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Key Points: The optimal tilt for anteriorly tilted coronal CT was examined. A 30° anteriorly tilted coronal CT best visualized the frontal sinus drainage pathway., (© 2024 ARS‐AAOA, LLC.)

Purpose: In Japan, two types of tests for diagnosing olfactory disorders, T and T (T&T) olfactometry and intravenous olfactory tests, are covered by insurance and performed on patients with olfactory disorders. This study examined the validity of these olfactory tests and whether psychophysical or morphological tests are more helpful in evaluating olfactory disorders., Methods: We evaluated patients who visited our department and underwent two types of olfaction tests and sinus computed tomography (CT). Data regarding the age, sex, peripheral blood eosinophil percentage, presence of bronchial asthma, diagnoses, olfactory symptom score, results of the two olfactory tests, and CT findings in eligible patients were extracted from medical records and retrospectively reviewed., Results: One hundred and sixty-three patients underwent all tests during the study period. The results of the T&T olfactometry and intravenous olfactory tests were significantly correlated. However, only the results of T&T olfactometry and olfactory cleft opacification on CT were statistically significant predictors of the olfactory symptom scores., Conclusion: T&T olfactometry and CT evaluations of olfactory cleft opacification helped evaluate olfactory dysfunction. It is important to note that intravenous olfactory tests are best performed with careful control and not blindly to assess olfactory disorders., (© 2024. The Author(s).)

Since 2019, SARS-CoV-2 has undergone mutations, resulting in pandemic and epidemic waves. The SARS-CoV-2 spike protein, crucial for cellular entry, binds to the ACE2 receptor exclusively when its receptor-binding domain (RBD) adopts the up-conformation. However, whether ACE2 also interacts with the RBD in the down-conformation to facilitate the conformational shift to RBD-up remains unclear. Herein, we present the structures of the BA.2.86 and the JN.1 spike proteins bound to ACE2. Notably, we successfully observed the ACE2-bound down-RBD, indicating an intermediate structure before the RBD-up conformation. The wider and mobile angle of RBDs in the up-state provides space for ACE2 to interact with the down-RBD, facilitating the transition to the RBD-up state. The K356T, but not N354-linked glycan, contributes to both of infectivity and neutralizing-antibody evasion in BA.2.86. These structural insights the spike-protein dynamics would help understand the mechanisms underlying SARS-CoV-2 infection and its neutralization., (© 2024. The Author(s).)

Objective: To elucidate the effectiveness of a 30-degree anteriorly tilted coronal CT in visualizing the anterior wall of the sphenoid sinus., Methods: Medical records and CTs of patients who underwent septoplasty, inferior turbinectomy, or endoscopic sinus surgery were reviewed. We evaluated the visibility of the anterior wall of the sphenoid sinus on conventional coronal CT scans and categorized its orientation. We then created anteriorly tilted coronal CT images to evaluate its improved visibility., Results: A total of 129 patients were evaluated. While conventional coronal CT scans fully visualized the anterior wall of the sphenoid sinus in cases with an Onodi cell, 17.7% remained unidentified when the Onodi cell was absent. However, anteriorly tilted coronal CT scans consistently identified the anterior wall regardless of the presence of an Onodi cell., Conclusion: Our study highlights the effectiveness of anteriorly tilted coronal CT scans in consistently visualizing the anterior wall of the sphenoid sinus, regardless of the presence of an Onodi cell. It is possible that some other structures may become less identifiable on anteriorly tilted coronal CT., Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

This study aimed to subjectively evaluate bone quality in the particulate cancellous bone and marrow (PCBM) graft area and to assess the survival rates of implants. A retrospective review was conducted based on patient age, sex, diagnosis, reconstructed site, number of implants, prosthetic type, and duration of follow-up. Images from computed tomography (CT) before implant insertion were obtained and used in this study. We selected a 4.0-mm diameter × 8.0-mm length region of interest in the implant placement area, and measured the CT attenuation value. No significant correlations were seen between CT attenuation values and implant survival rates in the maxilla and mandible. On the other hand, CT attenuation values and implant survival rates were significantly lower in patients with malignancy than in non-malignant cases. Placing implants in PCBM grafted bone requires a full understanding of bone quality before surgery and drilling to ensure primary stability, along with consideration of soft tissue management and maintenance programs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: This study aims to evaluate the presence of residual Plus Moist HS-W (PM), a novel calcium alginate packing material, during the initial postoperative visit following endoscopic sinus surgery. The research aims to identify factors that influence the quantity of remaining PM., Methods: A retrospective review of medical records was conducted for patients who underwent middle meatus packing with PM., Results: A total of fifty-two patients (representing 92 sides of paranasal sinuses) were included in the analysis. The remaining PM was classified as follows: absent (0) in 41 out of 92 cases, minimal (1) in 22 out of 92 cases, moderate (2) in 15 out of 92 cases, and substantial (3) in 14 out of 92 cases. Notably, all three patients who underwent Draf III surgery exhibited a significant amount of PM during their initial visit, with two patients classified as grade 2 and one patient as grade 3. Other factors investigated were found to be unrelated to the persistence of PM. Removal of all PM was achieved effortlessly using suction under flexible endoscopy., Conclusion: This study highlights the efficacy of PM in post-endoscopic sinus surgery care. It is important to limit an amount of PM, particularly in Draf III procedures., Competing Interests: Declaration of competing interest None, (Copyright © 2024. Published by Elsevier B.V.)

