Relationship between Brachial-Ankle Pulse Wave Velocity and Fundus Arteriolar Area Calculated Using a Deep-Learning Algorithm.

PURPOSE: Retinal vessels reflect alterations related to hypertension and arteriosclerosis in the physical status. Previously, we had reported a deep-learning algorithm for automatically detecting retinal vessels and measuring the total retinal vascular area in fundus photographs (VAFP). Herein, we investigated the relationship between VAFP and brachial-ankle pulse wave velocity (baPWV), which is the gold standard for arterial stiffness assessment in clinical practice. METHODS: Retinal photographs (n = 696) obtained from 372 individuals who visited the Keijinkai Maruyama Clinic for regular health checkups were used to analyze VAFP. Additionally, the baPWV was measured for each patient. Automatic retinal-vessel segmentation was performed using our deep-learning algorithm, and the total arteriolar area (AA) and total venular area (VA) were measured. Correlations between baPWV and several parameters, including AA and VA, were assessed. RESULTS: The baPWV was negatively correlated with AA (R = -0.40, n = 696, P < 2.2e-16) and VA (R = -0.36, n = 696, P < 2.2e-16). Independent variables (AA, sex, age, and systolic blood pressure) selected using the stepwise method showed a significant correlation with baPWV. The estimated baPWV, calculated using a regression equation with variables including AA, showed a better correlation with the measured baPWV (R = 0.70, n = 696, P < 2.2e-16) than the estimated value without AA (R = 0.68, n = 696, P < 2.2e-16). CONCLUSIONS: AA and VA were significantly correlated with baPWV. Moreover, baPWV estimated using AA correlated well with the actual baPWV. VAFP may serve as an alternative biomarker for evaluating systemic arterial stiffness.

Automated Focal Plane Merging From a Stack of Gonioscopic Photographs Using a Focus-Stacking Algorithm.

Purpose: The purpose of this study was to investigate the utility of automated focal plane merging with the collection of gonio-photographs with different depths of field (DOF) using an established focus-stacking algorithm. Methods: A cross-sectional study was conducted at Shimane University Hospital, Izumo, Japan. Sixteen eyes from 16 subjects from the glaucoma clinic were included in this study. Image processing was performed for the images of 16 eyes from 16 angle sector following the successful gonio-photography. The 256 sets of focus-stacked and best-focused images were prepared in random order and were compared for the DOF and informativeness to diagnose angle pathology by masked observers in each set as the subjective assessments. Moreover, the energy of the Laplacian (average |ΔI|), which is an indicator of image sharpness between the photographs with and without the focus-stacking processing was also analyzed with the Laplacian filter as the objective assessment. Results: The automated image processing was successfully performed in all stacks of images. The significant deepening of DOF and improvement of informativeness achieved in 255 (99.6%) and 216 (84.4%) images (P < 0.0001 for both, sign test) and the energy of the Laplacian also significantly increased in 243 (94.9%) images (P < 0.0001, sign test). Conclusions: Focal plane merging by the automated algorithm can make the gonio-images deeper focus compared with the paired best-focused images subjectively and objectively, which would be useful for angle pathological assessment in clinical practice. Translational Relevance: Focal plane merging algorithm for the automated gonio-photography can facilitate the angle assessment by providing informative deep-focus image, which would be useful for glaucoma care.

A Deep Learning Architecture for Vascular Area Measurement in Fundus Images.

Purpose: To develop a novel evaluation system for retinal vessel alterations caused by hypertension using a deep learning algorithm. Design: Retrospective study. Participants: Fundus photographs (n = 10 571) of health-check participants (n = 5598). Methods: The participants were analyzed using a fully automatic architecture assisted by a deep learning system, and the total area of retinal arterioles and venules was assessed separately. The retinal vessels were extracted automatically from each photograph and categorized as arterioles or venules. Subsequently, the total arteriolar area (AA) and total venular area (VA) were measured. The correlations among AA, VA, age, systolic blood pressure (SBP), and diastolic blood pressure were analyzed. Six ophthalmologists manually evaluated the arteriovenous ratio (AVR) in fundus images (n = 102), and the correlation between the SBP and AVR was evaluated manually. Main Outcome Measures: Total arteriolar area and VA. Results: The deep learning algorithm demonstrated favorable properties of vessel segmentation and arteriovenous classification, comparable with pre-existing techniques. Using the algorithm, a significant positive correlation was found between AA and VA. Both AA and VA demonstrated negative correlations with age and blood pressure. Furthermore, the SBP showed a higher negative correlation with AA measured by the algorithm than with AVR. Conclusions: The current data demonstrated that the retinal vascular area measured with the deep learning system could be a novel index of hypertension-related vascular changes.

Changes in sensory and pain perception thresholds after linear polarized near-infrared light radiation in the trigeminal region.

