Cases of screw-retained implant prosthesis in the anterior maxilla through multidisciplinary approach, including orthodontic teeth alignment / 대한치과보철학회지

The labio-palatal location of the implant in the maxillary anterior region is one of the important factors affecting the aesthetics of the implant prosthesis. However, the thin labial bone of maxilla could be absorbed in significant amounts after extraction of the teeth, which makes the implant be placed on the palatal side rather than the ideal location. In fact, in the cases of maxillary central incisor loss, UCLA was used for prosthetic restoration of palatally placed implant. In addition, with multidisciplinary treatment, GBR (Guided Bone Regeneration) was performed for compensating the absorbed alveolar bone and adjacent anterior tooth were aligned. Definitive restoration was performed after confirming aesthetic recovery of the gingiva with sufficient provisional restoration period. There were satisfactory results of functional and esthetic recovery of tooth loss through implant prosthesis.

Exosomal miR-181b-5p Downregulation in Ascites Serves as a Potential Diagnostic Biomarker for Gastric Cancer-associated Malignant Ascites

PURPOSE: Peritoneal carcinomatosis in gastric cancer (GC) patients results in extremely poor prognosis. Malignant ascites samples are the most appropriate biological material to use to evaluate biomarkers for peritoneal carcinomatosis. This study identified exosomal MicroRNAs (miRNAs) differently expressed between benign liver cirrhosis-associated ascites (LC-ascites) and malignant gastric cancer-associated ascites (GC-ascites), and validated their role as diagnostic biomarkers for GC-ascites. MATERIALS AND METHODS: Total RNA was extracted from exosomes isolated from 165 ascites samples (73 LC-ascites and 92 GC-ascites). Initially, microarrays were used to screen the expression levels of 2,006 miRNAs in the discovery cohort (n=22). Subsequently, quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) analyses were performed to validate the expression levels of selected exosomal miRNAs in the training (n=70) and validation (n=73) cohorts. Furthermore, carcinoembryonic antigen (CEA) levels were determined in ascites samples. RESULTS: The miR-574-3p, miR-181b-5p, miR-4481, and miR-181d were significantly downregulated in the GC-ascites samples compared to the LC-ascites samples, and miR-181b-5p showed the best diagnostic performance for GC-ascites (area under the curve [AUC]=0.798 and 0.846 for the training and validation cohorts, respectively). The diagnostic performance of CEA for GC-ascites was improved by the combined analysis of miR-181b-5p and CEA (AUC=0.981 and 0.946 for the training and validation cohorts, respectively). CONCLUSIONS: We identified exosomal miRNAs capable of distinguishing between non-malignant and GC-ascites, showing that the combined use of miR-181b-5p and CEA could improve diagnosis.

The Use of CD44 Variant 9 and Ki-67 Combination Can Predicts Prognosis Better Than Their Single Use in Early Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We previously demonstrated that CD44v9 and Ki-67 played an important role in predicting poor prognosis of early gastric cancer (EGC). However, little is known about combined use of both biomarkers as prognostic biomarker. The present study was performed to investigate the significance of CD44v9 and Ki-67 expression as a combination biomarker for EGC. MATERIALS AND METHODS: With tissue microarray for 158 EGC tissues, we performed immunohistochemical staining for CD44v9 and Ki-67. The whole patients were divided into three groups (group A, CD44v9-negative/Ki-67–low; group B, neither group A or C; and group C, CD44v9-positive/Ki-67–high). Its clinical significance was re-analyzed with adjustment via propensity score matching (PSM). For validation, we performed bootstrap resampling. RESULTS: The median follow-up duration was 90.4 months (range, 3.7 to 120.4 months). In the comparison according to CD44v9/Ki-67 expression, the combined use of the two biomarker clearly separated the three groups by 5-year survival rates (5-YSR, 96.3%, 89.8%, and 76.8% in group A, B, and C, respectively; p=0.009). After PSM, 5-YSR were 97.7% and 76.8% in group A+B and group C, respectively (p=0.002). Multivariable analysis demonstrated that group C had independently poor prognosis (hazard ratio, 9.137; 95% confidence interval, 1.187 to 70.366; p=0.034) compared with group A. Bootstrap resampling internally validated this result (p=0.016). CONCLUSION: This study suggests that both positive CD44v9 and high Ki-67 expression are associated with poor prognosis in EGC, and the combined use of these markers provides better prognostic stratification than the single use of them.