Objectives: Disruption of the oxidative stress defense system is involved in developing various diseases. Sulfur compounds such as glutathione (GSH) and cysteine (CysSH) are representative antioxidants in the body. Recently, supersulfides, including reactive persulfide and polysulfide species, have gained attention as potent antioxidants regulating oxidative stress and redox signaling. However, their involvement in the pathogenesis of chronic rhinosinusitis (CRS) remains unclear., Methods: To clarify the changes in sulfur compounds within the sinus mucosa of each CRS subtype, we measured sulfur compound levels in the sinus mucosa of control individuals ( n  = 9), patients with eosinophilic CRS (ECRS) ( n  = 13), and those with non-ECRS (nECRS) ( n  = 11) who underwent sinus surgery using mass spectrometry., Results: GSH and CysSH levels were significantly reduced, and the glutathione disulfide (GSSG)/GSH ratio, an oxidative stress indicator, was increased in patients with ECRS. Despite the absence of notable variations in supersulfides, patients with ECRS and nECRS exhibited a significant reduction in glutathione trisulfide (GSSSG), which serves as the precursor for supersulfides., Conclusions: This study is the first quantitative assessment of supersulfides in normal and inflamed sinus mucosa, suggesting that sulfur compounds contribute to the pathogenesis of CRS., Level of Evidence: N/A., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

Objectives: Double puncture arthrocentesis (DPA) of the temporomandibular joint (TMD) is considered an effective preservative option for managing mandibular condylar head fractures. However, the procedure is commonly performed by a traditional "blind" method using anatomical characteristics. In the present study, an ultrasonography (US) device was applied for the treatment of a case with a fractured mandibular condyle., Methods: A 79-year-old female was diagnosed right side condylar head fracture complaining pain of right TMD and reduced mouth opening range: inter-incisor distance of 20 mm. Since the fracture position was high and inoperable, the decision was made to perform DPA of the TMD. The US probe was positioned parallel and slightly oblique to the major axis of the mandibular ramus. Both the posterior and anterior insertions into the joint space were performed according to the axis mentioned above, which enabled the operator to visualize the entirety of the needle., Results: The device offered safety and ensured accuracy by providing real-time visual aid to the surgeon. The procedure provided an early increase in the inter-incisor distance (31 mm) and pain relief., Conclusions: Hence, for the preservative treatment of mandibular condylar head fractures, based on the present study, we recommend US-guided arthrocentesis as a safe, feasible, and effective therapeutic option instead of the conventional "blind" method., (© 2024. The Author(s) under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology.)

Conventional coronal CT scans of paranasal sinuses, aligned perpendicularly to the nasal floor, often deviate significantly from the endoscopic view during sinus surgery. This discrepancy complicates the interpretation of anatomical structures. In response, we propose the utilization of anteriorly tilted coronal CT slices to enhance anatomical understanding. These slices align more closely with the endoscopic view, fostering an intuitive grasp of paranasal sinus anatomy. This study aims to quantify the tilt of the endoscope to the nasal floor during endoscopic sinus surgery. To figure out the tilt of the endoscopically true coronal slices, we calculated the tilt of the endoscope to the nasal floor in the operative setting by taking pictures of the operation and measuring the image and sagittal CT. Fourteen patients (25 sides of paranasal sinuses) were analyzed. Endoscope tilts to the nasal floor were measured at different anatomical landmarks: 16.2 ± 9.7 degrees (lower edge of ground lamella), 29.8 ± 7.9 degrees (central ground lamella), 62.3 ± 10.1 degrees (most superior part), and 25.6 ± 7.0 degrees (optic canal). In conclusion, we showed the actual tilt of the endoscope to the nasal floor during endoscopic sinus surgery. A 30-degree anteriorly tilted coronal scan for frontal recess and sphenoid sinus is more intuitive than a traditional coronal scan, which helps surgeons understand the complex sinus anatomy.

