Effect of clinical experience and training with visual feedback on standardized palpation outcomes-Potential implications for assessment of jaw muscle sensitivity.

BACKGROUND: The evaluation of muscle pain and sensitivity by manual palpation is an important part of the clinical examination in patients with myalgia. However, the effects of clinical experience and visual feedback on palpation of the masticatory muscles with or without a palpometer are not known. OBJECTIVE: To estimate the effects of clinical experience and visual feedback on the accuracy of palpation in standardized settings. METHODS: Thirty-two dentists (age 35 ± 11 years) classified as either specialists (n = 16) or generalists (n = 16) participated in this experiment. All dentists were instructed to target force levels of 500- or 1000-gf, as determined on an electronic scale using either standardized palpometers or manual palpation (MP). All dentists participated in four different tests: MP, MP with visual feedback (MPVF), palpometer (PAL) and PAL with visual feedback (PALVF). Actual force values for each type of palpation from 0 to 2, 2 to 5 and 0 to 5 s were analysed by calculating target force level. RESULTS: The relative differences during 2-5 and 0-5 s with 1000 gf were significantly lower for generalists than for specialists (p < .05). In generalists and specialists, the coefficients of variation and the relative differences during 2-5 s were significantly lower for PAL and PALVF than for MP (p < .05). CONCLUSIONS: These findings suggest that the use of a palpometer, but not clinical experience with palpation of masticatory muscles, increases the accuracy of palpation, and ≥2 s of palpation with a palpometer is optimal for masticatory muscles.

Evaluation of dye decolorization using anaerobic granular sludge from an expanded granular sludge bed based on spectrometric and microbiome analyses.

The decolorization of 11 dyes by granular sludge from an anaerobic expanded granular sludge bed (EGSB) reactor was evaluated. Biological decolorization of Reactive Red 21, 23, and 180, and Reactive Yellow 15, 17, and 23 in model textile wastewater was observed for the first time after a 7-day incubation (over 94% decolorization). According to the sequencing analysis of 16S rRNA gene amplicons from EGSB granular sludge, the operational taxonomic unit related to Paludibacter propionicigenes showed the highest increase in relative abundance ratios in the presence of dyes (7.12 times on average over 11 dyes) compared to those without dyes.

Mandibular Advancement Device Therapy in Japanese Rugby Athletes with Poor Sleep Quality and Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) may contribute to poor sleep quality. This study assessed subjective sleep quality, the Respiratory Event Index (REI), reaction times, and the therapeutic effects of a custom-made mandibular advancement device (MAD) in male Japanese elite rugby athletes. The Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and level III sleep test (REI and minimum oxygen saturation [SpO2 min]) were used to evaluate sleep quality. MAD therapy was used daily for 3 weeks. A telephone-based reaction time test of kinetic vision (the ability to identify moving objects) was recorded within 15 min of waking and over 5 days of pre- and post-MAD therapy. Differences in variables were evaluated using paired t-tests. Of the 42 players (mean age, 26.3 ± 3.7 years; mean body mass index, 28.7 ± 3.2 kg/m2) included in this study, 29 (69.0%) had poor sleep quality (PSQI > 5.5), and 27 were diagnosed with OSA (64.3%) (mild = 16/moderate = 9/severe = 2). Six were treated with MAD therapy, which significantly improved the REI (p < 0.01), SpO2 min (p < 0.001), ESS score (p < 0.001), reaction times (p < 0.01), and sleep quality. A significant reduction in reaction times suggests that OSA treatment can improve kinetic vision. Future studies should systematically evaluate the impact of sleep-disordered breathing on kinetic vision in athletes.

Improving Nasal Airflow with a Novel Nasal Breathing Stent.

Nasal obstruction requires close attention, as it is a risk factor for obstructive sleep apnea (OSA). This study evaluated airflow rates of our newly designed nasal breathing stent (NBS) compared with those of existing nasal dilators in 10 adult men. We hypothesized that the NBS would expand the nasal passage more than the other nasal dilators by means of airflow measurements. We compared airflow measurements between the NBS and three existing appliances and no appliance. Velocity measurements were recorded by analyzing 499 videographic images when each appliance was placed next to a steam generator at 0, 5, and 10 mm from the outlet port for airflow visualization. The peak nasal inspiratory flow (PNIF) rate was measured using an inspiratory flow meter. The NBS resulted in significantly higher airflow velocity measurements at all distances from the outlet port and a higher PNIF rate than the other appliances. Thus, the NBS offers a significantly decreased resistance to air movement compared with other appliances. Future in-depth investigations are required to demonstrate the use of NBS as a nasal dilator in conjunction with continuous positive airway pressure/oral appliance treatments in patients with OSA.

