Protocol for an interventional study to reduce postpartum weight retention in obese mothers using the internet of things and a mobile application: a randomized controlled trial (SpringMom).

BACKGROUND: Obese pregnant women are known to experience poorer pregnancy outcomes and are at higher risk of postnatal arteriosclerosis. Hence, weight control during and after pregnancy is important for reducing these risks. The objective of our planned randomized controlled trial is to evaluate whether the rate of change in body weight in obese women before pregnancy to 12 months postpartum would be lower with the use of an intervention consisting of Internet of Things (IoT) devices and mobile applications during pregnancy to 1 year postpartum compared to a non-intervention group. METHODS: Women will be recruited during outpatient maternity checkups at four perinatal care institutions in Japan. We will recruit women at less than 30 weeks of gestation with a pre-pregnancy body mass index ≥ 25 kg/m2. The women will be randomly assigned to an intervention or non-intervention group. The intervention will involve using data (weight, body composition, activity, sleep) measured with IoT devices (weight and body composition monitor, activity, and sleep tracker), meal records, and photographs acquired using a mobile application to automatically generate advice, alongside the use of a mobile application to provide articles and videos related to obesity and pregnancy. The primary outcome will be the ratio of change in body weight (%) from pre-pregnancy to 12 months postpartum compared to before pregnancy. DISCUSSION: This study will examine whether behavioral changes occurring during pregnancy, a period that provides a good opportunity to reexamine one's habits, lead to lifestyle improvements during the busy postpartum period. We aim to determine whether a lifestyle intervention that is initiated during pregnancy can suppress weight gain during pregnancy and encourage weight loss after delivery. TRIAL REGISTRATION: UMIN: UMIN (University hospital Medical Information Network) 000,041,460. Resisted on 18th August 2020. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047278.

Significance of maternal screening for toxoplasmosis, rubella, cytomegalovirus and herpes simplex virus infection in cases of fetal growth restriction.

AIM: The objective of this study was to evaluate the significance of maternal toxoplasmosis, rubella, cytomegalovirus (CMV) and herpes simplex virus (TORCH) screening in cases of fetal growth restriction (FGR). MATERIAL AND METHODS: The medical records of women carrying fetuses with FGR who underwent TORCH screening over a 10-year period were retrospectively reviewed for maternal and congenital TORCH infection. Women carrying fetuses with FGR routinely underwent serologic TORCH tests and systematic ultrasound evaluation for congenital abnormalities. If a congenital CMV infection was suspected, amniotic fluid, placenta or neonatal urine was used for CMV DNA detection by polymerase chain reaction. RESULTS: In 319 patients, no cases of maternal or congenital infection with toxoplasma, rubella, or herpes simplex virus were found. Conversely, six cases (1.8%) were diagnosed with congenital CMV infection, two of which had no structural abnormalities other than FGR. CONCLUSIONS: A complete maternal TORCH screening for cases of FGR appears to be unnecessary. Although a maternal CMV test can be considered, the incidence of congenital CMV infection was found to be low in FGR cases.

Evolution of the cytoplasmic and mitochondrial phosphagen kinases unique to annelid groups.

Creatine kinase (CK) is a member of a group of phosphoryl transfer enzymes called phosphagen kinases that play a key role in cellular energy transactions in animals. Three CK isoform gene families are known-cytoplasmic CK (CK), flagellar CK (fCK), and mitochondrial CK (MiCK). Each of the isoforms has a unique gene structure (intron/exon organization). A broad array of other phosphagen kinases is present in animals. Some of these enzymes are found only in annelids and closely related groups including glyocyamine kinase (GK), lombricine kinase (LK), taurocyamine kinase (TK), and a unique arginine kinase (AK) restricted to annelids. Phylogenetic analyses of these annelid phosphagen kinases indicate that they appear to have evolved from a CK-like ancestor. To gain a greater understanding of the relationship of the CK isoforms to the annelid enzymes, we have determined the intron/exon organization of the genes for the following phosphagen kinases: Eisenia LK, Sabellastarte AK, and Arenicola mitochondrial TK (MiTK). Analysis of genomic database for the polychaete Capitella sp. yielded two putative LK genes [cytoplasmic LK and mitochondrial LK (MiLK)]. The intron/exon organization of these genes was compared with available data for cytoplasmic and mitochondrial CKs, and an annelid GK. Surprisingly, these annelid genes, irrespective of whether they are cytoplasmic (LK, AK, and GK) or mitochondrial (MiTK and MiLK), had the same 8-intron/9-exon organization and were strikingly similar to MiCK genes sharing seven of eight splice junctions. These results support the view that the MiCK gene is basal and ancestral to the phosphagen kinases unique to annelids.