Purpose: Endoscopic nasal and sinus surgery is a surgical procedure frequently performed by otolaryngologists. Postoperative bleeding is detrimental to both healthcare providers and patients. We investigated the epidemiology of postoperative bleeding during endoscopic nasal and sinus surgery and explored possible bleeding triggers., Methods: We evaluated the patients who underwent endoscopic nasal and sinus surgery. Data regarding the age, sex, presence of hypertension, and abnormal coagulability, including oral anticoagulants, diagnoses, operative procedures, intraoperative use of drills and blood loss, and postoperative antimicrobial administration of eligible patients, were extracted from medical records and retrospectively reviewed., Results: One hundred and eighty-six patients underwent endoscopic nasal or sinus surgery during the study period, and postoperative bleeding occurred in 9 patients (4.8%). Posterior nasal neurotomy (PNN) was the procedure most likely to cause postoperative bleeding (4 surgeries, 13.3%). Postoperative antimicrobial administration significantly reduced the incidence of postoperative bleeding (p = 0.04)., Conclusions: Postoperative bleeding requiring intervention occurs in 4.8% of cases, and PNN is associated with a high risk of postoperative bleeding. Wound infection is a potential cause of postoperative bleeding, and antimicrobial administration should be considered in addition to local treatment., (© 2023. The Author(s).)

Open axillary arterial injury is life-threatening, and upper-extremity reperfusion must be performed within approximately 6 h. We present the case of a patient who underwent reperfusion of the upper limb and nerve reconstruction of the post-ganglionic brachial plexus injury in one stage while maintaining stable vital signs. The injury was an avulsion with no fracture. Nerve grafting was necessary to reconstruct the nerves without tension. Although the sural nerve is commonly used, we decided to sacrifice the ipsilateral ruptured ulnar nerve because it was less likely to recover over a long reinnervation distance. Nine months postoperatively, the patient was able to flex the elbow and rotate the forearm, although finger function was poor. Nevertheless, the patient could use the hand to assist her in performing daily activities and return to the previous workplace as a clerk. J. Med. Invest. 71 : 332-334, August, 2024.

We investigated the effects of zoledronate (ZA) and compressive force, separately and in combination, on the proliferation and differentiation of human gingival fibroblasts (HGFs) to verify the mechanism underlying medication-related osteonecrosis of the jaw (MRONJ). The addition of 100 µM ZA markedly inhibited cell proliferation. Expression of type I collagen, fibroblast growth factor 2, and connective tissue growth factor genes, was decreased by ZA and compressive force. Similar results were observed for collagen expression by using Sirius red staining. These results, together with clinical findings that MRONJ is more common in cases with excessive mechanical stress on the oral mucosa, suggest that bisphosphonates such as ZA and mechanical stress may act in conjunction as risk factors for the development of MRONJ by affecting homeostasis of the oral mucosal tissues, including HGFs., (Copyright © 2023 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background/purpose: Most oral cancer (OC) cases are identified by family dentists in Japan. However, a significant number of patients with OC in Japan are referred to core hospitals at advanced stages. Therefore, identifying the factors that contribute to delayed referrals from family dentists to core hospitals is crucial for detecting OC in its earlier stages. The aim of this retrospective study was to identify the risk factors for referral delays from family dentists to core hospitals., Materials and Methods: The study included 63 patients with OC who were referred by family dentists to the Yamagata University Hospital between 2010 and 2022. The clinical parameters related to referral delays were retrospectively investigated using letters of reference provided by the family dentists and patient charts. Backward multiple regression analysis was performed to identify the relationships between the length of referral delay and potential risk factors. Additionally, backward multivariate logistic regression analysis was performed to examine the independent association between referral delays of >4 weeks and several clinical parameters., Results: Multiple regression analysis revealed that misdiagnosis of malignant lesions by family dentists ( P  = 0.047) was significantly associated with longer referral delays. Additionally, misdiagnosis of malignant lesions by family dentists was also an independent risk factor for referral delays of >4 weeks (odds ratio, 10.387; P  = 0.006)., Conclusion: Misdiagnosis of malignant lesions by family dentists was a significant risk factor for referral delays from family dentists to core hospitals. Our results will motivate family dentists to improve their ability to diagnose OC., (© 2023 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.)

