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This study assessed the clinical risk factors for periorbital dermatitis (PD) after using dorzolamide/timolol eye drops in a total of 1282 glaucoma patients. Both the PD(+) group and the PD(−) group were evaluated using clinical data such as age, sex, dosing duration, presence of benzalkonium chloride (BAK) in the formulation, ocular surgery history (e.g. cataract or glaucoma operations), height, weight, personal history of systemic hypertension, smoking, alcohol consumption, intraocular pressure, best-corrected visual acuity (BCVA), central corneal thickness, axial length, and visual field index (VFI). Univariate analyses showed that shorter dosing duration, higher rate of BAK-included cases, worse BCVA, worse VFI, more systemic hypertension history, and more ocular surgery history were more associated with the PD(+) group than the PD(−) group. The BAK(−) group showed a lower PD rate than the BAK-included group, which was supported by the Kaplan–Meier analysis (log-rank test, p = 0.0014). Multivariate analyses revealed that the probability of PD increased by 8 times if they had a history of ocular surgery and increased by 2.3% when the VFI decreased by 1% (Cox’s hazard regression test, p

Given that nonadherence is related to subject characteristics and drug tolerance and preserved eye drops tend to be more intolerable than preservative-free ones, we conducted a phase 4, parallel-grouped, investigator-blind, active-control, randomized, multicenter study. A total of 51 patients with intraocular pressure (IOP) ≥ 15 mmHg diagnosed with open-angle glaucoma or ocular hypertension were randomly assigned to the preserved latanoprost group (n = 26) and the preservative-free latanoprost group (n = 25). The efficacy variables were corneal/conjunctival staining grade, Ocular Surface Disease Index (OSDI), adherence at 12 weeks after the first administration; corneal/conjunctival staining grade at 4 weeks; and IOP, tear break-up time (TBUT), and hyperemia score at 4 and 12 weeks. The safety variables included visual acuity and drug tolerance questionnaire results. There was no statistically significant difference in corneal/conjunctival staining grade, OSDI, or TBUT between the groups at 4 and 12 weeks. However, the adherence rate was higher and the hyperemia score was lower in the preservative-free group than in the preserved group. The severity and duration of stinging/burning sensation were lower in the preservative-free group than in the preserved group. Overall, preservative-free latanoprost showed better ocular tolerance assessed by hyperemia scores and stinging/burning symptoms following higher adherence than preserved latanoprost.

Background Alopecia refers to a condition developed by gradual reduction of hair loss by various abnormal causes such as endocrine system, genetic factors, and stress. Stromal vascular fraction (SVF) isolated from the fat is one of the latest innovative solutions in the field of regeneration therapy. We focused on presenting effectiveness of clinical cases to improve AGA through transplantation of autologous SVF into the scalp. Objective To confirm the efficacy of the autologous SVF usage to the patients with AGA. Methods Nine patients (age range 43–64 years; 4 men, grade IV to V and 5 women, grade I to III), who are suffering from androgenic alopecia (AGA), were treated with single transplantation of autologous SVF in the upper scalp. Autologous SVF was isolated and characterized prior to the injection of live 7–9 × 106 cells into the patients’ treatment site. The hair loss improvement effect was assessed by three test criteria: hair skin quality, hair thickness and hair density 3 and 6 months after post-injection compared to pre-injection status. Results Hair density of SVF-treated side was significantly increased after 3 and 6 months of transplantation compared to non-treated side (P = 0.01 and P = 0.009 per each). And significant improvement in the score of the keratin on the scalp was seen in the injected area as compared to the non-injected area 6 months after transplantation (P = 0.032). Although thickness increase was observed at 3 and 6 months after transplantation, there was no statistical significance (P = 0.142 and 0.155, respectively). Conclusions One transplantation of autologous SVF for the AGA patients, hair density and score for the keratin were significantly increased within 6 months. This study shows that SVF is a very effective way to treat hair loss and most of subjects are satisfied with the result after treatment.

Background The incidence of tongue squamous cell carcinoma (TSCC) in young patients has recently increased, and these TSCCs are believed to be etiologically distinct from those in older patients, who have longer exposure to risk factors such as tobacco and alcohol. The prognosis of TSCCs in young patients remains controversial. Methods We retrospectively reviewed the records of 117 patients (2001–2011) who were diagnosed with squamous cell carcinoma of the oral tongue. Patients were divided into two age groups, older (ages over 40) and younger (ages 40 and younger). Data were compared between the two groups, and survival rates were analyzed. Results The results show that there are significant differences in overall, disease-free, and distant metastasis-free survival rates between the two groups. Five-year overall survival rates were 70% in older patients and 42% in young patients (p = 0.033). Five-year disease-free survival rates were 73% in older patients and 40% in young patients (p = 0.011), and 5-year distant metastasis-free survival rates were 97% in older patients and 62% in young patients (p = 0.033). Multivariate analysis revealed that histologic grade was the only independent risk factor for overall survival in both groups of patients (p = 0.002, HR = 2.287). The analysis also demonstrated that age was the critical risk factor for distant metastasis (p = 0.046, HR = 9.687). Conclusion In this study, young (ages 40 and younger) patients with squamous cell carcinoma of the oral tongue had a higher rate of distant metastasis and a worse prognosis. Accordingly, we propose the necessity of an extensive therapeutic regimen that should be used in all young patients with TSCC.

The objective was to investigate the effects of melatonin and exercise on insulin resistance (IR), hypertension and fatigue syndrome in a rat model of type 2 diabetes mellitus (T2DM).Rats were divided into 5 groups namely normal control (NC), T2DM control group (DC), diabetes plus exercise (DE), diabetes plus oral melatonin supplement (DM) and diabetes plus melatonin and exercise (DME) groups. Melatonin was administered orally 5mg/kg twice daily and 40min swimming/day 5days/week were regimented after diabetes induction.Blood pressure, fasting blood glucose, insulin, IR, serum leptin, lipid profiles, inflammatory cytokines, lipid peroxidation increased significantly (P0.01) while serum adiponectin, antioxidant activities (superoxide dismutase, glutathione), exercise performance significantly decreased (P0.001) in the DC group compared with the control group. Combined effects of exercise and melatonin ameliorated markedly hypertension, IR, biochemical alteration induced by diabetes and significantly increased exercise performance (P0.01). The expression glucose transporter type 4 (GLUT4) mitochondrial biogenesis related proteins such as peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1 α), nuclear respiratory factor (NRFs) and mitochondrial transcription factor-A were up-regulated skeletal and cardiac muscle in the DME group.Melatonin supplementation in combination with exercise behavior may ameliorate IR, hypertension and exercise performance or fatigue possibly by improving antioxidative activities, hyperlipidemia, inflammatory cytokines via up-regulation of GLUT4, PGC-1 α and mitochondrial biogenesis in T2DM rats.