The use of an intermaxillary fixation screw for mandibular setback surgery.

PURPOSE: To assess skeletal stability after mandibular setback surgery with and without an intermaxillary fixation (IMF) screw. PATIENTS AND METHODS: The subjects were 40 patients with mandibular prognathism. The subjects underwent sagittal split ramus osteotomy with titanium plate fixation and were divided into 2 groups, 1 with and 1 without an IMF screw. A lateral cephalogram was done preoperatively, immediately after surgery, and 1 month, 3 months, and 6 months postoperatively. The 2 groups were then compared statistically. RESULTS: In the comparison of the time-course change between the 2 groups with repeated measure analysis of variance, there were significant differences in occlusal plane (between subjects, F = 2.517; df = 4; P = .0437) and convexity (between subjects, F = 4.048; df = 4; P = .0038). However, there was no significant difference in the other measurements. CONCLUSION: This study suggested that in most measurements, there was no significant difference between 2 groups with and without an IMF screw in time-course skeletal change. However, use of IMF screws was helpful for orthognathic surgery as a rigid anchor of IMF.

A comparison of lower lip hypoesthesia measured by trigeminal somatosensory-evoked potential between different types of mandibular osteotomies and fixation.

PURPOSE: The purpose of this study was to compare objectively, the recovery of hypoestheia of the lower lip following orthognathic surgery using different procedures (sagittal split ramus osteotomy [SSRO]) and intra-oral vertical ramus osteotomy (IVRO)) and fixation methods (monocortical plate fixation and bi-cortical plate fixation). Hypoesthesia was evaluated using the trigeminal somatosensory-evoked potential (TSEP). PATIENTS AND METHODS: The subjects consisted of 174 patients (348 sides) with mandibular prognathism with or without asymmetry, who underwent mandibular ramus osteotomies using different fixation types. The patients were divided into 4 groups. The OAM group consisted of 128 sides who had SSRO using the Obwegeser method with mono-cortical absorbable plate fixation, the ODTM group consisted of 84 sides who had the Obwegeser-Dal Pont method with mono-cortical titanium plate fixation, the OTB group consisted of 32 sides who had the Obwegeser method with bi-cortical titanium plate fixation and the VO group consisted of 104 sides who underwent IVRO according to the Bell method without fixation. Trigeminal nerve hypoestheia at the region of the lower lip was assessed bilaterally by the TSEP method. An electroencephalograph recording system (Neuropack Sigma; Nion Koden Corp., Tokyo, Japan) was used to analyze the potentials. Each patient was evaluated pre-operatively and then post-operatively at 1 and 2 weeks, 1, 3, and 6 months, and 1 year. RESULTS: The mean measurable period and standard deviation of TSEP of the lower lip in the OAM group was 5.2 +/- 9.9 weeks, 10.9 +/- 13.1 weeks in the ODTM group, 7.8 +/- 4.5 weeks in the OTB group, and 2.5 +/- 6.3 weeks in the VO group. There were significant differences between the OAM and ODTM groups (P < .0001), the ODTM and OTB groups (P = .0001), the OTB and VO groups (P = .0221), the OAM and VO groups (P < .0001), and the ODTM and VO groups (P < .0001). CONCLUSION: This study proved using objective measurements that the recovery period from hypoesthesia of the lower lip following orthognathic surgery was dependent on the surgical procedure. Recovery in lower lip hypoesthesia after IVRO was significantly earlier than SSRO.