Fatty acid-binding protein 7 (FABP7) is vital for uptake and trafficking of fatty acids in the nervous system. To investigate the involvement of FABP7 in noise-induced hearing loss (NIHL) pathogenesis, we used Fabp7 knockout (KO) mice generated via CRISPR/Cas9 in the C57BL/6 background. Initial auditory brainstem response (ABR) measurements were conducted at 9 weeks, followed by noise exposure at 10 weeks. Subsequent ABRs were performed 24 h later, with final measurements at 12 weeks. Inner ears were harvested 24 h after noise exposure for RNA sequencing and metabolic analyses. We found no significant differences in initial ABR measurements, but Fabp7 KO mice showed significantly lower thresholds in the final ABR measurements. Hair cell survival was also enhanced in Fabp7 KO mice. RNA sequencing revealed that genes associated with the electron transport chain were upregulated or less impaired in Fabp7 KO mice. Metabolomic analysis revealed various alterations, including decreased glutamate and aspartate in Fabp7 KO mice. In conclusion, FABP7 deficiency mitigates cochlear damage following noise exposure. This protective effect was supported by the changes in gene expression of the electron transport chain, and in several metabolites, including excitotoxic neurotransmitters. Our study highlights the potential therapeutic significance of targeting FABP7 in NIHL., (© 2023. The Author(s).)

Purpose: Oral leukoplakia (OL) is a common potentially malignant oral disorder. Therefore, there is a need for simple screening methods for OL before its transformation into oral cancer. Furthermore, because invasive open biopsy is the sole method to determine if an OL lesion is dysplastic, there is also a clinical need for non-invasive methods to differentiate dysplastic OL from non-dysplastic OL. This study aimed to identify salivary metabolites that can help differentiate patients with OL from healthy controls (HC) and also dysplastic OL from non-dysplastic OL., Material & Methods: Whole unstimulated saliva samples were collected from patients with OL (n = 30) and HCs (n = 29). The OL group included nine patients with dysplastic OL and 20 with non-dysplastic OL. Hydrophilic metabolites in the saliva samples were comprehensively analyzed through capillary electrophoresis mass spectrometry. To evaluate the discrimination ability of a combination of multiple markers, a multiple logistic regression (MLR) model was developed to differentiate patients with OL from HCs and dysplastic OL from non-dysplastic OL., Results: Twenty-eight metabolites were evidently different between patients with OL and HCs. Finally, three metabolites (guanine, carnitine, and N-acetylputrescine) were selected to develop the MLR model, which resulted in a high area under curve (AUC) of the receiver operating characteristic (ROC) to differentiate patients with OL from HCs (AUC = 0.946, p < 0.001, 95% confidential interval [CI] = 0.889- 1.000). Similarly, two metabolites were evidently different between patients with dysplastic and non-dysplastic OL. Finally, only one metabolite (7-methylguanine) was selected in the MLR model, which revealed a moderate discrimination ability for dysplastic and non-dysplastic OL (AUC = 0761, p = 0.027, 95% CI = 0.551-0.972)., Conclusion: Our candidate salivary metabolites showed potential not only to discriminate OL from HC, but also to discriminate dysplastic OL from non-dysplastic OL., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Objectives: Dental implants are believed to contribute to improved masticatory function and oral health-related quality of life (OHRQOL), but the details remain unclear. The aim of this study was to evaluate the clinical outcomes of dental implant prosthetic rehabilitation after bone graft at the anterior mandible/maxilla based on OHRQOL, particularly in young and middle-aged patients., Methods: This retrospective study included 11 patients who received bone grafts at the anterior mandible/maxilla and dental implant surgery. Chewing function score and OHRQOL (using the Oral Health Impact Profile-14 questionnaire) were evaluated before and after completion of an implant-retained bridge or removable implant-supported denture., Results: Chewing function score tended to improve slightly after dental implant prosthetic rehabilitation, but none of the observed differences were significant. In the assessment of OHRQOL, relatively worse domain scores before completion of dental implant prosthetic rehabilitation were seen for Functional limitation, Psychological discomfort, and Psychological disability. Conversely, Social disability seemed relatively unaffected by tooth loss. All domain scores and total scores for items other than Physical disability and Social disability were significantly improved after completion of dental implant rehabilitation., Conclusions: Tooth loss in the anterior region may not significantly affect chewing function score, but can have a significant impact on OHRQOL. Bone grafts and dental implant prosthetic rehabilitation can resolve these problems, and the results of this study will benefit both patients and medical professionals in terms of treatment planning and informed consent., (© 2023. The Author(s).)

