evaluated using computed tomography (CT) to sequestrum, osteolysis, periosteal reaction, and mixed-type osteosclerosis, and determine the extent of resection. In some cases, samples were taken from within the bone, and real-time polymerase chain reaction was used to confirm the presence of bacteria and fungi. Results: The three-year cumulative cure rate was 81.7%. Patients with malignant tumors showing no osteolysis and undergoing sequestrum removal or marginal mandibulectomy had significantly worse prognosis than those with osteoporosis showing osteolysis and undergoing segmental mandibulectomy. Furthermore, patients with residual osteolysis, periosteal reactions, and mixed-type osteosclerosis on CT were more likely to develop recurrence. Eleven patients showed no osteolysis on CT images. Patients with cancer administered with high-dose denosumab had significantly poorer prognosis. Bacteria and fungi were also detected in samples obtained from gap-type periosteal reaction and mixed-type osteosclerosis. Conclusion: Surgery for MRONJ requires resection of the infected bone. Aside from the osteolysis area, the gap-/irregular-type periosteal reaction and mixed-type osteosclerosis must also be included in the resection area. Methods for determining the extent of bone resection in MRONJ without osteolysis are a future challenge.

Natural organic matter contained in natural water inhibits the adsorptive removal of 2-methylisoborneol (2-MIB) by powdered activated carbon (PAC). We investigated the relationship between water-quality indices and the adsorptive removal of 2-MIB by PAC. We collected three different raw water (i.e., two lake water and one river water) samples twice per month for 10 months. We characterized the raw water using total organic carbon concentration, ultraviolet absorption at 254 nm, electrical conductivity, and excitation–emission matrix analysis. The results were compared with 2-MIB removal rates evaluated from PAC adsorption experiments and revealed that there was no universal indicator that could explain the trends of the 2-MIB removal rate during the overall experimental period. The correlation trends between 2-MIB removal rates and water-quality indices differed significantly between the high and low water-temperature periods. Several water-quality indices related to the organic matter associated with biological processes, especially algal activities (i.e., soluble microbial products, chlorophylls, and phycocyanin), exhibited significant correlations with the 2-MIB removal rates (|R| > 0.7) under certain conditions (e.g., high lake-water temperature). Both the parallel factor (PARAFAC) analysis and fluorescence regional integration (FRI) method could evaluate such behaviors after including the regions associated with algal organic matter in the calculation. HIGHLIGHTS The correlations between water-quality indices and 2-MIB removal rates differed depending on place, high and low-water temperature periods.; Some biological, especially algal organic fractions significantly correlated with 2-MIB removal rates in lake water.; The EEM is a useful tool to detect algal organic matter (AOM) in natural water.; Both the PARAFAC analysis and FRI method can evaluate changes in AOM when suitable regions in EEM data were calculated.;

In this study, metal leaching was investigated in commercially available faucets in Japan to clarify their compliance to Japanese regulations. We purchased 37 faucets from the market and analyzed the leaching of cadmium, mercury, selenium, lead (Pb), arsenic, hexavalent chromium, boron, zinc (Zn), copper, manganese, and nickel. The leaching tests were performed with and without a conditioning treatment, that simulated approximately 1-month intermittent use of faucets on weekdays, and the results were compared to estimate the changes in metal leaching during the use of faucets. The results revealed that metal leaching from most of the faucets complied with Japanese regulations. However, the levels of Pb leaching from several faucets produced by certain manufacturers exceeded the Japanese standard. The conditioning treatment was generally effective in reducing metal leaching. However, the reductions in Pb and Zn leaching tended to be lower than those of the other metals. Nickel is not legally regulated in Japan; although the number of cases where nickel concentration in leachate exceeded the water quality management target value was greater, such cases were limited to faucets primarily made of copper alloys. We believe that these results will be helpful to improve the public health associated with metal leaching from faucets. HIGHLIGHTS Metal leaching was tested in commercially available faucets in Japan.; Leaching with and without conditioning was tested to estimate time-course decline in metal leaching.; Faucets of a certain manufacturer repeatedly exceeded the Japanese standard.; The declines in Pb and Zn leaching by the conditioning were limited.; Using faucets not made mainly of copper alloys may be useful to reduce the effect of nickel leaching.;