Condylar and disc positions after sagittal split ramus osteotomy with and without Le Fort I osteotomy.

PURPOSE: The purpose of this study is to examine the changes in temporomandibular joint (TMJ) morphology and clinical symptoms after sagittal split ramus osteotomy (SSRO) with and without a Le Fort I osteotomy. SUBJECTS AND METHODS: Of 45 Japanese patients with mandibular prognathism, 23 underwent SSRO and 22 underwent SSRO in combination with a Le Fort I osteotomy. The TMJ symptoms and joint morphology, including disc tissue, were assessed preoperatively and postoperatively by magnetic resonance imaging (MRI) and axial cephalography. RESULTS: There were significant differences between pre- and postoperative horizontal changes in the condylar long axis on the right side in the group undergoing SSRO (sagittal split ramus osteotomy) alone. However, there were no other significant differences in pre- and postoperative measurements in this group as compared with the group receiving SSRO plus Le Fort I osteotomy, and the preoperative disc position could not be changed in either group. CONCLUSION: These results suggest that SSRO, either with or without Le Fort I osteotomy, could not change the preoperative disc position or correct anterior disc displacement, although these procedures did improve the symptoms associated with TMJ dysfunction.

Evaluation of upper lip hypoesthesia with a trigeminal somatosensory-evoked potential following Le Fort I osteotomy in combination with mandibular osteotomy.

PURPOSE: The purpose of this study was to objectively evaluate hypoesthesia of the upper lip following Le Fort I osteotomy in combination with mandibular osteotomy with trigeminal somatosensory evoked potential (TSEP). SUBJECTS AND METHODS: The subjects consisted of 25 patients with mandibular prognathism with maxillary retrognathism mandibular prognathism with or without asymmetry, who underwent Le Fort I osteotomy in combination with sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO). Trigeminal nerve hypoesthesia at the region of the upper lip was assessed bilaterally by the TSEP method. The electrodes were placed exactly above the highest point of the vermilion border and on the mucosa of the upper lip. An electroencephalograph recording system (Neuropack Sigma; Nihon Koden Corp., Tokyo, Japan) was used to analyze the potentials. Each patient was evaluated preoperatively and then postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year. RESULTS: The average measurable period and standard deviation of TSEP of the upper lip was 7.8 +/- 10.7 weeks following Le Fort I osteotomy, TSEP of the lower lip was 4.6 +/- 9.2 weeks in the patients who underwent SSRO with Le Fort I osteotomy, and 1.2 +/- 0.4 weeks in the patients who underwent IVRO with Le Fort I osteotomy. CONCLUSION: This study objectively proved that hypoesthesia could appear in the upper lips following Le Fort I osteotomy with TSEP. The measurable period for the upper lip following Le Fort I osteotomy tended to be longer than that for the lower lip in the patients who underwent SSRO and IVRO with Le Fort I osteotomy.

Relationship between the morphologies of the masseter muscle and the ramus and occlusal force in patients with mandibular prognathism.

PURPOSE: The purpose of this study was to examine the relationship between the morphologies of the masseter muscle and the ramus and occlusal force in patients with mandibular prognathism. PATIENTS AND METHODS: The study group consisted of 71 patients with mandibular prognathism. They were divided into 2 groups, consisting of prognathism with or without symmetry, determined by frontal cephalogram analysis. All patients underwent 3-dimensional (3D) computed tomography (CT) and occlusal force was recorded with pressure-sensitive sheets. RESULTS: In the cross-sectional area of masseter muscle, there were no significant differences between the right and left sides in the symmetry and asymmetry groups. In occlusal force, there was no significant difference between the symmetry and asymmetry groups. Occlusal force was not significantly correlated to the cross-sectional area of the ramus, but it was significantly positively correlated to the cross-sectional area of the masseter muscle (P < .05). CONCLUSION: Occlusal force was associated with the ipsilateral cross-sectional area of masseter muscle in patients with prognathism; however, it was not associated significantly with the degree of mandibular deviation.