Objectives: The painless postoperative period can be significantly prolonged by using long-acting local anesthetics such as ropivacaine, though these local anesthetics are known for their slower onset of action. To compensate for this, a mixture of short-onset (e.g., lidocaine) and long-acting local anesthetics is used. However, the efficacy of such an anesthetic cocktail has not been elucidated in the field of oral and maxillofacial surgery., Materials and Methods: To address the research purpose, this prospective randomized controlled trial included 56 patients scheduled for impacted mandibular third molar extraction. All patients received the inferior alveolar nerve block (IANB) using either 2% lidocaine with epinephrine or a 1:1 mixture of 2% lidocaine with epinephrine and 0.75% ropivacaine., Results: Patients anesthetized using the lidocaine-ropivacaine mixture showed significantly prolonged postoperative analgesia and pain control than those anesthetized using lidocaine only., Conclusions: IANB using a lidocaine-ropivacaine mixture can provide prolonged postoperative anesthesia and pain control with extraction of mandibular third molars., Clinical Relevance: This method can be a noteworthy addition to existing methods of local anesthesia for the extraction of mandibular third molars. Trial registration number University Hospital Medical Information Network (No. UMIN000044315)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The aim of this study was to evaluate the radiographic characteristics and surgical removal of mesiodens among patients who had attended the Department of Dentistry, Oral and Maxillofacial-Plastic and Reconstructive Surgery of the Faculty of Medicine, Yamagata University. This study included 121 patients in the final analysis. We retrospectively reviewed medical records including patient age, sex, mesiodens number, direction, position, opportunity for detection, surgical approach and operating time. The 121 patients comprised 82 males and 39 females. Mean age was 7.6 ± 3.1 years (range, 4-35 years). The total number of mesiodens among these 121 patients was 147. Ninety-six patients had one mesiodens, 24 patients had two mesiodens and 1 patient had 3 mesiodens. Seventy-nine mesiodens were detected while taking X-rays for routine dental examination and/or orthodontic treatment at their family dental/orthodontic clinic. Mean operating time for removal of the 147 mesiodens was 32.2 ± 18.1 min. Among the 96 patients with one mesiodens, mean operating time for removal of the mesiodens was 30.7 ± 16.5 min. Operating time for removal of a mesiodens tended to be prolonged with increased distance from the alveolar crest. Early detection of mesiodens on routine radiographic check-ups and surgical planning considering patient age, crown direction, position of the mesiodens will contribute to improved treatment of mesiodens., Competing Interests: Declaration of Competing Interest We declare that the authors have no conflicts of interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Functional endoscopic sinus surgery has become popular worldwide. However, serious complications have been reported with it. A preoperative imaging evaluation is thus essential to avoid complications. The authors compared 0.5 mm slice computed tomography (CT) images reconstructed from sinus CT data with conventional 2 mm slice CT images. The authors evaluated patients who underwent endoscopic surgery. Data regarding age, sex, history of craniofacial trauma, diagnosis, operative procedure, and CT findings of eligible patients were extracted from medical records and retrospectively reviewed. One hundred twelve patients underwent endoscopic surgery during the study period. Six patients (5.4%) had orbital blowout fractures, and half of them could only be identified by 0.5 mm slice CT images. The authors presented the usefulness of 0.5 mm slice CT images in the preoperative imaging evaluation of functional endoscopic sinus surgery. Surgeons should also recognize that a small number of patients have "stealth" (asymptomatic and unrecognized) blowout fractures., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by Mutaz B. Habal, MD.)

Mitochondrial dysfunction can cause cochlear dysfunction and accelerate noise-induced hearing loss (NIHL). NADH dehydrogenase (ubiquinone) Fe-S protein 4 (Ndufs4) is one of the subunits of mitochondrial complex I and has a role in the assembly and stabilization of complex I. However, the involvement of Ndufs4 in the pathogenesis of NIHL has not been reported. The aim of this study was to evaluate whether Ndufs4 deletion causes vulnerability to noise exposures. The wild-type (WT) and Ndufs4 knockout (KO) mice with C57BL/6J genetic background were used. Cochlear histology and hearing thresholds were assessed after noise exposure at 100 or 86 dB sound pressure level (SPL). Immunostaining showed the widespread expression of Ndufs4 in the cochlea. After noise exposure at 100 dB SPL, auditory brainstem response (ABR) threshold shifts at 4 kHz in Ndufs4 KO mice were significantly higher than that in WT mice. After noise exposure at 86 dB SPL, ABR threshold shifts, wave 1 amplitudes, and the number of synapses in the inner hair cells were not significantly different. RNA sequencing revealed the decreased expression of energy generation-related genes inNdufs4 KO mice. Ndufs4 deficiency accelerates permanent low-frequency threshold shifts after moderate noise exposure.