Evaluation of static fracture resistances and patterns of pulpless tooth restored with poly-ether-ketone-ketone (PEKK) post / 대한치과보철학회지

PURPOSE: The purpose of present study was to investigate fracture strength and mode of failure of endodontically treated teeth restored with metal cast post-core system, prefabricated fiber post system, and newly introduced polyetherketoneketone (PEKK) post-core system. MATERIALS AND METHODS: A total of 21 mandibular premolar were randomly grouped into 3 groups of 7 each according to the post material. Group A was for metal cast post core; Group B for prefabricated glass fiber post and resin core; and Group C for milled PEKK post cores. All specimens were restored with metal crown. The fracture strength of each specimen was measured by applying a static load of 135-degree to the tooth at 2 mm/min crosshead speed using a universal testing machine. After the fracture strength measurement, the mode of failure was observed. The results were analyzed using Kruscal-Wallis test and post hoc Mann-Whitney U test at confidence interval α = .05. RESULTS: Fracture resistance of PEKK post core was lower than those of cast metal post and fiber reinforced post with composite resin core. In the aspect of fracture mode most of the root fracture occurred in the metal post core, whereas the post detachment occurred mainly in the fiber reinforced post. In the case of PEKK post core, teeth and post were fractured together. CONCLUSION: It is necessary to select appropriate materials of post for extensively damaged teeth restoration and clinical application of the PEKK post seems to require more research on improvement of strength.

A case of maxilla implant overdenture using Pekkton telescopic attachment with severe alveolar bone resorption / 대한치과보철학회지

It is necessary to set the correct occlusal plane and to distribute the occlusal force uniformly considering the state of the opposing dentition during the prosthetic of the single edentulous patient with severe alveolar bone resorption. Implant supported overdenture is superior to complete denture in terms of maintenance and stability, and limited implants are used in fully edentulous patients with high alveolar bone resorption. Telescopic attachments using a newly introduced material based on poly-aryl-ether-ketone (PAEK) have the advantages of typical telescopic copping, excellent abrasion resistance, and are lighter and more economical than conventional implant overdentures. In this case, we restored maxillary arch with a implant retained overdenture using the telescopic attachment made of Pekkton and the mandible was restored with fixed implant prosthesis. Through these procedures esthetic aspects and functional outcomes were satisfactorily achieved.

Full mouth rehabilitation of a patient with worn dentition and loss of posterior support by vertical dimension reestablishment: a clinical report / 대한치과보철학회지

Excessive teeth wear may result in the complications such as esthetic problems, hypersensitivity, and loss of vertical dimension. This clinical report focuses on the causes of severely worn dentition and the full-mouth rehabilitation of a patient with rheumatoid arthritis for 20 years. An interview, clinical and radiological examinations were performed to analyze the causes and decide the treatment plan. After delivery of the final prostheses, a night guard was used to protect the restorations and temporomandibular joints. The patient was satisfied esthetically and functionally.

Full mouth rehabilitation of severely worn dentition with implants and removable partial dentures / 대한치과보철학회지

Excessive tooth wear can lead to decrease in occlusal vertical dimension and can cause pathological changes in the oral environment and masticatory system. When recovering occlusal vertical dimension and occlusion, accurate diagnosis and analysis are essential. This clinical case describes a 75-year-old woman with severely worn dentition due to loss of the posterior support. Full mouth rehabilitation with occlusal vertical dimension increment was planned. Clinical and radiographic examinations, occlusal vertical dimension evaluation, and diagnostic wax-up were performed and patient adaptability was evaluated using provisional restorations. As for definitive restoration, considering economic condition of the patient, removable partial denture was fabricated and solitary implants were placed in the mandibular left and right posterior region to increase support and retention of the removable partial denture. During one year of follow-up, functional and esthetic outcomes were observed satisfactory.