Severe liver injury with traumatic cardiac arrest successfully treated by damage control surgery and transcatheter arterial embolization in the hybrid operating room: a case report.

BACKGROUND: The damage control approach is known to reduce the mortality rate in severely injured patients and has now become a common practice. Transcatheter arterial embolization (TAE) has been shown to be useful with combining with damage control laparotomy in identifying and controlling active arterial hemorrhage. Hybrid operating room (OR) allows both damaged control surgery and TAE in the same location in minimal time. We report a case of a patient with three cardiac arrests who was saved by early intervention using damage control surgery (DCS) with interventional radiology (IVR) in the hybrid OR. CASE PRESENTATION: A 46-year-old woman was injured in a collision with a tree while snowboarding. She was eventually transported to hybrid operating room in our hospital with the diagnosis of significant liver laceration and hemorrhagic shock. Damage control surgery was performed with perihepatic packing (PHP) and TAE was conducted to stop active bleeding from right hepatic artery. She experienced 3 times of cardiopulmonary arrest, which was successfully resuscitated on each occasion. Although she had total of 3 times of laparotomy but tolerated well. She was discharged on day 82 of hospitalization and showed no neurological sequelae. CONCLUSION: Saving the life of a patient with severe trauma requires a multidisciplinary approach with cooperation and early information sharing among trauma team members. Sharing treatment strategy with the trauma team and early intervention using DCS with IVR in the hybrid operating room could save the patient's life.

Botulinum toxin injection into the intrinsic laryngeal muscles to treat spasmodic dysphonia: A multicenter, placebo-controlled, randomized, double-blinded, parallel-group comparison/open-label clinical trial.

BACKGROUND AND PURPOSE: Botulinum toxin (BT) injection into the laryngeal muscles has been a standard treatment for spasmodic dysphonia (SD). However, few high-quality clinical studies have appeared, and BT is used off-label in most countries. METHODS: We performed a multicenter, placebo-controlled, randomized, double-blinded, parallel-group comparison/open-label clinical trial to obtain approval for BT (Botox) therapy in Japan. Twenty-four patients (22 with adductor SD and two with abductor SD) were enrolled. The primary end point was the change in the number of aberrant morae (phonemes) at 4 weeks after drug injection. The secondary end points included the change in the number of aberrant morae, GRBAS scale, Voice Handicap Index (VHI), and visual analog scale (VAS) over the entire study period. RESULTS: In the adductor SD group, the number of aberrant morae at 4 weeks after injection was reduced by 7.0 ± 2.30 (mean ± SE) in the BT group and 0.2 ± 0.46 in the placebo group (p = 0.0148). The improvement persisted for 12 weeks following BT injections. The strain element in GRBAS scale significantly reduced at 2 weeks after BT treatment. The VHI and VAS scores as subjective parameters also improved. In the abductor SD group, one patient responded to treatment. Adverse events included breathy hoarseness (77.3%) and aspiration when drinking (40.9%) but were mild and resolved in 4 weeks. CONCLUSIONS: Botulinum toxin injection was safe and efficacious for the treatment of SD. Based on these results, BT injection therapy was approved as an SD treatment in Japan.

Assessment of Screening for Nasal Obstruction among Sleep Dentistry Outpatients with Obstructive Sleep Apnea.

Oral appliances (OA), a common treatment modality for obstructive sleep apnea (OSA), are not suitable for patients with nasal obstruction. Rhinomanometry, the gold standard technique to assess nasal airway resistance, is not readily available in sleep dentistry clinics. We demonstrate the use of a portable lightweight peak nasal inspiratory flow (PNIF) rate meter to objectively assess nasal airflow and utilized the Nasal Obstruction Symptom Evaluation (NOSE) scale to subjectively assess nasal obstruction in 97 patients with OSA and 105 healthy controls. We examined the correlations between the following variables between the groups: demographics, body mass index, PNIF, NOSE scale scores, apnea-hypopnea index (AHI), minimum SpO2 (SpO2min), Mallampati classification, and Epworth Sleepiness Scale (ESS) scores. Patients with OSA had significantly lower PNIF values and higher NOSE scores than controls. In the patient group, PNIF was not significantly correlated with AHI, SpO2min, Mallampati classification, or NOSE or ESS scores. Lower PNIF values and higher NOSE scores suggested impaired nasal airflow in the OSA group. As daytime PNIF measurement bears no relationship to AHI, this cannot be used alone in predicting the suitability of treatment for OSA with OA but can be used as an adjunct for making clinical decisions.