Background: In early 2020, developing vaccines was an urgent need for preventing COVID-19 from a contingency perspective., Methods: S-268019-a is a recombinant protein-based vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), comprising a modified recombinant spike protein antigen adjuvanted with agatolimod sodium, a Toll-like receptor-9 agonist. In the preclinical phase, it was administered intramuscularly twice at a 2-week interval in 7-week-old mice. Immunogenicity was assessed, and the mice were challenged intranasally with mouse-adapted SARS-CoV-2 at 2 and 8 weeks, respectively, after the second immunization. After confirming the preclinical effect, a Phase 1/2, randomized, parallel-group clinical study was conducted in healthy adults (aged 20-64 years). All participants received 2 intramuscular injections at various combinations of the antigen and the adjuvant (S-910823/agatolimod sodium, in μg: 12.5/250, 25/250, 50/250, 25/500, 50/500, 100/500, 10/500, 100/100, 200/1000) or placebo (saline) in an equivalent volume at a 3-week interval and were followed up until Day 50 in this interim analysis., Results: In the preclinical studies, S-268019-a was safe and elicited robust immunoglobulin G (IgG) and neutralizing antibody responses in mice. When challenged with SARS-CoV-2, all S-268019-a-treated mice survived and maintained weight until 10 days, whereas all placebo- or adjuvant-treated (without antigen) mice died within 6 days. In the Phase 1/2 trial, although S-268019-a was well tolerated in adult participants, was safe up to Day 50, and elicited robust anti-spike protein IgG antibodies, it did not elicit sufficient neutralizing antibody levels., Conclusions: The S-268019-a vaccine was not sufficiently immunogenic in Japanese adults despite robust immunogenicity and efficacy in mice. Our results exemplify the innate challenges in translating preclinical data in animals to clinical trials, and highlight the need for continued research to overcome such barriers. (jRCT2051200092)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The ac losses in the conduction-cooled low temperature superconductor (LTS) pulse coil with stored energy of 1 MJ are estimated. The results have shown that the ac losses in 1 MJ coil as well as on the 100 kJ coil are low.

The immune responses to SARS-CoV-2 variants in COVID-19 cases are influenced by various factors including pre-existing immunity via vaccination and prior infection. Elucidating the drivers for upgrading neutralizing activity to SARS-CoV-2 in COVID-19 cases with pre-existing immunity will aid in improving COVID-19 booster vaccines with enhanced cross-protection against antigenically distinct variants, including the Omicron sub-lineage BA.4/5. This study revealed that the magnitude and breadth of neutralization activity to SARS-CoV-2 variants after breakthrough infections are determined primarily by upper respiratory viral load and vaccination-infection time interval. Extensive neutralizing breadth, covering even the most antigenically distant BA.4/5, was observed in cases with higher viral load and longer time intervals. Antigenic cartography depicted a critical role of the time interval in expanding the breadth of neutralization to SARS-CoV-2 variants. Our results illustrate the importance of dosing interval optimization as well as antigen design in developing variant-proof booster vaccines., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Introduction: Post-operative care after functional endoscopic sinus surgery (FESS) is essential for managing the long-term success of chronic rhinosinusitis. Post-operative sinus debridement promotes proper wound healing, but the procedure can be accompanied by discomfort and pain. Hence, we analysed the clinical factors related to sinus debridement time after FESS., Materials and Methods: We evaluated retrospectively the clinical factors affecting the time taken for post-operative sinus debridement on the first visit after the discharge. We reviewed 101 patients who underwent FESS at our hospital by the same surgeon and extracted patient information. The time for post-operative sinus debridement at the first outpatient clinic was measured., Results: The days of putting the cotton ball in the operated nostril were negatively associated with sinus debridement time (coefficient - -16.4 ± 5.7 seconds/day, P = 0.005). In contrast, current or history of asthma, amount of bleeding during the surgery, number of opened sinuses by the operation or the number of eosinophils in resected tissues under a microscope at ×400 was not associated., Discussion: We recommend the use of a cotton ball in the nostril after FESS because it shortens the sinus debridement time. Placing cotton balls in the nostril helps to maintain a humid wound environment and reduce crusting, leading to easier sinus debridement and better wound healing., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Annals of Maxillofacial Surgery.)