Accuracy of new implant impression technique using dual arch tray and bite impression coping

PURPOSE: The purpose of this in vitro study was to evaluate the accuracy of a new implant impression technique using bite impression coping and a dual arch tray. MATERIALS AND METHODS: Two implant fixtures were placed on maxillary left second premolar and first molar area in dentoform model. The model with two fixtures was used as the reference. The impression was divided into 2 groups, n=10 each. In group 1, heavy/light body silicone impression was made with pick up impression copings and open tray. In group 2, putty/light body silicone impression was made with bite impression copings and dual arch tray. The reference model and the master casts with implant scan bodies were scanned by a laboratory scanner. Surface tessellation language (STL) datasets from test groups was superimposed with STL dataset of reference model using inspection software. The three-dimensional deviation between the reference model and impression models was calculated and illustrated as a color-map. Data was analyzed by independent samples T-test of variance at α=.05. RESULTS: The mean 3D implant deviations of pick up impression group (group 1) and dual arch impression group (group 2) were 0.029 mm and 0.034 mm, respectively. The difference in 3D deviations between groups 1 and 2 was not statistically significant (P=.075). CONCLUSION: Within limitations of this study, the accuracy of implant impression using a bite impression coping and dual arch tray is comparable to that of conventional pick-up impression.

Using 17-gauge Spinal Anesthesia Needle as an Insertion Guide for Frontalis Sling Surgery with Silicone Rod

PURPOSE: In this study we investigated the surgical outcome and effectiveness of using a 17-gauge spinal anesthesia needle for guiding insertion of the silicone rod in frontalis sling surgery for patients having severe myogenic or neurogenic ptosis with risk of exposure keratopathy. METHODS: This study included on 8 patients (11 eyes) who previously received frontalis sling surgery with a 17-gauge spinal anesthesia needle because of severe myogenic or neurogenic ptosis with risk of exposure keratopathy. We investigated the technique, surgical outcome, and clinical features following frontalis sling surgery, and evaluated the advantages of using a 17-gauge spinal anesthesia needle. RESULTS: The mean age of patients was 54 years. Third nerve palsy was the most common etiology in severe ptosis with risk of exposure keratopathy (5 of 8, 62.5%). Main advantages of the 17-gauge spinal anesthesia needle are smaller skin incision that allows for minimal damage during tissue passage and easy guide for insertion. Other advantages included sterilization, minimizing infections, sharpness without distortion because it is disposable, and economic value. The mean follow-up period was 21.4 months, and the upper lid margin of all patients was adequately high above the pupil margin. Additionally, no major complications were observed in the patients. CONCLUSIONS: Frontalis sling surgery with a silicone rod is a safe and effective method for patients with severe myogenic or neurogenic ptosis with risk of exposure keratopathy. The 17-gauge spinal anesthesia needle is useful and economical in frontalis sling surgery for guiding insertion of the silicon rod as an alternative option to the Wright needle.

Ursodeoxycholic Acid Induces Death Receptor-mediated Apoptosis in Prostate Cancer Cells

BACKGROUND: Bile acids have anti-cancer properties in a certain types of cancers. We determined anticancer activity and its underlying molecular mechanism of ursodeoxycholic acid (UDCA) in human DU145 prostate cancer cells. METHODS: Cell viability was measured with an MTT assay. UDCA-induced apoptosis was determined with flow cytometric analysis. The expression levels of apoptosis-related signaling proteins were examined with Western blotting. RESULTS: UDCA treatment significantly inhibited cell growth of DU145 in a dose-dependent manner. It induced cellular shrinkage and cytoplasmic blebs and accumulated the cells with sub-G1 DNA contents. Moreover, UDCA activated caspase 8, suggesting that UDCA-induced apoptosis is associated with extrinsic pathway. Consistent to this finding, UDCA increased the expressions of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) receptor, death receptor 4 (DR4) and death receptor 5 (DR5), and TRAIL augmented the UDCA-induced cell death in DU145 cells. In addition, UDCA also increased the expressions of Bax and cytochrome c and decreased the expression of Bcl-xL in DU145 cells. This finding suggests that UDCA-induced apoptosis may be involved in intrinsic pathway. CONCLUSIONS: UDCA induces apoptosis via extrinsic pathway as well as intrinsic pathway in DU145 prostate cancer cells. UDCA may be a promising anti-cancer agent against prostate cancer.