Effect of Laryngeal Suspension and Upper Esophageal Sphincter Myotomy for Severe Dysphagia Due to Brainstem Disease.

OBJECTIVES: Surgical procedure is considered in patients with severe dysphagia when conservative treatment fails. This study aimed to evaluate laryngeal suspension (LS) and upper esophageal sphincter (UES) myotomy for treating severe dysphagia due to brain disease. METHODS: Fourteen patients underwent LS and UES myotomy, with a median follow-up of 5 years and 6 months when conservative treatment failed. The penetration-aspiration scale (PAS), the Dysphagia Severity Scale (DSS), the Eating Status Scale (ESS), and diet contents were evaluated just before surgery, at discharge, and at the last follow-up. RESULTS: Preoperative intake was tube feeding in all patients. The patients learned the extended head and flexed neck posture to open the esophageal inlet. PAS, DSS and ESS scores, and diet contents were significantly improved at discharge compared with before surgery, and were maintained until the last follow-up. Eight patients had pneumonia during their hospital stay, and five had pneumonia between discharge and at the last follow-up. Age was significantly, negatively correlated with DSS and ESS at the last follow-up. CONCLUSION: Although LS and UES myotomy require a long inpatient rehabilitation and the risk of pneumonia after surgery is high, the outcome is favorable and the effects last for a long time.

Development of an interference-filter-type external-cavity diode laser for resonance ionization spectroscopy of strontium.

A frequency tunable external-cavity diode laser (ECDL) using a narrow bandwidth (∼0.3 nm) interference filter has been developed for resonance ionization spectroscopy of strontium (Sr) with high isotopic selectivity. Improved wavelength and single mode stabilities of this interference-filter-type ECDL (IF-ECDL) over a commonly used (also home-made) Littrow-type ECDL were theoretically expected and experimentally confirmed by both a wavelength meter and a home-made Fabry-Perot interferometer. The measured spectral profile of the dominant isotope 88Sr using our IF-ECDL in the 689.4 nm intercombination transition shows that the Lorentzian component (∼1.3 MHz) of the spectrum width is consistent with the obtained fringe width of the interferometer. High 90Sr isotopic selectivity of ∼104 with respect to 88Sr is expected in this transition, which indicates that even if the manufacturing accuracy is not comparable to commercial Littrow-type ECDLs, our compact IF-ECDL having sufficient wavelength stability is a promising laser source for background-free analysis of radioactive 90Sr in marine samples.

Mouthguards and their use in sports: Report of the 1st International Sports Dentistry Workshop, 2016.

There appears to be much confusion or misinformation worldwide regarding mouthguards and their use in sports. In an effort to clarify where the international dental community stands on mouthguards and mouthguard research, the workshop looked at some important questions. The goal was to one day formulate consensus statements related to these questions, which will be based on current scientific evidence-based research, to motivate the international community of the importance of dentally fitted laminated mouthguards and the wearing of them by athletes of all sports. There are only five sports in the United States that require the use of mouthguards. If, through workshops such as this, the importance of wearing dentally fitted laminated mouthguards can be demonstrated, then more sports may require their athletes to wear them.

Lip muscle training improves obstructive sleep apnea and objective sleep: a case report.

The present study assessed the potential of lip muscle training for improving sleep. A patient with heavy snoring, daytime sleepiness and dry mouth underwent lip muscle training. Lip closure force LCFmax increased by 67.3% and LCFmin by 152% post-training. AHI decreased from 12.2 to 3.9 events/h by reducing hypopneic episodes. TST, sleep stage N3 and REM sleep increased, and WASO, sleep stage N1, and AI decreased. The patient switched from mouth to nose breathing during sleep and stopped snoring. Improved LCF, by moving the tongue into the anterior-superior oral cavity, may increase upper airway space and reduce the hypopnea index.

Assessment of clasp design and flexural properties of acrylic denture base materials for use in non-metal clasp dentures.