Background/purpose: Although mandibular advancement oral appliances (OAs) are the most widely used and accepted therapeutic modality for obstructive sleep apnea (OSA), whether these maxillary and mandibular appliances should be semi-fixed or fixed remains uncertain. This randomized crossover pilot study compared the efficacy, side effects, and patient preference of semi-fixed and fixed OAs for the treatment of OSA. Materials and methods: Patients with mild to moderate OSA were recruited and randomly assigned to either the semi-fixed or fixed OA group, whereby they used their assigned OA for the first 4 weeks, followed by assessments for sleep parameters (including the Apnea-Hypopnea Index [AHI]) and temporomandibular joint pain as a side effect. After a two-week washout period, patients were switched to the alternative OA for 4 weeks, followed by repeated assessments. Patient preference was assessed at the end of the completed treatment period. Results: Fifteen patients were enrolled and completed the full study protocol. Both types of OAs were efficient in reducing the patient's AHI in comparison to baseline (i.e., without OA). However, there was no significant difference in AHI reduction between the semi-fixed and fixed OA devices. Regarding the side effect of temporomandibular joint pain and patient preference, the semi-fixed OA device was superior to the fixed OA device on both measures. Conclusion: While both semi-fixed and fixed OAs are effective in treating patients with OSA, semi-fixed OAs are superior in regards to both patient preference and reduced side effects. Thus, semi-fixed OAs may be the preferred therapeutic modality for OSA.

Membrane fouling is a serious problem in drinking water treatment systems. Biological contact filters (BCFs) are often used as a pretreatment to remove ammonia, dissolved organic matter (DOM), and metal ions such as iron and manganese. In this study, the effect of BCF as a pretreatment for membrane fouling was evaluated using a laboratory-scale mini module consisting of a mini BCF column and a mini MF column. Initially, it was confirmed that the main foulant was a biopolymer (at low concentration) in the raw water. Subsequently, the biopolymer concentrations in the BCF influent and effluent were measured with the excitation emission matrix (EEM) fluorescence spectroscopy and the liquid chromatograph organic carbon detector (LC-OCD). The fouling potential of the BCF influent and effluent was also measured to evaluate MF membrane fouling rate. The results demonstrate that application of the BCF reduced the biopolymer concentration of the effluent and reduced membrane fouling. The effect of BCF was also established in an actual drinking water treatment plant. It was found that optimizing the contact time of raw water with the BCF was crucial to reduce membrane fouling.

The anaerobic treatment is a potential way to realize the energy production in wastewater treatment. However, it is necessary to increase the organic matter concentration in municipal wastewater. In this study, we proposed a wastewater treatment system that involved an anaerobic membrane bioreactor (AnMBR) combined with a forward osmosis (FO) process to concentrate the wastewater. The energy balance of this system was estimated by the calculation based on the FO condensation test and batch methane fermentation test. The methane yield from the condensed municipal wastewater in the batch methane fermentation test at 40°C was 0.22 m3 -CH4 /kg-CODCr_rem, putting CODCr as the chemical oxygen demand was determined by chromium oxidation method. The energy generated from the yielded methane was estimated to be 0.33 kWh/m3. Nevertheless, the total energy consumption was 0.39 kWh/m3, which was higher than 0.2 kWh/m3 of a conventional activated sludge process. It was found that it is possible to get a net energy if the fermentation temperature in the AnMBR process can be reduced to below 34°C. [ABSTRACT FROM AUTHOR]

In this study, the details of proteins causing membrane fouling in membrane bioreactors (MBRs) treating real municipal wastewater were investigated. Two separate pilot-scale MBRs were continuously operated under significantly different operating conditions; one MBR was a submerged type whereas the other was a side-stream type. The submerged and side-stream MBRs were operated for 20 and 10 days, respectively. At the end of continuous operation, the foulants were extracted from the fouled membranes. The proteins contained in the extracted foulants were enriched by using the combination of crude concentration with an ultrafiltration membrane and trichloroacetic acid precipitation, and then separated by two-dimensional polyacrylamide gel electrophoresis (2D-PAGE). The N-terminal amino acid sequencing analysis of the proteins which formed intensive spots on the 2D-PAGE gels allowed us to partially identify one protein (OmpA family protein originated from genus Brevundimonas or Riemerella anatipestifer) from the foulant obtained from the submerged MBR, and two proteins (OprD and OprF originated from genus Pseudomonas) from that obtained from the side-stream MBR. Despite the significant difference in operating conditions of the two MBRs, all proteins identified in this study belong to β-barrel protein. These findings strongly suggest the importance of β-barrel proteins in developing membrane fouling in MBRs. [ABSTRACT FROM AUTHOR]