Adjuvant Chemotherapy for Advanced Gastric Cancer in Elderly and Non-elderly Patients: Meta-Analysis of Randomized Controlled Trials / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study evaluated the benefits of adjuvant chemotherapy on elderly patients with advanced gastric cancer (AGC) using meta-analysis of well-designed randomized controlled clinical studies. MATERIALS AND METHODS: PubMed, Embase, and Cochrane were searched to retrieve clinical studies evaluating the benefits of adjuvant chemotherapy in the elderly with AGC. Hazards ratios (HRs) with 95% confidence intervals (CIs) were pooled across studies using a fixed-effects model. RESULTS: Two studies were included in this meta-analysis to estimate HR for the overall survival (OS), and relapse-free survival (RFS) between adjuvant chemotherapy and surgery in elderly and non-elderly patients. HR for OS in the elderly and non-elderly was 0.745 (95% CI, 0.552 to 1.006, p=0.055) and 0.636 (95% CI, 0.522 to 0.776; p < 0.001), respectively, which showed no heterogeneity regarding HR between the two groups (p(interaction)=0.389). HR for RFS in the elderly and non-elderly was 0.613 (95% CI, 0.466 to 0.806; p < 0.001) and 0.633 (95% CI, 0.533 to 0.753; p < 0.001), respectively (p(interaction)=0.846). CONCLUSION: Meta-analysis suggests that the benefit of adjuvant chemotherapy to the elderly is not big enough to reach statistical significance while the HR for OS is less than 1 (0.745) and no heterogeneity are observed regarding the HR between the elderly and non-elderly patients.

Full mouth rehabilitation of severely worn dentition using posterior implants: a clinical report

This clinical report focuses on the treatment of a patient with esthetic and functional impairments due to severe worn dentition. Absence of posterior support for a prolonged period require comprehensive prosthetic restoration. Accurate clinical and radiographic examinations, diagnostic wax-up, and occlusal vertical dimension evaluation were performed and the degree of patient adaptability was evaluated using an interim restoration. After 8 weeks of stabilization with interim restoration and confirmation of absence of any abnormal findings, definitive prostheses were fabricated. Satisfactory functional and esthetic outcomes were observed after 6 months of follow-up.

Population-Based Regional Cancer Incidence in Korea: Comparison between Urban and Rural Areas / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to investigate differences in organ-specific cancer incidence according to the region and population size in Korea. MATERIALS AND METHODS: We reviewed the data of the cancer registration program of Gyeongnam Regional Cancer Center between 2008 and 2011. Age-standardized rates of cancer incidence were analyzed according to population size of the region and administrative zone. RESULTS: Incidence of thyroid cancer has been increasing rapidly in both urban and rural areas. However, the thyroid cancer incidence was much lower in rural areas than in urban areas and megalopolis such as Seoul. Gastric cancer was relatively more common in rural areas, in megalopolis near the sea (Ulsan, Busan, and Incheon), and other southern provinces (Chungcheongnam-do, Gyeongsangbuk-do, and Gyeongsangnam-do). A detailed analysis in Gyeongsangnam-do revealed that rural areas have relatively low incidence of thyroid and colorectal cancer, and relatively high incidence of gastric and lung cancer compared to urban areas. CONCLUSION: This study suggests that there are some differences in cancer incidence by population size. Thyroid and colorectal cancer incidence was increasing, and gastric and lung cancer was slightly decreasing in urban areas, whereas gastric and lung cancer incidence still remains high in rural areas.