The prevention of periodontal bone loss at the osteotomy site after anterior segmental and dento-osseous osteotomy.

PURPOSE: Degeneration of the gingival margin and periodontal bone loss between segments can occur in various segmental osteotomies. However, treatment and management of these problems have not yet been resolved; improvement of the conventional method is necessary. The purpose of this retrospective study is to evaluate the usefulness and advantage of orthodontic devices in osteotomies. PATIENTS AND METHODS: Forty Japanese adults presented with jaw deformities diagnosed as mandibular prognathism with maxillary protrusion, bimaxillary protrusion, and anterior crowding. Of these 40 patients, 20 (group 1) underwent anterior segmental osteotomy or dento-osseous osteotomy along with our original orthodontic periodontal management. The remaining 20 (group 2) patients underwent conventional procedures. After surgery, pocket depth and periodontal bone loss at the osteotomy site were evaluated. RESULTS: In all cases of patients who underwent our original technique, degeneration of the gingival marginal and periodontal defects at the osteotomy site were not found. The rate of alveolar bone height in group 1 significantly increased and that in group 2 significantly decreased after maxillary osteotomy (P < .05). CONCLUSION: This technique may prevent periodontal defects from occurring at the interdental osteotomy site.

Maxillary stability following Le Fort I osteotomy in combination with sagittal split ramus osteotomy and intraoral vertical ramus osteotomy: a comparative study between titanium miniplate and poly-L-lactic acid plate.

PURPOSE: The purpose of this study was to compare changes in maxillary stability after Le Fort I osteotomy with titanium miniplate and poly-L-lactic acid (PLLA) plate (Fixsorb-MX; Takiron Co, Osaka, Japan). PATIENTS AND METHODS: The subjects were composed of 47 Japanese patients with diagnosed jaw deformity: 24 underwent Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO); and 23 underwent Le Fort I osteotomy intraoral vertical ramus osteotomy without internal fixation. Each group was divided into titanium plate and PLLA plate groups. Time course changes between plate groups were compared using lateral and posteroanterior cephalography. RESULTS: Significant differences were identified between titanium plate and PLLA plate groups in A point after Le Fort I osteotomy and SSRO (P < .05). Significant differences existed between titanium plate and PLLA plate groups in vertical component of posterior nasal spine after Le Fort I osteotomy in both combinations with SSRO and intraoral vertical ramus osteotomy (P < .05). However, no significant differences were identified in measurements on posteroanterior cephalography. CONCLUSION: These results suggest a slight tendency for vertical impaction after Le Fort I osteotomy both in combination with SSRO and intraoral vertical ramus osteotomy with PLLA plates, although differences in time course changes were not clinically apparent, and normal occlusion was established in all patients.

Change in condylar long axis and skeletal stability following sagittal split ramus osteotomy and intraoral vertical ramus osteotomy for mandibular prognathia.

PURPOSE: The purpose of this study was to compare postsurgical time course changes in condylar long axis and skeletal stability between sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO). PATIENTS AND METHODS: Of 40 Japanese patients with a diagnosed jaw deformity, 20 underwent IVRO without internal fixation and 20 underwent SSRO with rigid internal fixation. The time course change in condylar long axis and skeletal stability were assessed with axial, frontal, and lateral cephalograms. RESULTS: A significant difference in the rotation direction of condylar long axis was seen in horizontal axial cephalogram images (P <.01). In Pog-N perpendicular to SN, the IVRO group showed gradual decrease, although SSRO group showed gradual increase in lateral cephalogram (P <.05). CONCLUSION: The present results suggest a significant difference between SSRO and IVRO in time course changes in proximal segment including condyle and distal segment.