Cerebral palsy is a non-progressive disorder resulting from central nervous system damage caused by multiple factors. Almost all cerebral palsy patients have a movement disorder that makes dental treatment difficult. Oral hygiene management is difficult and the risks for periodontitis, dental caries and loss of multiple teeth are high. Placement of dental implants for multiple missing teeth in cerebral palsy patients needs multiple rounds of general anesthesia, and the prognosis is poor despite the expense. Therefore, making the decision to perform multiple dental implant treatments on cerebral palsy patients is difficult. A 33-year-old female patient with cerebral palsy and mental retardation was scheduled for multiple implant treatments. She underwent computed tomography (CT) under sedation and the operation of nine dental implants under general anesthesia. Implant-supported fixed prosthesis treatment was completed. During follow-up, she had the anterior incisors extracted and underwent the surgery of 3 additional dental implants, completing the prosthetic treatment. Although oral parafunctions existed due to cerebral palsy, no implant failure was observed 9 years after the first implant surgery.

Amyotrophic lateral sclerosis (ALS), the most common adult onset motor neuron disease, is pathologically characterized by progressive loss of the upper and lower motor neurons. Mutations in the Cu/Zn superoxide dismutase gene (SOD1) account for about 20% of familial ALS cases and a small percentage of sporadic ALS (SALS) cases, and have revealed a validated genotype-phenotype correlation. Herein, we report a p.Gly13Arg mutation in SOD1 exon 1 in a patient with SALS who presented with a rapidly progressive course, predominantly affecting the lower motor neurons. A 48-year-old man presented with progressive weakness and muscle atrophy of the left upper and lower limbs, followed by muscle fasciculation and cramping. The clinical features of the patient were clearly suggestive of ALS, and implied a sporadic form with rapid progression, predominantly affecting the lower motor neurons. Sequencing of the SOD1 gene by PCR revealed a missense mutation of G to C (c.37G>C) in exon 1, and amino acid substitution of glycine by arginine (p.Gly13Arg). This is the first case identifying the p.Gly13Arg mutation of SOD1 in the Korean population, and clinical assessments of this patient revealed a different phenotype compared with other cases.

The purpose of the present study was to investigate and compare the clinical characteristics of burning mouth syndrome (BMS) patients with bilateral and unilateral symptoms. Of 769 patients with oral burning sensation, 421 patients with primary BMS were included. Among them, 324 patients who complained of oral symptoms on both sides of the oral cavity were assigned to the bilateral group and 97 patients who complained of symptoms only on one side of the oral cavity were assigned to the unilateral group. Clinical characteristics, psychological status, and salivary secretion were compared between the two groups. There were no significant differences in the mean age, sex ratio, unstimulated and stimulated salivary flow rates, or duration of symptoms between the two groups. The bilateral group had higher levels of psychological distresses compared with the unilateral group. The bilateral group had higher prevalence rates in burning, taste alteration, and xerostomia than the unilateral group. The proportion of patients who considered dental procedures as an initiating factor of BMS symptoms was higher in the unilateral group than in the bilateral group. Conclusively, BMS patients with bilateral and unilateral symptoms had different clinical characteristics, suggesting that the neuropathic mechanisms in these two groups are different.

Background: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinical-radiological entity, characterized by mild encephalitis or encephalopathy associated with a reversible lesion of the corpus callosum, which commonly involves the splenium. MERS with autoimmune thyroid disease has rarely been reported. Case Report: A 37-year-old man with Grave’s disease presented to our institution, with symptoms of confused mentality, visual hallucinations, headache, and fever. Because there was no other etiology for changed mentality, headache, and fever, except for elevated antithyroid antibodies (antimicrosomal antibodies, anti-thyroglobulin antibody, and thyrotropin binding inhibitor immunoglobulin) in the blood and mild pleocytosis in the CSF study, we diagnosed the case as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT). A hyperintense signal on T2-weighted images, a hypointense signal on T1-weighted images, and a non-enhancing lesion in the splenium of corpus callosum on initial magnetic resonance imaging (MRI) disappeared on follow-up MRI, which was compatible with the criteria of MERS. Conclusion: Although MRI images in autoimmune thyroid disease have usually been unremarkable, we report a case of MERS in SREAT.

Purpose: The population of end-stage renal failure patients dependent on hemodialysis continues to expand with an increasing number of patients having an unsuitable cephalic vein or failed radio- and brachio-cephalic fistula. In these patients, the transposed basilic vein to brachial artery arteriovenous fistula (BaVT) provides autologous choice for hemodialysis. The results of basilic vein transposition arteriovenous fistula were assessed. Materials and Methods: Three hundred cases of BaVT performed at a single center during the period of January 2005 to December 2011 were reviewed retrospectively. Data including demographics and postoperative complications were collected. Primary and secondary patency rates were determined by using Kaplan-Meier methods. Results: The median age of patients was 57.4±13.1 years, and 154 patients were male. Renal failure was associated with hypertension in 88.7%, and with diabetes in 34.0%. The mean follow-up was 27.4±20.0 (12 to 72) months. There was no operation-related death. Eighteen patients required prosthetic graft interposition because of short vein. Thirty-five postoperative complications developed in 41 patients (148 cases), including thrombosis, stenosis, hematoma, seroma, arm swelling, steal syndrome, infection and aneurysm formation. Primary patency of BaVT was 69%, 60%, 53%, 52%, 44%, and 22% at 1, 2, 3, 4, 5, and 6 years, respectively. Secondary patency was 99%, 97%, 97%, 97%, 95%, and 95%, respectively. Conclusion: Chronic renal failure patients with hemodialysis may benefit from BaVT, because of high patency, less radiologic procedure, and less infection rate. The BaVT fistula should be used in preference to polytetrafluoroethylene grafts for secondary access.

Objectives: To assess the association between muscle invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis on the basis of preoperative magnetic resonance imaging (MRI). Materials and Methods: Twenty-six patients with oral squamous cell carcinoma of the posterior mandibular alveolar ridge were evaluated by MRI. The associations between cervical lymph node metastasis and independent factors evaluated by MRI were analyzed. Overall survival was also analyzed in this manner. Representative biopsy specimens were stained with anti-podoplanin and anti-CD34 antibodies. Results: Mylohyoid muscle invasion was associated with cervical lymph node metastasis. A combinational factor of mylohyoid and/or buccinator muscle invasion was also associated with cervical lymph node metastasis. Cervical lymph node metastasis and masticator space invasion had a negative effect on overall survival. No lymphatic vessels were identified near the tumor invasion front within the mandible. In contrast, lymphatic vessels were identified near the front of tumor invasion in the muscles. Conclusion: This study demonstrates an association between muscular invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis.

Purpose: Despite acceptance of laparoscopic totally extraperitoneal (TEP) repair for repair of inguinal hernia, it is still considered to require a prolonged learning curve. We hypothesized that there would be differences in the learning curve for laparoscopic TEP repair among beginner surgeons with or without a supervisor. The current study was conducted to observe the learning curve for laparoscopic TEP repair performed by a surgeon without a supervisor. Methods: A retrospective analysis of the consecutive 143 patients was conducted to document patients’ demographics, hernia types, operative time, and operative outcomes after the operation. Patients were divided into 7 consecutive groups, each comprising 20 patients. Results: The mean age of the study population was 52.5 years (± 18.9 SD), ranging from 16 to 89 years. The learning curve of this technique was almost horizontal throughout the time course. The mean operative time was quite stable among each group. Comparison of the mean operation time and the length of hospital stay among each group did not show significant differences. There was one recurrence in group V. Conclusion: The learning curve for laparoscopic TEP repair is not that prolonged if there is an experienced specialized supervisor and opportunities to observe the entire procedure performed by the supervisor are available. It is not the laparoscopic instrument skills but the way the procedure is performed that is important for successful outcomes.