CD44 Variant 9 Serves as a Poor Prognostic Marker in Early Gastric Cancer, But Not in Advanced Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The present study is to investigate the significance of CD44 variant 9 (CD44v9) expression as a biomarker in primary gastric cancer. MATERIALS AND METHODS: With various gastric tissues, we performed immunohistochemical staining for CD44v9. RESULTS: The positive expression rates for CD44v9 in tumor, including adenoma, early gastric cancer (EGC), and advanced gastric cancer (AGC), were higher than those in non-tumor tissues (p=0.003). In addition, the higher expression for CD44v9 was observed as the tissue becomes malignant. In the analysis of 333 gastric cancer tissues, we found that positive expression rates for CD44v9 were higher in the intestinal type or well differentiated gastric cancer than in the diffuse type or poorly differentiated gastric cancer. Interestingly, the positive expression indicated poor prognosis in EGC (5-year survival rate [5-YSR] in stage I, 81.7% vs. 95.2%; p=0.013), but not in AGC (5-YSR in stage II, 66.9% vs. 62.2%; p=0.821; 5-YSR in stage III, 34.5% vs. 32.0%; p=0.929). Moreover, strong positive expression (3+) showed a trend suggesting worse prognosis only in EGC, and it appeared to be associated with lymph node metastasis. CONCLUSION: This study suggests that CD44v9 may be a good biomarker for prognosis prediction and for chemoprevention or biomarker-driven therapies only for EGC.

Using implants for worn dentition with the altered vertical dimension of occlusion based on shortened dental arch concept: a case report / 대한치과보철학회지

Excessive occlusal wear can result in unacceptable damage to the residual teeth structure, anterior guidance and masticatory function. An 86-year-old man presented with worn dentition and anterior deep bite due to loss of the posterior support. Two implants covered by Korean national health insurance, fixed partial denture and direct composite resin were used to restore the dentition, instead of removable prosthesis. The occlusal vertical dimension was increased by 2 mm in the premolar area and shortened dental arch concept was applied. This treatment was a less expensive alternative to full-mouth rehabilitation with positive esthetic and functional outcomes after 7 months of follow-up.

Full-mouth rehabilitation of the patient with severe tooth wear using all ceramic restorations / 대한치과보철학회지

Tooth wear is known as a normal physiological process which gradually progresses. It is reported that vertical dimension can be kept stable because amount of physiologically worn loss could be compensated by growth of alveolar bone and tooth eruption. However, excessive tooth wear as pathologic wear can cause pathologic pulp, disharmony with occlusal plane, functional disorders and esthetic problems so that full mouth rehabilitation could be needed in these cases. Recovery of function and esthetic improvement should be considered for alteration of the vertical dimension. Determination of the vertical dimension of occlusion is needed to be in harmony with the neuromuscular system. This clinical report describes 36 year-old female patient who had chief complaint of severely worn dentition and esthetic discomfort. An increase of 2.0 mm at maxillary incisal edge was done to restore vertical dimension. It was based on the degree of tooth wear and esthetics.

Full-mouth rehabilitation of the patient with severe tooth wear using all ceramic restorations / 대한치과보철학회지

Tooth wear is known as a normal physiological process which gradually progresses. It is reported that vertical dimension can be kept stable because amount of physiologically worn loss could be compensated by growth of alveolar bone and tooth eruption. However, excessive tooth wear as pathologic wear can cause pathologic pulp, disharmony with occlusal plane, functional disorders and esthetic problems so that full mouth rehabilitation could be needed in these cases. Recovery of function and esthetic improvement should be considered for alteration of the vertical dimension. Determination of the vertical dimension of occlusion is needed to be in harmony with the neuromuscular system. This clinical report describes 36 year-old female patient who had chief complaint of severely worn dentition and esthetic discomfort. An increase of 2.0 mm at maxillary incisal edge was done to restore vertical dimension. It was based on the degree of tooth wear and esthetics.