The olfactory epithelium can regenerate after damage; however, the regeneration process is affected by various factors, such as viral infections, head trauma, and medications. Zinc is an essential trace element that has important roles in organ development, growth, and maturation. Zinc also helps regulate neurotransmission in the brain; nevertheless, its relationship with olfactory epithelium regeneration remains unclear. Therefore, we used a severe zinc deficiency mouse model to investigate the effects of zinc deficiency on olfactory epithelium regeneration. Male wild-type C57BL/6 mice were divided into zinc-deficient and control diet groups at the age of 4 weeks, and methimazole was administered at the age of 8 weeks to induce severe olfactory epithelium damage. We evaluated the olfactory epithelium before and 7, 14, and 28 days after methimazole administration by histologically analyzing paraffin sections. RNA sequencing was also performed at the age of 8 weeks before methimazole administration to examine changes in gene expression caused by zinc deficiency. In the zinc-deficient group, the regenerated olfactory epithelium thickness was decreased at all time points, and the numbers of Ki-67-positive, GAP43-positive, and olfactory marker protein-positive cells (i.e. proliferating cells, immature olfactory neurons, and mature olfactory neurons, respectively) failed to increase at some time points. Additionally, RNA sequencing revealed several changes in gene expression, such as a decrease in the expression of extracellular matrix-related genes and an increase in that of inflammatory response-related genes, in the zinc-deficient group. Therefore, zinc deficiency delays olfactory epithelium regeneration after damage in mice., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The synthesis and various electromagnetic properties of different NbTi/Cu multifilamentary films with high aspect-ratio cross-sections are described. These films are found to have strong anisotropy of properties like ac losses and critical current density.

Objective: Head and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital., Methods: The patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund-Mackay (LM) staging system., Results: In total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020)., Conclusion: We found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2022. Published by Elsevier B.V.)

To control the coronavirus disease 2019 (COVID-19) pandemic, there is a need to develop vaccines to prevent infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. One candidate is a nasal vaccine capable of inducing secretory IgA antibodies in the mucosa of the upper respiratory tract, the initial site of infection. However, regarding the development of COVID-19 vaccines, there is concern about the potential risk of inducing lung eosinophilic immunopathology as a vaccine-associated enhanced respiratory disease as a result of the T helper 2 (Th2)-dominant adaptive immune response. In this study, we investigated the protective effect against virus infection induced by intranasal vaccination of recombinant trimeric spike protein derived from SARS-CoV-2 adjuvanted with CpG oligonucleotides, ODN2006, in mouse model. The intranasal vaccine combined with ODN2006 successfully induced not only systemic spike-specific IgG antibodies, but also secretory IgA antibodies in the nasal mucosa. Secretory IgA antibodies showed high protective ability against SARS-CoV-2 variants (Alpha, Beta and Gamma variants) compared to IgG antibodies in the serum. The nasal vaccine of this formulation induced a high number of IFN-γ-secreting cells in the draining cervical lymph nodes and a lower spike-specific IgG1/IgG2a ratio compared to that of subcutaneous vaccination with alum as a typical Th2 adjuvant. These features are consistent with the induction of the Th1 adaptive immune response. In addition, mice intranasally vaccinated with ODN2006 showed less lung eosinophilic immunopathology after viral challenge than mice subcutaneously vaccinated with alum adjuvant. Our findings indicate that intranasal vaccine adjuvanted with ODN2006 could be a candidate that can prevent the infection of antigenically different variant viruses, reducing the risk of vaccine-associated enhanced respiratory disease., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Fibroepithelial polyps are benign tumors of mesodermal origin. They rarely occur in the nasal cavity, with only four such cases reported in the relevant English literature. The location was the inferior turbinate in three cases and anterior nasal septum in one case. The etiology has been suggested in other organs; however, it is entirely unknown in the nasal cavity. Pathological findings play an essential role in the diagnosis of fibroepithelial polyps. We report the case of a 76-year-old woman with fibroepithelial polyps originating from the posterior part of the nasal septum. The fibroepithelial polyps were white-yellow lobular masses that differed from a common inflammatory polyp. We made the diagnosis by excluding the other possible tumors based on a pathological examination. This is the first report about fibroepithelial polyps arising from the posterior nasal septum. She had no potential risk factors that might trigger fibroepithelial polyps in the nasal cavity. This case is a valuable example when considering the potential causes (e.g., female hormones and mechanical pressure) of nasal fibroepithelial polyps.