Amyotrophic lateral sclerosis (ALS) is a devastating human neurodegenerative disease. The precise pathogenic mechanisms of the disease remain uncertain, and as of yet, there is no effective cure. Human adipose stem cells (hASC) can be easily obtained during operative procedures. hASC have a clinically feasible potential to treat neurodegenerative disorders, since cytosolic extract of hASC contain a number of essential neurotrophic factors. In this study, we investigated effects of hASC extract on the SOD1 G93A mouse model of ALS and in vitro test. Administration of hASC extract improved motor function and prolonged the time until symptom onset, rotarod failure, and death in ALS mice. In the hASC extracts group, choline acetyltransferase immunostaining in the ventral horn of the lumbar spinal cord showed a large number of motor neurons, suggesting normal morphology. The neuroprotective effect of hASC extract in ALS mice was also suggested by western blot analysis of spinal cord extract from ALS mice and in vitro test. hASC extract treatment significantly increased expression of p-Akt, p-CREB, and PGC-1α in SOD1 G93A mouse model and in vitro test. Our results indicated that hASC extract reduced apoptotic cell death and recovered mutant SOD1-induced mitochondrial dysfunction. Moreover, hASC extract reduced mitochondrial membrane potential. In conclusion, we have demonstrated, for the first time, that hASC extract exert a potential therapeutic action in the SOD1 G93A mouse model of ALS and in vitro test. These findings suggest that hASC hold promise as a novel therapeutic strategy for treating ALS.

Objective To investigate the distribution and phenotypes of hemifacial microsomia (HFM) and its association with other anomalies. Methods This study included 249 Korean patients with HFM, whose charts, photographs, radiographs, and/or computed tomography scans acquired during 1998–2018 were available from Seoul National University Hospital and Dental Hospital. Prevalence according to sex, side involvement, degree of mandibular deformity, compensatory growth of the mandibular body, and Angle's classification, and its association with other anomalies were statistically analyzed. Results Prevalence was not different between male and female patients (55.0% vs. 45.0%, p > 0.05). Unilateral HFM (UHFM) was more prevalent than bilateral HFM (BHFM) (86.3% vs. 13.7%, p < 0.001). Although distribution of the Pruzansky–Kaban types differed significantly in patients with UHFM (I, 53.0%; IIa, 18.6%; IIb, 24.7%; III, 3.7%; p < 0.001), no difference was observed in occurrence between the right and left sides (52.6% vs. 47.4%, p > 0.05). Among patients with BHFM, prevalence of different Pruzansky–Kaban types on the right and left sides was greater than that of the same type on both sides (67.6% vs. 32.4%, p < 0.05). Despite hypoplasia of the condyle/ramus complex, compensatory growth of the mandibular body on the ipsilateral side occurred in 35 patients (14.1%). Class I and II molar relationships were more prevalent than Class III molar relationships (93.2% vs. 6.8%, p < 0.001). Forty-eight patients (19.3%) had other anomalies, with 50.0% and 14.4% in the BHFM and UHFM groups (p < 0.001). Conclusions Patients with HFM require individualized diagnosis and treatment planning because of diverse phenotypes and associations with other anomalies.

Background Pedicle screw augmentation with bone cement has been experimentally demonstrated to increase the pullout strength. However, the mechanisms of screw loosening are complicated and interacting. Although vertebroplasty augmentation and fenestrated screw augmentation have been compared in many studies, there has been no comparative study on their clinical effects and complications in real clinical settings. We investigated clinical effects of bone cement augmentation of a pedicle screw and differences according to augmentation methods. Methods Of the total 241 patients who had osteoporosis and underwent posterior pedicle screw fixation without anterior bone graft between January 2010 and December 2016, 132 patients with ≥2 years of radiological follow-up were included in this retrospective study. The patients were divided into group I (unaugmented) and group II (bone cement augmented). Group II was subdivided into II-S group (solid screw augmented) and II-F group (fenestrated screw augmented). The incidence of screw loosening was compared between groups I and II. Cement leakage, screw loosening, and screw fractures were investigated in the subgroups. Results In total, 36 of 71 (52%, group I) unaugmented cases and 96 of 170 (56%, group II) augmented cases were followed up for ≥2 years. Of the total 78 solid screw augmented cases, 42 (56%) were in II-S group; 54 of the total 92 (59%) fenestrated screw augmented cases were in II-F group. Groups I and II were homogenous regarding demographic characteristics; II-S and II-F groups were also homogenous. The incidence of screw loosening was 50.0% (18/36) in group I and 7.3% (7/96) in group II (p < 0.001). Cement leakage developed in 2 of 42 (4.8%) cases in II-S group and in 5 of 54 (9.3%) cases in II-F group (p = 0.462). Screw loosening developed in 6 of 42 (14.3%) cases in II-S group and in 1 of 54 cases (1.9%) in II-F group (p = 0.041). Screw fracture developed in none of 42 cases in II-S group and in 3 of 54 cases (5.6%) in II-F group (p = 0.254). Conclusions In osteoporotic patients, bone cement augmentation of a pedicle screw decreased the incidence of screw loosening, and fenestrated screw augmentation was more effective than vertebroplasty augmentation.

The aim of this study was to investigate the pattern, amount, and distribution of postsurgical relapse in skeletal Class III patients treated with two-jaw surgery (TJS) using conventional three-stage method (CTM) and surgery-first approach (SFA). A total of 38 patients who underwent the nonextraction approach and TJS (LeFort I posterior impaction and mandibular setback) were divided into CTM and SFA groups (all n = 19/group). Lateral cephalograms were taken before treatment (T0), at 1 month before surgery (T1), immediately after surgery (T2), and at debonding (T3) for CTM patients and at T0, T2, and T3 stages for SFA patients. Cephalometric measurements and statistical analyses were performed. There were no significant differences in the cephalometric variables at all stages except maxillary incisor inclination (U1-UOP) and overbite at T0 between 2 groups. They also did not exhibit significant differences in the amounts of surgical movement except for advancement of the maxilla. The mandible in both groups was rotated slightly clockwise by surgery and counterclockwise during T2-T3 without a significant difference. Distribution of cases with "high relapse" (>30%) and "low relapse" (