PURPOSE: The purpose of this study was to investigate the possibilities of utilizing new acrylic denture base materials in resin clasps using three-point flexural tests and cantilever beam tests. METHODS: Seven non-metal clasp denture (NMCD) materials and four acrylic denture base materials were used for three-point flexural tests and six NMCD materials and three acrylic denture base materials were used for cantilever beam tests. The flexural strength, elastic modulus, and 0.05% proof stress were measured by three-point flexural tests according to International Organization for Standardization (ISO) 20795-1. And load at 0.5mm deformation, elastic modulus were measured by Cantilever beam tests. RESULTS: For the three-point flexural tests, only materials that met the conditions for both flexural strength and elastic modulus were the polycarbonate Reigning N (REN) and the acrylics Acron (AC), Pro Impact (PI), Procast DSP (PC) and IvoBase High Impact (HI) which are required in ISO 20795-1, Type 3 denture base materials. And for cantilever beam tests there was no significant difference between PI and either EstheShot (ES), EstheShot Bright (ESB), REN or Acry Tone (ACT) in load at 0.5mm deformation, and no significant difference between PI and either Lucitone FRS (LTF), ES, ESB, REN or ACT in elastic modulus. CONCLUSIONS: The results thus suggested that some of the acrylic materials used as denture base materials may also be usable for NMCDs, and that the flexural properties of the acrylic material PI resemble those of ES, ESB and ACT, meaning that similar clasp designs may also be feasible.

Rheological properties of elastomeric impression materials for selective pressure impression technique.

PURPOSE: The selective impression technique is recommended for removable prosthodontics. However, the viscoelastic rheological properties of impression materials, particularly the time-dependent viscoelastic changes in impression material immediately after tray seating, are unknown. The objective of this study is to clarify the viscoelastic rheological properties of impression materials by focusing on tray seating. METHODS: In this study, eight types of polyvinylsiloxane (PVS), two types of polyether, and two types of alginate impression materials were used. The storage modulus (G'; degree of stiffness) and loss tangent (tanδ; degree of hardening) were determined as functions of time from 0 to 360 s, commencing immediately after the completion of mixing, using a stress control-type rheometer. Thus, G' and tanδ at 0s and 20 s were compared. RESULTS: Stiffness was found to be widely distributed (4.49-0.26 × 10(4)Pa) among PVS-types, even immediately after mixing the impression material. There was also variation among polyethers (1.55-0.5 × 10(4)Pa) and among alginates (0.64-0.21 × 10(4)Pa). The hardening of all impression materials progresses beyond 20 s after the completion of mixing. CONCLUSIONS: The G' values varied with each impression material, even immediately after mixing, and the accurate impression-taking time was determined from the results of tanδ. These results provide unique insight into the selective impression technique.

Scratch test of thermoplastic denture base resins for non-metal clasp dentures.

PURPOSE: Several thermoplastic denture base resins have been introduced for the fabrication of non-metal clasp dentures. Although the surface of these materials is easily damaged, the surface roughness and characteristics of scratches created have not been evaluated. The purpose of this study was to evaluate the surface roughness of thermoplastic resins using a scratch test for the development of future materials. METHODS: Four thermoplastic (polyamide: Valplast(®); VLP and Lucitone FRS(®); FRS, polyethylene terephthalate: EstheShot(®); ES, and polyester: EstheShot Bright(®); ESB) and two conventional acrylic (Heat-polymerizing: Urban(®); HC, and Pour type auto-polymerizing: Pro-Cast DSP(®); PR) denture base resins were examined. Eight specimens, approximately 10mm×10mm×30mm in size, of each material were fabricated. Scratch test was performed by a scratch tester with a diamond indenter of 10-µm radius and cone angle 90°, applying a constant load of 500mN, and 2-mm-long scratches were made. The scratch marks were studied under 3D laser measuring microscope and cross-section profiles at approximately 0.5mm, 1.0mm, and 1.5mm from the starting point were extracted and measured with analysis software. Data from 24 cross-section profiles in each denture base material were analyzed. RESULTS: The maximum depths of ES, ESB and FRS were greater than VLP, PR and HC, and the scratch widths of ES, ESB, FRS and VPL were greater than PR and HC. CONCLUSIONS: The results showed that the surface of thermoplastic denture base resins was easily damaged compared to polymethyl methacrylate.