Multiple Cerebral Infarctions with Neurological Symptoms and Ophthalmic Artery Occlusion after Filler Injection

PURPOSE: To report a case of visual loss, side weakness and facial palsy due to ophthalmic artery occlusion with diffuse multiple cerebral infarctions after injection of hyaluronic acid. CASE SUMMARY: A 50-year-old female visited our clinic for visual loss in the left eye after filler injection in the glabella. Her best corrected visual acuity was 1.0 in the right eye and hand motion in the left eye. The intraocular pressure was 8 mm Hg in the right eye and 14 mm Hg in the left eye. In the left eye, there was abnormal pupillary light reflex and complete extra-ocular muscles palsy with blepharoptosis. A pale retina with a cherry-red-spot also appeared in the left fundus. A central retinal artery occlusion was observed on fluorescein angiography and brain magnetic resonance imaging showed multiple cerebral infarctions at the frontal, temporal, parietal and occipital lobes. Four days later, the motor weakness was aggravated and dysarthria and aphasia became worse. According to symptoms, a hemorrhagic transformation in subacute infarctions developed based on brain computed tomography. After 3 months of follow up, the visual acuity in the left eye was no light perception. However, the general conditions including ophthalmoplegia and motor weakness were improved.

Anthocyanins From the Fruit of Vitis coignetiae Pulliat Potentiate the Cisplatin Activity by Inhibiting PI3K/Akt Signaling Pathways in Human Gastric Cancer Cells

BACKGROUND: Cisplatin (cis-diaminedichloroplatinum, CDDP) is a widely used chemotherapeutic agent for the treatment of many cancers. However, initial resistance to CDDP is a serious problem in treating these cancers. Vitis coignetiae Pulliat (Meoru in Korea) have shown anti-nuclear factor kappa B and anti-epidermal growth factor receptor activities in cancer cells. METHODS: In this study, in order to seeking an approach to increase the anti-cancer effects of CDDP with natural products. Here, we investigated anthocyanins isolated from Vitis coignetiae Pulliat (anthocyanidins isolated from meoru, AIMs) can enhance anti-cancer effects of cisplatin (CDDP) in stomach cancer cells. The cell viability of SNU-1 and SNU-16 cells after treated with AIMs and CDDP were analyzed by MTT assay. The expressions of Akt and X-linked inhibitor of apoptosis protein (XIAP) proteins were examined by western blot in AIMs- and CDDP-treated cells. RESULTS: We found that AIMs enhanced anticancer effects of CDDP, which activity was additive but not synergistic. AIMs suppressed Akt activity of the cancer cells activated by CDDP. AIMs also suppressed in XIAP an anti-apoptotic protein. CONCLUSIONS: This study suggests that the anthocyanins isolated from fruits of Vitis coignetiae Pulliat enhanced anti-cancer effects of CDDP by inhibiting Akt activity activated by CDDP.

Cyclosporine A as a Primary Treatment for Panniculitis-like T Cell Lymphoma: A Case with a Long-Term Remission / Journal of the Korean Cancer Association, 대한암학회지

Subcutaneous panniculitis-like T cell lymphoma (SPTL) is a distinctive cutaneous lymphoma characterized by an infiltration of subcutaneous tissue by neoplastic T cells, similar to panniculitis. It is well-established that patients who are diagnosed with SPTL usually respond poorly to chemotherapy, showing fatal outcome. As a first line treatment for SPTL, anthracycline-based chemotherapy was most frequently used. For the treatment of SPTL, the efficacy of cyclosporine A has been recently reported in relapsed SPTL after anthracycline-based chemotherapy. However, it is still not clear whether cyclosporine A can be used as a first-line treatment against SPTL. Here, we report a case of SPTL, which achieved complete remission for nine years after first-line cyclosporine A therapy. This study suggests that cyclosporine A can induce a complete long-term remission as a first-line treatment.