Objectives/Hypothesis Current management for peritonsillar abscess in pediatric patients includes intensive medical therapy using antibiotics with or without surgical drainage. However, attaining proper surgical drainage is difficult in young children because they have narrow oral cavities and are less cooperative than adults. The aim of this study was to investigate which factors are associated with a good response to nonsurgical treatment of a pediatric peritonsillar abscess. Study Design A retrospective analysis. Methods This study included consecutive children who visited our pediatric clinic for the treatment of peritonsillar abscess. All patients initially received medical treatment, and additional surgical treatment was provided if the patient appeared unlikely to recover. Multivariate logistic regression models were constructed to identify factors associated with a good response to nonsurgical treatment. In addition, a receiver operating characteristic curve was used to identify the age cutoff for predicting good treatment response. Results A total of 88 children were included the study. Patient age, recurrent tonsillitis, and abscess size were significantly associated with response to nonsurgical treatment (adjusted odds ratios = 1.485, 2.403, and 1.325, respectively) after adjusting for sex, body mass index, season, serum C-reactive protein levels, and tonsil grade. The age cutoff associated with good response to nonsurgical treatment was 7.5 years (80.0% sensitivity, 51.5% specificity). Conclusion Our findings suggest that a younger age, fewer episodes of acute tonsillitis, and smaller abscess size predict a successful response to nonsurgical treatment in children with peritonsillar abscess. Level of Evidence 4. Laryngoscope, 125:2608–2611, 2015

Purpose The aim of this study was to identify independent predictors of outcome and to characterize the patterns of failure in a long-term, single-institution experience with the management of adenoid cystic carcinoma (ACC) of the head and neck using survival analyses. Patients and methods We investigated prognostic factors, such as gender, age, primary tumor site, TNM stage, treatment modalities, perineural invasion, metastases, surgical margins, histological grade, cervical lymph node metastasis, and postoperative RT spread through 86 cases of ACC diagnosed by Seoul National University Dental Hospital (SNUDH) from 1984 to 2013. The overall survival and disease-free survival were evaluated. Survival rates were predicted and Kaplan–Meier's survival curves were generated for each factor. Cox proportional hazard models were used for multivariate survival analysis. Results Survival analysis shows that overall survival (OS) at 5 years, 10 years, and 20 years was 75%, 55%, and 41%, respectively. Disease-free survival (DFS) at 5 years, 10 years, and 20 years was 58%, 44%, and 28%, respectively. Univariate analysis revealed that age, primary tumor site, histological subtype, clinical stage, cervical lymph node metastasis, and presence of distant metastasis were significant predictors while perineural invasion, margin involvement, and gender did not demonstrate statistical difference between the treatment groups. Our multivariate analysis revealed that advanced clinical stage (stages III and IV), distant metastasis, and age over 60 years were independent significant prognostic factors. Conclusions Recurrence and metastasis were the main cause of treatment failure of ACC in head and neck. T stage, age, primary tumor site, histologic type, cervical lymph node metastasis, and distant metastasis were the independent prognostic factors of ACC in head and neck. Radical surgery and reasonably postoperative radiotherapy were the main treatment strategy.

Purpose Patients who have secondary hip osteoarthritis as sequelae of Legg-Calve-Perthes disease (LCPD) are severe deformities of femoral head and acetabulum. A few studies have presented that the clinical results and risks associated with total hip arthroplasty (THA) for patients with a history of LCPD were not satisfactory. In this study, we reported the radiographic and clinical outcomes of THA in patients with sequelae of LCPD. Materials and methods Between March 2007 and May 2012, 23 hips (23 patients) underwent cementless THA and were followed up at least 2 years after surgery. There were 11 male patients and 12 female patients with an average age of 49.2 years old (range, 25 to 69 years old), and the average follow up period was 40.8 months (range, 24 to 84 months). The clinical and radiological evaluations were performed. Results The Harris hip score improved from 48.3 points preoperatively to 92.4 points at the time of the last follow-up. The shortening of affected limb was improved from -1.6 cm to 0.2 cm. The complications included one case of sciatic nerve palsy that developed after extensive lengthening of lower extremity, three cases of intraoperative femur fractures. There was no component loosening. Conclusion Fractures and motor nerve palsies may be more frequent in this population. Careful preoperative planning should be performed to overcome the technical pitfalls. If overcoming this early complication, the clinical and radiological evaluations showed excellent outcomes at average 40-month follow-ups.

Objectives: The aim of this study was to verify the clinical effectiveness of decompression in decreasing the size of a cyst. In addition to the different types of cysts, we tried to reveal what effect host factors, such as the initial size of the lesion and the age of the patient, have on the velocity of cyst shrinkage. Materials and Methods: With the aid of a panoramic view, we measured the size of the cysts before and after decompression in 13 dentigerous cysts (DCs), 14 keratocystic odontogenic tumors (KTOCs), and 5 unicystic ameloblastoma (UA) cases. The velocity of shrinkage in the three cystic groups was calculated. Relationships between the age of the patient, the initial size of the cyst, and the shrinkage velocity were investigated. Results: The three types of cysts showed no inter-type differences in their velocity of shrinkage. However, there was a statistically meaningful relationship between the initial size of the lesion and the absolute velocity of shrinkage in the DC group (P=0.02, R=0.65) and the KTOC group (P=0.02, R=0.56). There was also a significant relationship between the age of the patient and the absolute velocity of shrinkage in the KTOC group (P=0.04, R=0.45) and the UA group (P=0.04, R=0.46). Conclusion: There was no difference in the decrease in size due to decompression among the different types of cysts. However, the age of the patient and the initial size of the lesion showed a significant relationship with the velocity of shrinkage.

Purpose: Despite advancements in surgery, laparoscopic totally extraperitoneal (TEP) repair for inguinal hernia in patients with previous lower abdominal surgeries has been a burden to surgeons. This study was conducted in order to assess the feasibility of laparoscopic intraperitoneal onlay m esh (IPOM) hernia repair as an alternative method for these cases. Methods: From May 2006 to November 2010, 48 IPOM repairs were performed in 43 patients. All medical records were reviewed retrospectively. Results: Mean age of patients was 61 years old and male to female ratio was 37:6. Five were direct and 43 were indirect hernias. There were 15 recurrent inguinal hernias after either open or laparoscopic hernia repair, and five of 15 were recurrent cases more than two times. Mean operative time was 44.5 minutes, and mean postoperative hospital stay was 1.41 days. There were two cases of postoperative swelling at the groin area and two patients complained of pain that required oral pain-killers during out-patient follow-ups. Recurrence developed in one case. Conclusion: Even though laparoscopic IPOM repair is not a preferred m ethod for inguinal hernia, it can be applied as an alternative method in specific cases involving difficulties in approaching the usual plane of repair.

