Unresolved Palliative Care Needs of Elderly Non-Cancer Patients at Home: A Multicenter Prospective Study.

INTRODUCTION/OBJECTIVES: There is growing consensus on the benefits of initiating palliative care early in the disease trajectory; however, palliative care needs for non-cancer patients remain to be elucidated. We investigated the trajectory of unresolved palliative care needs of non-cancer patients at home and explored associated factors. METHODS: We conducted a multicenter prospective cohort study of elderly non-cancer patients at home in Japan between Jan 2020 and Dec 2020. Physicians assessed their palliative care needs using the Integrated Palliative Care Outcome Scale (IPOS). Unresolved palliative care needs were defined as IPOS symptoms above 2 (moderate). RESULTS: In total, 785 patients were enrolled. The most frequent unresolved palliative care needs at enrollment were poor mobility (n = 438, 55.8%), followed by weakness/lack of energy (n = 181, 23.1%) and poor appetite (n = 160, 20.4%). Multivariate logistic regression analysis revealed that female and musculoskeletal disease were significantly positively associated with pain at starting home visits (OR = 1.89, P = .015; OR = 2.69, P = .005). In addition, neurological diseases were significantly positively associated with constipation and poor mobility 3 months after starting home visits (OR = 3.75, P = .047; OR = 3.04, P = .009). CONCLUSIONS: The order of the prevalence of unresolved palliative care needs may remain relatively stable over time, even for those receiving home-based palliative care services. We identified several specific diseases and conditions that were significantly associated with unresolved palliative care needs.

Condylar Resorption Following Compressive Mechanical Stress in Rabbit Model - Association of Matrix Metalloproteinases.

BACKGROUND/AIM: Idiopathic condylar resorption (ICR) is a morphological change of the condylar head that occurs following orthodontic treatment or orthognathic surgery. This complication is serious, as it can cause relapse after mandible treatment. The aim of this experimental study was to evaluate the mechanism of influence of condylar resorption on compressive mechanical stress in temporomandibular joint following a change in occlusal position by mandible advancement. MATERIALS AND METHODS: An osteotomy procedure at the midline of mandible was performed in 15 rabbits, with the left side moved forward by 3.5 mm. Advancement of the left side of the mandible resulted in compressive mechanical stress on condylar head on the left side. Samples were subjected to micro-computed tomography, histological staining and immunohistochemistry. RESULTS: The area and depth of anterior condylar resorption at two weeks were significantly different as compared to those at one week (p<0.05). TRAP staining confirmed the significantly largest number of TRAP-positive cells after two weeks (p=0.02), compared to one week. MMP-3 and MMP-13 immunostaining of the anterior condylar head at two weeks revealed high levels of both proteins from the surface to the deep layer of cartilage. CONCLUSION: Compressive mechanical stress following mandible advancement results in load on the anterior surface of the condylar head, which leads to bone resorption there, and induces MMP-3 and MMP-13 related to degradation of condylar head cartilage.

A qualitative study of factors promoting EBM learning among medical students in Japan.

Objectives: To identify the elements needed to facilitate undergraduate EBM learning among Japanese medical students. Methods: We conducted a qualitative study based on individual semi-structured interviews. Participants were physicians working at universities, teaching hospitals, or clinics who teach EBM to medical students. Purposive sampling was used to recruit participants via email through the researchers' acquaintances. Six physicians agreed to participate in the study and were interviewed individually from October 2019 to January 2020. The interviewees were asked about their own EBM learning and teaching experiences, what they kept in mind when teaching EBM to medical students, and what they felt was needed to improve current undergraduate EBM education. Interviews were recorded. Transcripts were analysed using thematic analysis. Results: Thematic analysis extracted five themes: finding foreground questions, observing role models, active learning, understanding patient backgrounds, and understanding the reason for learning EBM. To promote EBM education for medical students, it is first necessary for students to actively participate in clinical practice and identify foreground questions by observing their supervisors practicing EBM. In addition to acquiring skills in information retrieval and critical appraisal, understanding a patient's background leads to understanding the significance of learning EBM, which improves students' motivation to learn EBM. Conclusions: This study identified five themes that promote undergraduate EBM education. Curriculum development incorporating these elements would improve EBM education in Japan and other countries.