Changes in the chewing path of patients in skeletal class III with and without asymmetry before and after orthognathic surgery.

PURPOSE: The purpose of this study was to examine the relation between changes in the condylar long axis and the chewing path before and after mandibular ramus osteotomy for patients with prognathism with and without asymmetry. PATIENTS AND METHODS: Eleven men and 16 women with mandibular prognathism were divided into groups on the basis of symmetry and osteotomy procedure. Preoperative and postoperative frontal chewing paths were recorded. The chewing path consisted of 4 components: deviated side range, undeviated side range, vertical range, and incisal path angle. The angle of the condylar long axis and the 4 components of the chewing path were compared between groups and the differences were analyzed statistically. RESULTS: No significant differences in each of the 4 chewing path components were found between groups on the basis of symmetry or osteotomy procedure. A positive correlation was found between the changes in incisal path angle when chewing on the undeviated side and condylar long axis angle on the undeviated side (P < .05). A positive correlation was also found between the changes in undeviated side range when chewing on the deviated side and condylar long axis angle on the deviated side (P < .05). CONCLUSION: This study suggests that surgically induced increase in the condylar long axis is correlated with increase in side range and incisor path angle, although surgical orthodontic treatment does not significantly change the chewing pattern.

The assessment of blood loss in orthognathic surgery for prognathia.

PURPOSE: It is difficult to predict the need for blood transfusion during orthognathic surgery. The purpose of this study was to evaluate differences between patients who underwent different orthognathic procedures, and to assess the need for transfusion in orthognathic surgery. SUBJECTS AND METHODS: We examined 62 prognathic patients who underwent orthognathic surgery in our hospital. The subjects were divided into 4 groups according to procedure. Pre- and postoperative values of blood parameters were evaluated statistically. RESULTS: A greater amount of blood was lost in the double-jaw surgeries than in the single-jaw surgeries. There was a significant difference between sagittal split ramus osteotomy (SSRO) combined with Le Fort I osteotomy and intraoral vertical ramus osteotomy (IVRO) ( P < .05). However, none of the patients required transfusion intraoperatively. In all groups except the IVRO group, there were significant differences in red blood cell count, hemoglobin, and hematocrit between preoperative values and 1 week postoperative values ( P < .05). Although the values of red blood cell, hemoglobin, and hematocrit tended to decrease until 2 weeks postoperative, no complications occurred. Simple regression analysis showed significant positive correlation between duration of operation and blood loss ( P < .05). CONCLUSION: The present results indicate that there is little risk of marked bleeding in routine procedures, and that IVRO causes minimal bleeding. Transfusion was not necessary in IVRO or SSRO with or without Le Fort I osteotomy.

The use of polylactic acid/polyglycolic acid copolymer and gelatin sponge complex containing human recombinant bone morphogenetic protein-2 following condylectomy in rabbits.

PURPOSE: To examine the results of a polylactic acid/polyglycolic acid copolymer and gelatin sponge complex (PGS) with or without recombinant human bone morphogenetic protein-2 (rhBMP-2) used to treat condylar defects in rabbits. MATERIAL AND METHODS: Adult male Japanese white rabbits (n=60; 3kg; 12-16 weeks old) were divided into three groups of 20 each. All rabbits underwent condylectomy. In the two implanted groups, PGS with or without 5 microg of rhBMP-2 was implanted to the condylar defect without fixation. No material was implanted into the control group. Animals were sacrificed at 2, 4, 8, 12 and 24 weeks postoperatively, and the temporomandibular joints (TMJs) were examined histologically. RESULTS: Four weeks after implantation, growth of bone and cartilage-like tissue was observed in all rabbits that received PGS implants (with and without rhBMP-2). A cartilage-like layer was derived from the bone marrow at the operated surface. There was no growth of bone tissue in the control rabbits, but they also had a cartilage-like layer directly derived from the operated surface. CONCLUSION: This study demonstrated that PGS with or without rhBMP-2 could induce regeneration of new bone and cartilage-like tissue in the TMJ.