The newly identified tumor suppressor, N-myc downstream-regulated gene 2 (NDRG2), has been studied in various cancers because of its anticancer and antimetastasis effects. In this study, we examined the effect of NDRG2 expression on cell viability in MDA-MB-231 human breast cancer cells under conditions that are similar to the microenvironment of solid tumors, which include glucose deprivation. NDRG2 overexpression enhanced the pro-apoptotic effects of glucose deprivation. Glucose deprivation also induced the activation of AMP-activated protein kinase (AMPK), which plays a role in protecting tumor cells from metabolic stresses. NDRG2 overexpression strongly reduced glucose deprivation-induced AMPK phosphorylation and increased the cleavage of poly (ADP-ribose) polymerase (PARP), which indicated the induction of apoptosis. The expression of a constitutively active form of AMPK effectively blocked glucose deprivation-induced apoptosis in NDRG2-overexpressing MDA-MB-231 cells. Moreover, NDRG2 overexpression also enhanced the pro-apoptotic effects of 2-deoxyglucose (2-DG) or hypoxia, an inducer of metabolic stresses. Finally, we showed that LKB1 is an upstream kinase of AMPK that is involved in the inhibition of glucose deprivation-induced AMPK activity in NDRG2-overexpressing cells. Our findings collectively suggest that NDRG2 is a negative regulator of AMPK activity and functions as a sensitizer of glucose deprivation.

Eosinophilic gastrointestinal disorder (EGID) is an uncommon disease that is accompanied by intestinal eosinophil infiltration without a secondary cause of eosinophilia. Eosinophilic enteritis is a secondary portion of EGID that can present a range of gastrointestinal symptoms according to the affected depth of the intestinal layer. The subserosal type of eosinophilic enteritis presenting as ascites is relatively rarer than the mucosal type. In general, eosinophilic enteritis occurs in patients with food allergies, but its mechanism is unclear. The authors experienced a 29-year-old female patient with a large amount of ascites with diarrhea and abdominal pain. The patient was diagnosed with an influenza A infection one week earlier. Peripheral eosinophilia (absolute eosinophil count: 6,351 cells/mm3) and eosinophilic ascites (97% of white blood cells in the ascites are eosinophil) were present. Abdominal CT revealed a large amount of ascites and edematous changes in the ileum and ascending colon wall. A diagnosis of eosinophilic enteritis was confirmed as eosinophilic ascites by paracentesis, with eosinophil infiltration of the bowel wall by an endoscopic biopsy. The patient's symptoms improved rapidly after using steroids. To the best of the author’s knowledge, this is the first report of eosinophilic enteritis with massive ascites after an influenza A virus infection in a Korean adult.

We compared preoperative autologous blood donation (PABD) using serial manual whole blood (WB) and PABD using a single session, double-unit erythrocytapheresis in terms of the hemodynamic recovery and clinical outcomes.This study included 56 donors in the WB PABD group and 117 donors in the double-unit erythrocytapheresis PABD group. All subjects were men with body weight70 kg, Hb level13.3g/dL, Hct40%, and who were scheduled for oral and maxillofacial surgery. Three cycles of manual WB collection for PABD or a single session, double-unit erythrocytapheresis using the Alyx was performed.There were no significant differences in donor demographic variables including age, height, weight, Hb, Hct, or red cell mass between the 2 groups. The double-unit erythrocytapheresis was completed earlier than the last manual WB PABD (at 15.3 ± 4.7 days and 6.5 ± 3.2 days before surgery, p0.001). Hct values before surgery were higher in the double-unit erythrocytapheresis PABD group than in the manual WB PABD group (39.7 ± 3.2 vs. 38.6 ± 2.7, p=0.024). ΔHct and %ΔHct before the first PABD and before surgery were lower in the double-unit erythrocytapheresis PABD group than in the manual WB PABD group (-5.6 ± 2.8 vs. -6.8 ± 2.7, p=0.010 and -12.3 ± 5.9 vs. -14.8 ± 5.6, p=0.008, respectively). The incidence of additional allogeneic blood transfusions during or after surgery and the post-operative Hb and Hct values were similar in the 2 groups. The length of hospital stay after surgery was significantly longer in the manual WB PABD group than in the double-unit erythrocytapheresis group (6.1 ± 2.5 vs. 5.4 ± 1.9, p=0.043). Of the 33 donors in the double-unit erythrocytapheresis PABD group, 7 (21.2%) reported discomforts related to the procedure, and 6 graded the discomforts (hypocalcemia, perioral tingling sense, paresthesia, dizziness, stuffiness, pain on the intravenous site, and muscle tension) as mild.The single session, double-unit erythrocytapheresis prolonged the time interval between PABD and surgery and led to better hemodynamic recovery than the serial manual WB PABD, and hypocalcemic symptoms were mild.

PURPOSE : This study of 20 healthy male subjects by applying various scapular stabilization exercise to compared Serratus anterior and lower trapezius is change in ultrasound images. METHOD : Thirty healthy subjects voluntarily participated in this study. Ultrasound imaging was recorded from the increasing the activity of Serratus anterior(SA) and Lower trapezius(LT) muscles using Push-up plus, Wall slide, Scapular plane shoulder elevation with resistance exercise. Thickness changes in the Serratus anterior(SA) and lower trapezius(LT) muscles between the relaxed and contracted states in the each exercises. To identify statistical significance, one-way ANOVA with repeated measures was used with the significance level of .05. RESULT : The results of this study were as follows : 1) There were statistically significant difference in thickness changes in the Serratus anterior(SA) and lower trapezius(LT) muscles between the relaxed and contracted states in the each exercises. 2) The Scapular plane shoulder elevation with resistance is more effective to Strengthening in the scapular stabilization muscles than Push up-plus and Wall slide. CONCLUSION : The Scapular plane shoulder elevation with resistance may be used to effectively that patient with various shoulder pain.

Objectives The purpose of this study was to evaluate and compare the treatment outcomes of partial glossectomy with or without elective neck dissection in patients with tongue squamous cell carcinoma (SCCa). Materials and methods A total of 98 patients who were diagnosed with tongue SCCa and underwent partial glossectomy between 2005 and 2014 were evaluated. Only 14 patients received elective neck dissection, and 84 patients received only partial glossectomy. Results There were 56 men and 42 women with a mean age of 57 years and mean follow-up period of 33.7 months. There were 70 patients graded as T1 and 28 as T2. The total occult metastasis rate was 17.3%. The 5-year overall survival rate was 83.3% with elective neck dissection and 92.4% with observation. The 5-year disease-free survival rate was in 70.7% in the elective neck dissection group and 65.3% in the observation group. Conclusion We retrospectively reviewed the records of 98 patients with tongue SCCa. These patients were divided into two groups, those who underwent elective neck dissection and those who did not. There was no statistically significant difference between the groups undergoing partial glossectomy with or without elective neck dissection.

Purpose To identify the risk factors associated with relapse or treatment failure after surgery for bisphosphonate-related osteonecrosis of the jaw (BRONJ) in patients with osteoporosis. Patients and Methods We performed a retrospective cohort study of BRONJ in patients with osteoporosis who had undergone surgical procedures from 2004 to 2016 at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The predictor variables were a set of heterogeneous variables, including demographic (age, gender), anatomic (maxilla or mandible, or both, affected location), clinical (disease stage, etiology, comorbidities, history of intravenous bisphosphonate intake), time (conservative treatment before surgery, bisphosphonate treatment before the development of BRONJ, discontinuation of the drug before surgery, interval to final follow-up, interval to reoperation in the case of relapse or treatment failure), and perioperative variables (type of anesthesia, type of surgical procedures). The primary outcome variable was relapse after surgery that required reoperation (yes vs no). The descriptive and bivariate statistics were computed to assess the relationships between the study variables and the outcome. To determine the risk factors, we conducted a survival analysis using the Cox model. Results The final sample included 325 subjects with a median age of 75 years, and 97% were women. After surgery, 30% of patients did not completely recuperate and underwent repeat surgery. The interval from the first surgery to reoperation ranged from 10 days to 5.6 years. Relapse or treatment failure most often occurred immediately after surgery. The type of surgical procedure and mode of anesthesia were the most important factors in the treatment outcome. A drug holiday did not appear to influence the likelihood of relapse after surgery. Conclusions Treatment of BRONJ in patients with osteoporosis might benefit from more careful and extensive surgical procedures rather than curettage performed with the patient under local anesthesia.