Evaluation of changes in prescription among Japanese elderly patients before and after transition to home care.

Background: Most patients receiving home care have multimorbidity and tend to be prescribed multiple drugs with the complicated regimen. Family physicians (FPs) are responsible for patients' prescriptions after transition to home care. This study aimed to assess changes in medication regimen complexity and potentially inappropriate medications (PIMs) made by FPs before and after transition to home care. Methods: A retrospective cohort study was conducted in six home care clinics in Ibaraki Prefecture, Japan. Data from patients aged 65 years and older taking any medication who initiated home care between April 2018 and March 2019 were collected using medical records. The medication regimen complexity index-Japanese version (MRCI-J) score and the presence of PIMs were assessed before and 3 months after transition to home care. Results: The mean age of 169 patients was 84.0 years. MRCI-J score and percentage of PIMs remained unchanged between before and 3 months after home care initiation. However, MRCI-J score significantly decreased among patients with polypharmacy, but significantly increased among patients with nonpolypharmacy. In multiple regression analysis, a greater number of medications before home care initiation was associated with a decreasing MRCI-J score, but pharmacist home visit services were not associated with changes in MRCI-J score. Conclusions: Our results suggest that FPs involved in home care are trying to adjust prescriptions by simplifying the medication regimen of patients with polypharmacy, and adding symptomatic drugs to those with nonpolypharmacy.

Influence of bone condition on implant placement accuracy with computer-guided surgery.

BACKGROUND: The impact of the jaw bone condition, such as bone quantity and quality in the implant placement site, affecting the accuracy of implant placement with computer-guided surgery (CGS) remains unclear. Therefore, this study aimed to evaluate the influence of bone condition, i.e., bone density, bone width, and cortical bone thickness at the crestal bone on the accuracy of implant placement with CGS. METHODS: A total of 47 tissue-level implants from 25 patients placed in the posterior mandibular area were studied. Implant placement position was planned on the simulation software, Simplant® Pro 16, by superimposing preoperative computed tomography images with stereolithography data of diagnostic wax-up on the dental cast. Implant placement surgery was performed using the surgical guide plate to reflect the planned implant position. The post-surgical dental cast was scanned to determine the position of the placed implant. Linear and vertical deviations between planned and placed implants were calculated. Deviations at both platform and apical of the implant were measured in the bucco-lingual and mesio-distal directions. Intra- and inter-observer variabilities were calculated to ensure measurement reliability. Multiple linear regression analysis was employed to investigate the effect of the bone condition, such as density, width, and cortical bone thickness at the implant site area, on the accuracy of implant placement (α = 0.05). RESULT: Intra- and inter-observer variabilities of these measurements showed excellent agreement (intra class correlation coefficient ± 0.90). Bone condition significantly influenced the accuracy of implant placement using CGS (p < 0.05). Both bone density and width were found to be significant predictors. CONCLUSIONS: Low bone density and/or narrow bucco-lingual width near the alveolar bone crest in the implant placement site might be a risk factor influencing the accuracy of implant placement with CGS.

The relationship between neurosensory disturbance of the inferior alveolar nerve and the lingual split pattern after sagittal split osteotomy.

OBJECTIVE: The aim of this study was to evaluate the relationship between neurosensory disturbance (NSD) and the different types of bilateral sagittal split osteotomy (BSSO) lingual fracture created. STUDY DESIGN: The study group consisted of 45 patients with mandibular deformities (90 sides; 14 males and 31 females). Computed tomography (CT) scans were obtained preoperatively and 1 week postoperatively. All patients were divided into lingual fracture line groups on the basis of their postoperative scans. NSD was tested preoperatively and 1, 3, and 12 months postoperatively by using a sensory touch Semmes-Weinstein (SW) test and the 2-point discrimination (TPD) test. RESULTS: Patients were divided into 2 groups on the basis of their lingual fracture lines after mandibular BSSO; among the 45 patients, 39 sides (43.3%) had short-splits, and 51 sides (56.7%) had long-splits. The short-split group was less affected at all tested times, and the difference between the 2 groups was significant 1 month postoperatively on TPD test but not at other times on the both tests. CONCLUSIONS: The split type did not affect the NSD incidence at 3 and 12 months postoperatively.