Different expression of 25-kDa heat-shock protein (Hsp25) in Meckel's cartilage compared with other cartilages in the mouse.

The 25-kDa heat-shock protein (Hsp25) is expressed in the cartilage of the growth plate and suggested to function in chondrocyte differentiation and degeneration. Using immunohistochemistry, we examined the temporal and spatial occurrence of Hsp25 in Meckel's cartilage in embryonic mice mandibles, and in other types of cartilage in both embryonic and adult mice. In adults, Hsp25 immunoreactivity was detected in the hypertrophic chondrocytes located in growth plates of long bones and in non-osteogenic laryngeal and tracheal cartilages. No chondrocytes in the resting or proliferating phase exhibited Hsp25 immunoreactivity. In the embryonic mandibles, resting and proliferating chondrocytes in the anterior and intermediate portions of Meckel's cartilage showed Hsp25 immunoreactivity from the 12th day of gestation (E12) through E15, whereas those in the posterior portion showed little or no immunoreactivity. After E16, the overall Hsp25 immunoreactivity in Meckel's cartilage substantially reduced in intensity, and little or no immunoreactivity was detected in the hypertrophic chondrocytes located in the degenerating portions of Meckel's cartilage. The antisense oligonucleotide for Hsp25 mRNA applied to the culture media of the mandibular explants from E10 embryos caused significant inhibition of the development of the anterior and middle portions of Meckel's cartilage. These results suggested that Hsp25 is essential for the development of Meckel's cartilage and plays different roles in Meckel's cartilage from those in the permanent cartilages and the cartilages undergoing endochondral ossification.

Hepatocyte growth factor is essential for migration of myogenic cells and promotes their proliferation during the early periods of tongue morphogenesis in mouse embryos.

Temporal and spatial occurrence of hepatocyte growth factor (HGF) and its cognate receptor c-Met in the mouse mandibular development was investigated by immunohistochemistry and quantitative reverse transcriptase-polymerase chain reaction. HGF was first recognized in the mesenchymal cells of the first branchial arch at the 10th day of gestation (E10), before tongue formation, whereas HGF receptor (c-Met) -positive myogenic cells first appeared at E11 in the center of mandibles. By E12, HGF turned to be colocalized with c-Met in the differentiating tongue myoblasts. Between E14 and E16, HGF disappeared, whereas c-Met remained, in the tongue myoblasts. The levels of HGF mRNA in the developing tongue decreased in accordance with the increase of desmin mRNA levels from E11 to E17. These in vivo results strongly suggest that the HGF/c-Met system takes part in the earlier stages of tongue development. To elucidate this hypothesis, the antisense oligodeoxyribonucleotide (A-ODN) for mouse HGF mRNA was added to the organ culture system of mandible with serumless, defined medium. Mandibular arches from E10 mouse embryos were cultured at 37 degrees C for 10 days in the absence or presence of A-ODN, control (sense) oligonucleotide (C-ODN), or A-ODN plus recombinant HGF. In the control mandibular explants cultured without HGF or ODN, the anterior two-third of the tongue derived from the first branchial arch was formed. It contained abundant desmin-positive myoblasts and was equivalent to the tongue of E14-E15. In contrast, in the presence of A-ODN in the medium, neither the swelling nor myogenic cells were found in the tongue-forming region of explants, and myogenic cells accumulated behind the tongue-forming region. Such dysplasia of tongue was never induced in the presence of C-ODN or A-ODN plus recombinant HGF in the medium. The effect of A-ODN appeared to be developmental stage-specific, because tongue dysplasia occurred when A-ODN was present during the earlier 4 days but not during the later 4 days of the culture. Furthermore, recombinant HGF added to the culture without ODNs during the earlier 4 days caused elevation in the number of mitotic myoblasts. These results suggest that HGF regulates both the migration and proliferation of myogenic cells during the earlier stages of tongue development.