Linearly polarized light in the near-infrared portion of the spectrum has recently been associated with a variety of musculoskeletal disorders including temporomandibular disorders. The purpose of this study was to determine whether short-term linearly polarized near-infrared light radiation in the trigeminal region affects sensory and pain perception thresholds in the trigeminally mediated region and in the cervically mediated region of normal subjects. Thirty-five normal female volunteers participated in this study. Each subject received an 8-minute course of irradiation in the right cheek, and sensory/nociceptive perception thresholds were compared before and immediately after the irradiation in the right cheek and the right forearm. As a result, this study demonstrated a significant elevation of the heat-induced pain threshold in both regions and a tendency for the warm sensation threshold to elevate in the cervical region. In addition, a significant increase in vibratory sensitivity was observed in the trigeminal region. In conclusion, our results provided additional evidence that the warming sensation has a negative feedback influence on heat pain intensity in humans, and provides a theoretical basis for the application of linear polarized near-infrared light radiation to the trigeminal region.

Muscle hardness characteristics of the masseter muscle after repetitive muscle activation: comparison to the biceps brachii muscle.

The purpose of this study was to compare hardness characteristics of the masseter muscle to those of the biceps brachii muscle during repetitive muscle movements. Seventeen asymptomatic female subjects participated in this study. Each subject, on separate days, undertook a 5-minute unilateral chewing gum task on the right side and a 5-minute flexion-extension exercise on the right hand with a 2kg dumbbell. Using a handheld hardness meter, muscle hardness was measured in the right masseter and in the biceps brachii muscle at eight time points (before the task, immediately after the task, and at 1, 3, 5, 10, 30, and 60 minutes after the task), and the data obtained before and after the task on each muscle were compared. Comparisons of the normalized data were also performed between the two muscles at each time point. As a result, a significant increase in muscle hardness was seen at 1 minute after the task in the biceps brachii muscle (p=0.0093). In contrast, the masseter muscle showed a tendency to lower hardness, with the lowest point of hardness occurring at 10 minutes after the task (p = 0.0160). Between the two muscles, there was a difference in the normalized data immediately after the task, and at 1, 5, and 10 minutes after the task (0.01

Morphological evaluation of changes in velopharyngeal function following maxillary distraction in patients with repaired cleft palate during mixed dentition.

OBJECTIVE: To describe the morphological changes of nasopharyngeal components after maxillary distraction and clarify whether the morphological characteristics are related to velopharyngeal function (VPF). DESIGN: Perceptual judgments of hypernasality and nasendoscopy were performed before and after treatment. Lateral cephalograms were obtained to describe the morphological changes. SETTING: Department of Oral and Maxillofacial Surgery, Miyazaki Medical College, Miyazaki, Japan. PARTICIPANTS: Nine patients with repaired cleft palate in the mixed dentition stage underwent maxillary distraction using a face mask and an intraoral fixed appliance system. OUTCOME MEASURES: The severity of hypernasality, velopharyngeal insufficiency, and measurements such as pharyngeal depth, velar length, and the rotation of the palatal plane were evaluated. RESULTS: Increase in pharyngeal depth was not always proportional to the amount of advancement. It depended on the posture of the posterior pharyngeal wall and the rotation of palatal plane. CONCLUSION: Cephalometric measurements of the nasopharynx before and after surgery confirmed subsequent changes in VPF. These were suggested to be useful in predicting future VPF. When performing maxillary distraction in patients with cleft palate in the mixed dentition stage, and when velopharyngeal closure is found to occur by velar contact against the hypertrophied adenoid, patients should be counseled about risks of subsequent deterioration in their speech before surgery.

Changes in bite force and muscle forces in the upper extremities after counter irritation.

Today, physical therapy is recognized as an effective, reversible, and conservative treatment for temporomandibular disorders (TMD). The purpose of this investigation is to explore the feasibility of utilizing counter irritation with ischemic pain at a remote site outside of the head and neck region as a method for restoring muscle force in a course of physical therapy. Twenty healthy asymptomatic female subjects were recruited for this study. The experiments were performed over two days, with the two experimental days randomly assigned to the experiment performed with or without counter irritation. The counter irritation was applied to the subject's left hand using a submaximal effort tourniquet procedure. The maximal bite, finger-pinch, and handgrip forces were measured on the right side, and the results from the days with and without the counter irritation were compared. As a result, a significantly higher mean maximal bite force and a trend toward higher finger-pinch force were observed with the irritation than without the irritation, while there was no significant difference in the handgrip force. These findings indicate that counter irritation outside of the head and neck may be useful for increasing bite force, and may be applicable in the treatment of TMD for the restoration of masticatory muscle force.

Involvement of NMDA receptors in Zif/268 expression in the trigeminal nucleus caudalis following formalin injection into the rat whisker pad.