Factors associated with influenza vaccination in Japanese elderly outpatients.

BACKGROUND: Elderly patients benefit from influenza vaccination, but the number of Japanese elderly patients who are vaccinated is insufficient. Several factors are associated with influenza vaccination acceptance, but little is known about Japanese elderly outpatients. The purpose of this study was to examine factors associated with influenza vaccination in elderly outpatients in Japan. METHODS: During the 2017-2018 influenza season, outpatients from one hospital and one clinic in Kitaibaraki City, Ibaraki, Japan, participated in this study. Patients answered a self-report questionnaire exploring factors such as their vaccination status during the 2017-2018 season, past influenza vaccination, perceived susceptibility to influenza and adverse events of the vaccine, perceived vaccine efficacy, physician recommendations. Multivariable logistic regression analyses were conducted to identify factors associated with vaccination. RESULTS: Of 377 patients, 316 (83.8%) responded, and the vaccination rate was 57%. Eighty-three patients (27.0%) reported that their physician recommended the influenza vaccine. In multivariate analysis, influenza vaccination was associated with higher age (odds ratio (OR) 1.09, 95% confidence interval (CI) 1.03-1.14), physician recommendations (OR 2.49, 95% CI 1.18-5.25), low perceived susceptibility to vaccine-related adverse events (OR 0.33, 95% CI 0.15-0.74), and belief in vaccine efficacy (OR 4.73, 95% CI 2.08-10.8). CONCLUSIONS: Influenza vaccination was associated with belief in vaccine efficacy, perceived susceptibility to vaccine-related adverse events, physician recommendations, and older age. Increasing the frequency of physician recommendations may lead to increased vaccination coverage.

Histologic and histomorphometric evaluation of the bone regeneration following cortical bone repositioning in a rabbit mandible.

BACKGROUND: Although bone graft (BG) is the gold standard for bone augmentation, its use is hampered by donor site morbidity and limited quantity. PURPOSE: To evaluate the capabilities of bone formation by cortical bone repositioning (CBR) as the healing response following grafting of autogenous bone block without filling biomaterial at the gap between gap and recipient. MATERIALS AND METHODS: Twelve Japanese White rabbits were divided into three groups (postoperative 2, 5, and 8 weeks). A cortical block was freed from the mandibular body, half of the block was positioned and fixed overlapped the original bone surface beside the defect and the other half remained only elevated above the defect. Three areas were decided for the evaluation; BG, CBR, and defect (D) area. Areas were evaluated by micro-CT, histology, and histomorphometric analysis. RESULTS: There is no statistical difference between BG and CBR by evaluating distance and area in histomorphometrical analysis (P < .05). D area showed statistical decrease compared with BG and CBR at week 2. Histologically, new bone was evident at week 2, mature bone was observed in all three areas at week 8, D area disappeared and fused completely with the elevated bone block. CONCLUSION: CBR has potential for bone augmentation as BG induced from its own regenerative ability of healing process.

Japanese regional-quota medical students in their final year are less motivated to work in medically underserved areas than they were in their first year: a prospective observational study.

INTRODUCTION: In Japanese medical schools, a special regional quota (chiikiwaku) system has been widely implemented to increase the number of physicians in medically underserved areas (MUAs). Regional quota students are required to take out a student loan but are exempted from repayment after fulfilling an approximately 9-year obligatory practice period. This study investigated the anticipated willingness of final-year regional quota students to remain in MUAs after their obligatory practice period, as well as factors associated with this willingness during students' first year. METHODS: The participants in this prospective observational study were all regional quota students at Japanese medical schools. Baseline data were collected when students were in their first year, and their anticipated willingness to remain in MUAs after their obligatory practice period was the primary outcome, determined by questionnaire during the students' final year. The association between baseline data and willingness to remain in MUAs was analyzed by the Χ2 test and logistic regression analysis. RESULTS: At baseline, 405 first-year students in 38 medical schools answered the questionnaire; of these, 208 (51.4%) students were followed up 5 years later. The proportion of regional quota students who anticipated being willing to remain in MUAs decreased from 52.3% to 19.2% after 5 years. In multivariate analysis, anticipated willingness to remain in MUAs in the sixth year was associated with rural upbringing (odds ratio (OR) 2.1), influence of income on work preference (OR 0.3) and willingness to remain in MUAs as assessed during the first year (OR 3.3). CONCLUSIONS: Regional quota students' anticipated willingness to remain in MUAs decreased as they progressed through medical school. To increase the number of physicians in MUAs, it may be useful to recruit regional quota students who come from rural areas, who do not place a high priority on expected incomes, and who initially anticipate a willingness to remain in MUAs.