PURPOSE The purpose of the study was to determine the incidence, duration, and risk factors for postoperative transient hypotony after pars plana silicone oil removal. METHODS This was a retrospective, noncomparative, interventional case series. The records of 89 eyes of 89 patients who underwent pars plana silicone oil removal with at least 6 months of follow-up were reviewed. Postoperative transient hypotony was defined as an intraocular pressure of

The purpose of this study was to evaluate the long-term functional and esthetic outcomes of radial forearm flap (RFF) donor site repaired with split thickness skin graft (STSG). Nineteen patients underwent surgical reconstruction of oro-facial defects by the use of RFF and their donor sites were reconstructed with STSG. The patients were followed up at least for 12 months postoperatively and the left hand was the non-dominant hand in all of them. Objective methods including pinch strength, grip strength, range of motion, current perception threshold (CPT) and two-point discrimination, and subjective methods including patients interview, visual analogue score (VAS) about function, sensitivity, pain and color match, were collectively employed for donor site assessment. Our data revealed some degree of reduction in motor function and sensation compared to the non-donor hand. The difference of pinch strength means was 9.81% and of the grip strength was 12.6%. The difference of wrist flexion means was 17.6% and of wrist extension was 13.4%. However, none of the patients had functional defects of forearm supination and pronation, wrist ulnar deviation or wrist radial deviation. Subjective evaluation showed that the donor site repaired with STSG was well accepted by the patients particularly from a functional point of view. These results demonstrate that STSG represents a favorable choice for RFF donor site repair.

Downregulation of the N-myc downstream-regulated gene 2 (NDRG2) gene is involved in the progression of aggressive forms of cancer, along with the poor prognosis of cancer patients. In the current study, we examined the effect of NDRG2 expression on the metastatic potential of HT1080 human fibrosarcoma and B16F10 murine melanoma cells in both in vitro and in vivo systems. In gelatin zymography, NDRG2 expression remarkably suppressed the matrix metalloproteinase (MMP)-9 activity and slightly inhibited MMP-2 activity of both cell lines. Tumor migration and invasion in vitro were significantly reduced by NDRG2 expression, and NDRG2 inhibited tumor cell proliferation in an anchorage-independent semisolid agar assay. Specifically, we found that NDRG2 affects invasion through suppression of nuclear factor kappa B (NF-kappaB) activity. In animal experiments, subcutaneously injected B16F10-NDRG2 cells showed delayed tumor growth compared with B16F10-mock cells. Furthermore, severe metastasis from primary tumor mass into the draining lymph nodes was observed after injection of B16F10-mock cells, but not with B16F10-NDRG2 cells. Pulmonary metastasis after intravenous injection of B16F10 cells was also reduced by NDRG2 expression. Intra- and peritumoral angiogenesis that is critical for the tumor growth and metastasis was clearly found in tumors after injection with B16F10-mock cells, whereas it was impaired in tumors after injection with B16F10-NDRG2 cells. Collectively, our data show that NDRG2 expression significantly suppresses tumor invasion by inhibiting MMP activities, which are regulated through the NF-kappaB signaling. Moreover, results from animal experiments provide evidence for the regulatory role of the NDRG2 gene in metastatic tumors.

The purposes of this study were to measure the cytotoxic effect of CKD-602 on oral squamous cell carcinoma (OSCC) cell lines, to evaluate the apoptotic aspect of dead cells, and to identify the signaling molecules involved in apoptosis. The human OSCC cell lines A253, HSC-3 and KB were treated with CKD-602. The apoptotic proportion of the cells was analyzed using flow cytometry. The expression of Bax, Bcl-2, and p53 were detected by western blotting analysis. CKD-602 showed excellent cytotoxicity to the OSCC cell lines. Most cell death was attributed to apoptosis rather than necrosis. CKD-602 induced the down-regulation of Bcl-2 in A253 and HSC-3 cells, and p53 was expressed in the KB cell line after treatment with CKD-602.

The purpose of this study was to demonstrate gait disturbance after fibular flap transfer using preoperative and postoperative gait analysis. The gait performance of 20 patients was assessed at the Laboratory for Biomechanics, Seoul National University Hospital. Kinematic and kinetic data were collected simultaneously while walking on a 25-m walkway. One month postoperatively, a significant (p < 0.05) decrease in the time-distance parameter as well as a significant (p < 0.05) decrease in the peak plantarflexion and dynamic range was seen. Only peak plantarflexion in swing was significantly (p < 0.05) decreased until 3 months postoperatively. On the basis of the gait analysis results, it was concluded that normalization of the patients' gaits would be expected within 3 months after the operation. There were no permanent pathological changes in the donor site.

Introduction Our objective was to report a patient treated with 3-dimensional virtual-surgery simulation-assisted asymmetric bilateral mandibular distraction osteogenesis. Methods A boy (age, 9.5 years) had mandibular hypoplasia and facial asymmetry, induced by bilateral condylar fractures at 4 years of age. The asymmetric bilateral mandibular distraction osteogenesis was planned to correct facial asymmetry and mandibular hypoplasia. The 3-dimensional virtual-surgery simulation results were 11 mm of horizontal distraction on the right side and 4.5 mm of horizontal and 18 mm of vertical distraction on the left side of the mandible. Bilateral ramus osteotomies were performed, and intraoral unidirectional distraction devices were inserted. After a 6-day latency period, distraction was performed at 1 mm per day, followed by a 5-month consolidation period. Transarch and interarch elastics and an acrylic plate were used during distraction and consolidation. Total treatment time was 30 months. Results Satisfactory outcomes were obtained (achievement ratios between postconsolidation results and simulated results: gonial angle, 106% and 103.9%; mandibular body length, 94.2% and 89.9%; ramus height, 104.1% and 94.5% [values of the right and left sides, respectively]). The chin-point deviation and the transverse cant of the maxillary occlusal plane were significantly improved (10.1 mm to 3.3 mm; −6.8° to −4.4°). At 53 months of follow-up, the Class I molar relationship was well maintained. The transverse cant of the maxillary occlusal plane was slightly improved to −3.7° during pubertal growth. Conclusions Three-dimensional virtual-surgery simulation can help clinicians to determine the optimal vector and amount of distraction with high accuracy in complex cases requiring simultaneous correction of a hypoplastic mandible and facial asymmetry.