We investigated the involvement of N-methyl-D-aspartate (NMDA) glutamate receptor in the expression of the proteins Zif/268 and c-Fos elicited by painful stimuli. To this purpose, the effect of the administration of MK-801, an NMDA receptor antagonist, on Zif/268 and c-Fos expression following a noxious stimulus, represented by formalin injection into the whisker pad of rats, was examined in neurons of the trigeminal nucleus caudalis. Furthermore, the co-localization of formalin injection-evoked Zif/268 and c-Fos expression and subunit 1 of the NMDA receptor (NR1) was studied in this nucleus. Zif/268 or c-Fos immunoreactivity elicited by formalin injection was significantly reduced by pretreatment with MK-801 in the superficial layer of the trigeminal nucleus caudalis; more than 40% of the neurons expressing Zif/268 and c-Fos in this layer were also immunolabeled by NR1. On the other hand, there was little effect of MK-801 administration on Zif/268 and c-Fos immunoreactivity in the nucleus proprius and deep lamina V of the trigeminal nucleus caudalis, while most neurons expressing Zif/268 or c-Fos in these two regions were labeled by NR1. These results point out differences between the superficial and deeper layers of the trigeminal nucleus caudalis in the involvement of NMDA receptor in the mechanisms underlying the expression of protein products of immediate early genes induced by painful stimuli.

Measurement of muscle hardness using a hardness meter: application to the masseter and temporal muscles and reproducibility of measurement.

This study was designed to evaluate the intra-examiner and inter-examiner reliability of measurements of masticatory muscle hardness and to confirm that the muscle hardness increases with contraction using a commercially available muscle meter. Twenty healthy asymptomatic female subjects participated in this study. Hardness was expressed as numerical relative values (0-100). First, muscle hardness was measured at a standardized point located in the masseter muscle and temporal muscle in a randomized order by two examiners, and again by one of the same examiners after ten minutes for the reproducibility study. Then the muscle hardness was measured at each point for 0 kgf, 3 kgf, 6 kgf, and 9 kgf levels of bite force. As a result, intraclass correlation coefficient (ICC) analysis revealed good intra-examiner reliability in the masseter muscle (ICC = 0.711), good intra-examiner reliability in the temporal muscle (ICC = 0.643), good inter-examiner reliability in the masseter muscle (ICC = 0.631), and unacceptable inter-examiner reliability in the temporal muscle (ICC = 0.008). Also, our results showed that muscle hardness increased with contraction, and relationships with a slope of 1.229, a y-intercept of 62.513, and a correlation coefficient of 0.448 were observed in the masseter muscle. However, no correlation was found between muscle hardness and bite force in the temporal muscle. The findings indicate that measurement of hardness provides reliable physiological information about the masseter muscle in this setting.

Differential effects of NMDA and AMPA/KA receptor antagonists on c-Fos or Zif/268 expression in the rat spinal dorsal horn induced by noxious thermal or mechanical stimulation, or formalin injection.

The involvement of N-methyl-D-aspartate (NMDA) and alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA)/kainate (KA) receptors in the induction of c-Fos and Zif/268 expression in spinal dorsal horn neurons following noxious thermal or mechanical stimulation, or formalin injection into the rat hind paw was examined by intrathecal administration of a competitive NMDA receptor antagonist, 2-amino-5-phosphonopentanoic acid (APV) or an AMPA/KA receptor antagonist, 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX), or both, 30 min prior to noxious stimulation. APV caused a significant reduction in the level of c-Fos expression in the superficial layer induced by each of these three noxious stimuli. The effects of APV on Zif/268 expression or of CNQX on c-Fos or Zif/268 expression in the superficial layer induced by these three noxious stimuli were dependent on the type of stimulus applied to the rat hind paw. The noxious thermal stimulus-evoked c-Fos expression level was reduced by APV and/or CNQX, while Zif/268 expression was hardly changed. Both c-Fos and Zif/268 expressions following formalin injection were reduced by APV alone and APV+CNQX, but not by CNQX alone. Zif/268 expression following noxious mechanical stimulation was significantly reduced only by APV+CNQX although APV or CNQX alone did not affect the expression, while c-Fos expression was reduced by APV and APV+CNQX but not by CNQX alone. These findings suggest that NMDA and AMPA/KA receptors are differentially involved in c-Fos and Zif/268 expression in the spinal dorsal horn following noxious thermal, formalin and mechanical stimulation.

Primary neck management among patients with cancer of the oral cavity without clinical nodal metastases: A decision and sensitivity analysis.

BACKGROUND: A standardized neck management strategy for oral cancer patients without clinical nodal metastases remains to be established. Consequently, a decision and sensitivity analysis of two neck management protocols, involving either prophylactic neck dissection or careful observation, was conducted using the Oral Cancer Registry of Kyushu, Japan. METHODS: We calculated probabilities of subclinical nodal metastases and 5-year survival using the registry data. A two-way sensitive analysis was conducted using the probabilities and parameters of the complete nodal metastasis resection rate (x) and a utility rating that describes the health state induced by dissection (y) compared with the neck condition in a careful-observation group. RESULTS: We solved the threshold curve for y and x for the expected utility between the two groups. The results showed that prophylactic neck dissection must guarantee a complete resection of subclinical nodal metastases with no disadvantage to health state to be evaluated as equally satisfactory as careful observation. CONCLUSIONS: Careful observation involving standardized systematic preoperative and postoperative screening of the neck seems preferable to prophylactic neck dissection for oral cancer patients without subclinical nodal metastases.