Sinonasal inverted papilloma (IP) is the most common benign tumor in sinonasal cavities. Treatment involves excising the whole tumor, so it is essential to evaluate the extent of the tumor by preoperative radiographic findings. Magnetic resonance imaging (MRI) is superior to computed tomography (CT) for determining a tumor's location as MRI can discern the difference between mucus and IP. We herein report a 51-year-old man with sinonasal IP treated with endoscopic sinus surgery (ESS). Preoperative MRI showed findings resembling a convoluted cerebriform pattern on T2-weighted imaging, but this site was not enhanced by intravenous gadolinium at all. We preoperatively suspected that this site was not part of the tumor but rather the accumulation of mucus, and indeed, we found no tumor at this site when we performed the surgery. This patient is a valuable example of misleading findings of IP on T2-weighted imaging and underscores the importance of contrast-enhanced T1-weighted imaging to determine the extent of IP.

Actinomycosis is a bacterial infection caused by actinomyces. Although almost 50% of cases are related to the head and neck region, those in the nose and paranasal sinuses (PNS) are rare. Actinomycosis of the PNS is presumed to be typically caused by dental caries, dental manipulation, and maxillofacial trauma, which facilitate the penetration of oral pathogens into the sinus, and should thus be treated by the combination of surgical removal and potent antibiotics for at least two months. The current use of these antibiotics might be redundant, considering the nature of actinomycosis of the PNS, which does not invade the mucosal surface. We herein report a 67-year-old female treated with endoscopic sinus surgery (ESS) and diagnosed with actinomycosis of the PNS by pathological findings. She had no history of dental impairment or treatment. She was given routine perioperative prophylactic antibiotics (cefazolin) during the surgery, followed by low-dose clarithromycin. The mucosa of the PNS normalized without any discharge by three months after the operation. The patient is a valuable example that should prompt reconsideration of the commonly accepted pathogenesis and treatment of actinomycosis of the PNS.

Background: The immune profile against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has dramatically diversified due to a complex combination of exposure to vaccines and infection by various lineages/variants, likely generating a heterogeneity in protective immunity in a given population. To further complicate this, the Omicron variant, with numerous spike mutations, has emerged. These circumstances have created the need to assess the potential of immune evasion by Omicron in individuals with various immune histories., Methods: The neutralization susceptibility of the variants, including Omicron and their ancestors, was comparably assessed using a panel of plasma/serum derived from individuals with divergent immune histories. Blood samples were collected from either mRNA vaccinees or from those who suffered from breakthrough infections of Alpha/Delta with multiple time intervals following vaccination., Findings: Omicron was highly resistant to neutralization in fully vaccinated individuals without a history of breakthrough infections. In contrast, robust cross-neutralization against Omicron was induced in vaccinees that experienced breakthrough infections. The time interval between vaccination and infection, rather than the variant types of infection, was significantly correlated with the magnitude and potency of Omicron-neutralizing antibodies., Conclusions: Immune histories with breakthrough infections can overcome the resistance to infection by Omicron, with the vaccination-infection interval being the key determinant of the magnitude and breadth of neutralization. The diverse exposure history in each individual warrants a tailored and cautious approach to understanding population immunity against Omicron and future variants., Funding: This study was supported by grants from the Japan Agency for Medical Research and Development (AMED)., Competing Interests: The authors declare no competing interests., (© 2022 Elsevier Inc.)

One safety concern during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine development has been the vaccine-associated enhanced disease, which is characterized by eosinophilic immunopathology and T helper cell type 2 (T H 2)–biased immune responses with insufficient neutralizing antibodies. In this study, we established a lethal animal model using BALB/c mice and a mouse-passaged isolate (QHmusX) from a European lineage of SARS-CoV-2. The QHmusX strain induced acute respiratory illness, associated with diffuse alveolar damage and pulmonary edema, in T H 2-prone adult BALB/c mice, but not in young mice or T H 1-prone C57BL/6 mice. We also showed that immunization of adult BALB/c mice with recombinant spike protein without appropriate adjuvant caused eosinophilic immunopathology with T H 2-shifted immune response and insufficient neutralizing antibodies after QHmusX infection. This lethal mouse model is useful for evaluating vaccine-associated enhanced respiratory disease during SARS-CoV-2 infection and may provide new insights into the disease pathogenesis of SARS-CoV-2.