To assess the changes in diabetic retinopathy (DR) in Type 2 diabetes (T2DM) patients after bariatric surgery.Consecutive 20 patients with T2DM who underwent bariatric surgery and were followed for at least 12 months were enrolled. The case history was reviewed retrospectively, and laboratory data were assessed at baseline and every 3 months postoperatively. Two retinal specialists evaluated the severity of DR with dilated fundus examination preoperatively and postoperatively. Factors associated with DR progression were assessed.During the follow-up period, 2 of 12 patients without DR and 2 of 3 patients with mild nonproliferative DR before surgery developed moderate nonproliferative DR. All five patients with moderate nonproliferative DR or worse preoperatively had progression requiring intervention. Preexisting DR (P = 0.005) and albuminuria (P = 0.01) were identified as associated with DR progression. Six patients (30%) entered remission of T2DM, but remission of T2DM could not halt the DR progression.Diabetic retinopathy progression can occur in patients with or without before DR after bariatric surgery, regardless of remission of T2DM. All patients with T2DM should be examined regularly by an ophthalmologist postoperatively, and more carefully patients with previous DR or albuminuria.

Malignant peripheral nerve sheath tumour in the oral cavity is extremely rare. We report a case of malignant peripheral nerve sheath tumour on the maxillary gingiva without evidence of neurofibromatosis. A 54-year-old woman presented with a soft, non-tender mass without ulceration on her maxillary gingiva. The patient did not have signs of neurofibromatosis type 1. A partial maxillectomy with a wide resection margin was performed. Four months after presentation, local recurrence as well as lung and liver metastases were found.

Objective To compare the effectiveness of cyclosporine solution versus triamcinolone acetonide in orabase in the treatment of oral lichen planus (OLP) in reducing signs and symptoms. Study design One hundred thirty-nine biopsy-proven OLP patients were randomly assigned to cyclosporine (68) or steroid (71) applied onto the target lesion and affected areas. Assessments were at weeks 0, 2, 4, 8 by clinical scoring and grid measurement of the target lesion (reticulation, erythema, ulceration). Patients ranked severity of pain and burning sensation using visual analog scales. Results Although clinical response, pain, burning sensation, area of reticulation, erythema, and ulceration at week 4 were all worse in patients receiving cyclosporine than in those receiving steroid, the differences were not statistically significant. Large patient-to-patient variability was evident over the observation period, with little evidence of marked changes in levels over time in both treatment groups. Conclusion Topical cyclosporine appears no more effective than steroid in the treatment of oral lichen planus.

Oral squamous cell carcinoma (OSCC) accounts for 4.5% of all malignant tumors in Korean males and 3.5% in Korean females. The high recurrence rate, and in particular the high local recurrence rate, constitutes a major therapeutic problem for the Korean population, yet there is a paucity of reports addressing the independent predictors of response and survival rate of OSCC in Korea. The present study was designed to investigate the prognostic value of clinical and demographic data within a set of 861 cases of OSCC in Korea. The medical records of 861 OSCC patients who received treatment between 1984 and 1996 at 22 Korean hospitals were reviewed retrospectively with respect to several patient characteristics, including age at diagnosis, gender, location, TNM stage, and treatment. Independent patient-related and treatment-related factors that significantly influenced disease outcome after treatment were analyzed. To assess the independent factors affecting survival rate, univariate and multivariate regression analyses of the survival data were performed using the Cox proportional hazards model. A tree-structured survival model was also derived using survival tree with unbiased detection of interaction (STUDI). The multivariate Cox regression analysis showed that age, gender, composite stage, and treatment method were significant independent prognostic factors. Radiation dose, stage, size of tumor mass, and age of patient also strongly impacted survival time. OSCC is an extremely malignant carcinoma whose prognostic factors are multiple and complex. Based on the findings of this study, we believe that the prognosis of OSCC might depend directly on cancer stage as determined by the TNM system. Furthermore, the survival rate is positively affected by treatment of the neck upon presentation of the cancer, as this can prevent late neck disease due to persistent growth of occult metastases.

Background: Akt is a serine/threonine kinase that plays an important role in tumorigenesis and influences prognosis in several cancers. However, its importance in oral squamous cell carcinomas (OSCC) has not been elucidated. Aim: To investigate the association between the expression of activated Akt, clinicopathological factors, and E-cadherin, PCNA (proliferating cell nuclear antigen), and VEGF (vascular endothelial growth factor) expression to verify the validity of Akt as a prognostic factor in OSCC. Methods: Phosphorylated Akt (p-Akt), E-cadherin, PCNA, and VEGF expression were assessed immunohistochemically in 84 OSCCs. The results were analysed in relation to clinicopathological factors. Results: p-Akt was expressed in 29 cases. It was significantly correlated with lymph node metastasis, TNM stage, and E-cadherin expression. Univariate analysis showed that p-Akt expression, E-cadherin expression, PCNA expression, differentiation, tumour size, lymph node metastasis, TNM stage, and recurrence correlated with prognosis. Multivariate analysis showed that p-Akt expression is an independent prognostic factor in patients with OSCC. Conclusions: This study revealed that Akt activation is a significant prognostic indicator for OSCC and is correlated with E-cadherin expression. The inhibition of Akt is a possible molecular approach to the treatment of OSCC.

Aiming at once-a-week injection, a novel sustained release formulation of recombinant human growth hormone (SR-hGH) using sodium hyaluronate was developed for the treatment of children who have growth failure due to the lack of adequate secretion of endogenous growth hormone.SR-hGH was produced in the form of solid microparticle using a Niro spray dryer and characterized by Malvern particle size analysis, scanning electron microscopy (SEM), size exclusion chromatography (SEC), reverse phase-high-performance chromatography (RP-HPLC), and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). After in vitro release test, pharmacokinetic and pharmacodynamic studies were carried out in beagle dogs. SR-hGH was dispersed in medium-chain triglyceride (MCT) and administered at a dose of 1.0 mg hGH/kg subcutaneously.SR-hGH microparticles were successfully produced with a mean particle size of 5.6+/-1.0 microm. Physicochemical analysis with SEC, RP-HPLC, and SDS-PAGE showed that hGH extracted from SR-hGH was intact and comparable to that of hGH bulk standard indicating no structural change in hGH during the formulation processes. Monomeric content of hGH recovered from SR-hGH was 97.4% by SEC analysis, and its purity was 96% by RP-HPLC analysis. In vitro release test showed the sustained-release characteristics of SR-hGH up to 48 h with the complete release of hGH loaded. The continuous and monotonous release profile observed in in vitro release test was supported by pharmacokinetic study in beagle dogs. Delayed absorption of hGH was observed with Cmax of 69.5+/-8.0 ng/ml and Tmax between 10 and 12 h. The administration of SR-hGH induced elevation of serum insulin-like growth factor-I (IGF-I) level for 6 days with a maximum value higher than the predose level by ca. 350 ng/ml. After 6 days, IGF-I level returned to the initial baseline level.Sustained-release formulation of hGH for once-a-week injection was successfully developed using high-molecular-weight sodium hyaluronate. No adverse effect was observed during and after the in vivo test using beagle dogs.