Do Mandibular Third Molars Play a Role in Fractures of the Mandibular Angle and Condyle?

INTRODUCTION: The relationship between impacted mandibular third molars with angle and condylar fractures is subject of many publications, yet their conclusions differ widely, hence the authors wanted to investigate this topic in their patients. METHODS: The authors designed a retrospective study including 241 patients who presented with angle and/or mandibular condyle fractures over a 13-year period at the authors' institution. The study variable was the presence/absence of third molars. The authors used the Pell and Gregory system to classify their position, whereas the angulation was classified using Archer classification. The outcome variables were the presence of angle and condylar fractures. Other study variables included fracture etiology. RESULTS: Assaults were the most frequent cause of angle fractures (62.7%), whereas falls were mostly responsible for condylar fractures (79.6%). Angle fractures were mostly isolated (66.3%), whereas condylar fractures were mostly associated with other fractures (62.6%). The majority of the angle fractures occurred in patients with third molars (63.6%), on the contrary the majority of the condylar fractures occurred in patients without mandibular third molars (78.3%). Angle fractures were mostly associated with fully erupted or superficially impacted third molars (90,9%). Finally in the presence of mesioangulated third molars, condylar fractures did not happen in 83.8% of patients. CONCLUSIONS: According to the authors' findings, fully erupted or superficially impacted mandibular third molars are a risk factor for angle fractures but at the same time a protective factor for the condyle. On the contrary, the absence of mandibular third molars "strengthens" the angle and represents a risk factor for condylar fractures.

Cortical Bone Repositioning Technique for Horizontal Alveolar Bone Augmentation: A Case Series.

The objective of this study was to present a novel procedure for cortical bone repositioning (CBR) that maintains a secure space under the periosteum by replacement of the lateral cortex via fixation, employing titanium screws. Seven systemically healthy patients presenting with horizontal alveolar bone defects in radiographs and CT images were enrolled for CBR technique for horizontal alveolar bone augmentation. A lateral cortical bone block was cut in the defects and freed from the original bony surface. A screw was inserted into the block, and the block was placed laterally to allow fixation. The block was checked for adequate stability, and the flap was closed after creation of periosteal releasing incisions to ensure tension-free closure. There were no complications, and 16 implants were placed uneventfully. Preoperative bone width in the defect area was 3.28 mm; the postoperative 4-month bone width in the same area was 6.46 mm. The mean implant stability quotient (ISQ) at placement was 68. At the secondary operation for changing to a healing abutment, the mean ISQ was 72. All patients were functionally and esthetically rehabilitated with implant-supported dentures. CBR technique is a simple procedure without the use of any biomaterials or devices. The main advantage of this technique in comparison to autogenous grafts is the lack of donor site issues. This technique has the possibility of inducing the patient's regenerative ability for bone healing.

Clinical evaluations of complete autologous fibrin glue, produced by the CryoSeal® FS system, and polyglycolic acid sheets as wound coverings after oral surgery.