Oral squamous cell carcinoma (OSCC) is one of the most common head and neck cancers. OSCC generally has a poor prognosis due to its tendency towards local invasion and subsequent metastasis, which is mediated by multiple proteolytic enzymes and angiogenesis. The purpose of this study was to evaluate the anti-cancer effects of genistein, a soybean product known to be an effective natural anti-angiogenic agent, with respect to tumor growth, angiogenesis and in vitro invasion in an OSCC model. Northern blot analysis for vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and matrix metalloproteinase-2 (MMP-2), in vitro invasion assay and gelatin zymography were carried out for HSC-3 cells treated with genistein (27.3 microg/ml). In the animal experiment, genistein (0.5 mg/kg) was injected into tumor (HSC-3)-bearing mice (male balb/c/nu). The tumor growth rate and metastasis to lymph node or lung were compared and the microvessel density (CD31) was subsequently analyzed by immunohistochemistry. The genistein-treated group showed a down-regulation in VEGF mRNA expression, but not in bFGF and MMP-2 mRNA expression. Genistein reduced in vitro invasion through the artificial basement membrane and gelatin zymography also showed a reduced gelatinolytic activity in the genistein-treated group. In the genistein-treated mice, a significantly lower CD31 immunoreactivity was found. However, the tumor growth and metastatic behavior in the experimental group and the control group were similar and there were no significant differences. These results suggest the possible use of genistein as an anti-cancer agent in oral squamous cell carcinoma. However, it appears from the present study that anti-angiogenic therapy consisting of a single application of genistein may not provide a satisfactory treatment for OSCC. As a result, further research is recommended to confirm that genistein may be employed as an adjunct treatment modality for OSCC.

Objective The aim of this study was to introduce a new inferior alveolar nerve (IAN) defect repair method that does not require a nerve graft. Study design The IAN was isolated after removal of a buccal cortical window. The scarred area or neuroma caused by the dental implant was excised with fresh cut ends and an epineural margin. If the excised gap was too wide for direct closure, the incisive nerve was intentionally transected 5 mm anterior to the mental foramen to obtain sufficient posterior mobilization of the distal stump of the IAN. The nerve ends were then approximated directly by sliding the distal nerve end to the proximal cut end. After completing the nerve repair by using four 10-0 nylon epineural sutures, the cortical window was repositioned with a microplate and screws. Results Using this technique, 3 nerve repairs without a nerve graft were successfully achieved for gaps ∼10 mm in size. Conclusions The great advantage of this technique is that a moderate nerve defect can be anastomosed without a nerve graft when direct closure of the nerve segment is impossible without tension.

Bariatric surgery is an efficient procedure for remission of type 2 diabetes (T2DM) in morbid obesity. However, in Asian countries, mean body mass index (BMI) of T2DM patients is about 25 kg/m2. Various data on patients undergoing gastric bypass surgery showed that control of T2DM after surgery occurs rapidly and somewhat independent to weight loss. We hypothesized that in non-obese patients with T2DM, the glycemic control would be achieved as a consequence of gastric bypass surgery. From September 2009, the 172 patients have had laparoscopic single anastomosis gastric bypass (LSAGB) surgery. Among them, 107 patients have been followed up more than 1 year. We analyzed the dataset of these patients. Values related to diabetes were measured before and 1, 2, and 3 years after the surgery. The mean BMI decreased during the first year after the surgery but plateaued after that. The mean glycosylated hemoglobin level decreased continuously. The mean fasting and postglucose loading plasma glucose level also decreased. After LSAGB surgery in non-obese T2DM patients, the control of T2DM was possible safely and effectively. However, longer follow-up with matched control group is essential.

Objective: When an alveolar cleft is too large to close with adjacent mucobuccal flaps or large secondary fistula following a primary bilateral palatoplasty exists, a one-stage procedure for bone grafting becomes challenging. In such a case, we have used the tongue flap to repair the fistula and cleft alveolus followed by bone grafting to the cleft defect performed several months later. The purpose of this article is to report on our experiences with the use of an anteriorly based Y-shaped tongue flap to fit the palatal and labial alveolar defects and on the ultimate result of the bone graft. Patients: A series of 14 patients were treated with this approach from January 1994 to December 1998. The average age of the patients was 15.8 years (range 5 to 28 years). The mean period of follow-up following the second stage bone graft operation was 45.9 months (range 9 to 68 months). In 9 of the 14 patients, the long-fork type of a Y-shaped tongue flap was used for extended coverage of the labial-side alveolar defects with the palatal fistula; in the remaining patients, the short-forked design was used. Results: All patients demonstrated a good clinical result after the initial repair of cleft alveolus and palatal fistula. There was no fistula recurrence, although partial necrosis of distal margin in long-forked tongue flap occurred in one patient. Furthermore, the bone graft, which was performed an average of 8 months after the tongue flap repair, was always successful. Occasionally, transferred tongue tissue bulging interfered with the hygienic care of nearby teeth; however, these problems could be solved with proper contour-plasty performed afterward. No donor site complications such as sensory disturbance, change in taste, limitations in tongue movement, normal speech impairments, or tongue disfigurement were encountered. Conclusion: This two-stage reconstruction of a bilateral cleft alveolus using a Y-shaped tongue flap and iliac bone graft was very successful. It may be indicated for a bilateral cleft alveolus patient in which the direct closure of the cleft defect with adjacent tissue or the buccal flap is not easy because of scarred fibrotic mucosa and accompanied residual palatal fistula.

Angiogenesis is an essential process for the growth and invasion of cancer. However, it is uncertain that anti-angiogenic effects can be a major treatment strategy of oral cancer. The aim of this study was to investigate whether thalidomide and paclitaxel, which are known to be potent inhibitors of angiogenesis, have inhibitory effects on the growth of oral squamous cell carcinoma (OSCC) xenotransplanted into nude mice and whether anti-angiogenesis can be included as a major treatment strategy of oral cancer. After human OSCC cell line, KB, was subcutaneously inoculated into 32 nude mice, the volume of tumor was measured every 3 days. When the tumor mass reached 300-500 mm3, thalidomide (200 mg/kg) and paclitaxel (13 mg/kg) were administered into the animals and tumor volume change was checked. The excised tumor masses on the 30th day after administration were frozen and processed for immunohistochemistry using vascular endothelial growth factor (VEGF) and CD31, and for real-time reverse transcription-polymerase chain reaction (RT-PCR). We evaluated VEGF expression and the expression of its mRNA and CD31 for vessel density. Paclitaxel showed an inhibitory effect on the growth of transplanted human OSCC and reduced the immunohistochemical expression of VEGF and CD31 and VEGF mRNA (P

Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of the synovial tissue, that usually affects the knee, ankle and other major joints. Involvement of the temporomandibular joint is, however, very rare. We describe a new case of recurrent PVNS arising from the temporomandibular joint that was classified as diffuse extra-articular type and was successfully treated surgically. The etiology and clinical features of PVNS are discussed and the previously reported cases in the literature are reviewed.