The CryoSeal® FS System has been recently introduced as an automated device for the production of complete fibrin glue from autologous plasma, rather than from pool allogenic or cattle blood, to prevent viral infection and allergic reaction. We evaluated the effectiveness of complete autologous fibrin glue and polyglycolic acid (PGA) sheet wound coverings in mucosa defect oral surgery. Postoperative pain, scar contracture, ingestion, tongue dyskinesia, and postoperative bleeding were evaluated in 12 patients who underwent oral (including the tongue) mucosa excision, and received a PGA sheet and an autologous fibrin glue covering. They were compared with 12 patients who received a PGA sheet and commercial allogenic fibrin glue. All cases in the complete autologous fibrin glue group demonstrated good wound healing without complications such as local infection or incomplete cure. All evaluated clinical measures in this group were similar or superior to the commercial allogenic fibrin glue group. Coagulation and adhesion quality achieved with this method was comparable to that with a PGA sheet and commercial fibrin glue. Covering oral surgery wounds with complete autologous fibrin glue produced by an automated device was convenient, safe, and reduced the risk of viral infection and allergic reaction associated with conventional techniques.

Association between Excessive Alcohol Use and Alcohol-Related Injuries in College Students: A Multi-Center Cross-Sectional Study in Japan.

Alcohol-related injuries in college students are a major public health problem worldwide. We clarified the association between excessive drinking and alcohol-related injuries in Japanese college students. This was a cross-sectional study with a self-administered questionnaire. From January to March 2013, we sampled all college students and graduate students aged 20 years or older during annual health examinations at three colleges in Mie Prefecture in Japan. The questionnaire assessed the frequency of alcohol drinking, amount of alcohol consumed per day, binge drinking during the past year, alcohol-related injuries during the past year, and demographic data. Logistic regression analysis was conducted on the association between excessive alcohol use and alcohol-related injuries. A total of 2,842 students underwent health examinations, of whom 2,177 (76.6%) completed the questionnaire. Subjects included 1,219 men (56.0%) and 958 women (44.0%). Eighty-eight men (7.2%) and 93 women (9.7%) were classified as excessive weekly drinkers, while 693 men (56.8%) and 458 women (47.8%) were determined to be binge drinkers. Eighty-one men (6.6%) and 26 women (2.7%) had experienced alcohol-related injuries during the past year. In the logistic regression analysis, binge drinkers (odds ratio 25.6 [8.05-81.4]) and excessive weekly drinkers (odds ratio 3.83 [2.41-6.09]) had a history of significantly more alcohol-related injuries, even after adjusting for age and sex. In conclusion, alcohol-related injuries in college students in Japan were strongly associated with excessive drinking. As a strategy for preventing such injuries in this population, an interventional study is required to identify effective methods for reducing excessive alcohol use.

Sandwich bone graft for vertical augmentation of the posterior maxillary region: a case report with 9-year follow-up.

The loss of teeth followed by bone resorption often lead to defects in the alveolar ridge, making installation of dental implants difficult. Correction of such bone defects, especially lack of height of the ridge, is a difficult problem for all dental surgeons. This report describes the outcome of treatment after alveolar ridge augmentation in the atrophic posterior maxillary region via segmental sandwich osteotomy combined with placement of an interpositional autograft prior to placement of endosseous implants. The technique was successfully used to treat a deficiency in the vertical dimension of the posterior maxillary region. Six months after graft surgery, two implants were successfully placed in accordance with the original treatment protocol, and they survived for 9 years of follow-up.

Elderly patients with maxillofacial trauma: study of mandibular condyle fractures.

BACKGROUND/AIM: The aim of this study was to investigate the trends and characteristic features of mandibular condyle fractures in elderly patients in terms of etiology, patterns, and treatment modalities. PATIENTS AND METHODS: Records of 201 patients aged 65 years and older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University from January 2002 to December 2013, were retrospectively analyzed. Patient records and radiographs were examined, with the following information: relevant medical history, cause of fracture, the presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fracture, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted. RESULTS: A fall was responsible for the majority of the fractures (173/201). With condyle fractures, there was a significant difference between the contacted and non-contacted group in regard to incidence. Furthermore, there was a significantly greater number of cases with symphysis and condyle combination fractures in the non-contacted group (70.9%) than in the contacted group (51.9%). As for the method of treatment, arthrocentesis was the most commonly employed. CONCLUSIONS: The present findings suggest that contacted molars in the maxilla and mandible have an influence on condyle fractures in elderly individuals.

Evaluation of the treatment modalities for neurosensory disturbances of the inferior alveolar nerve following retromolar bone harvesting for bone augmentation.

SUBJECTS: The purpose of this study was to evaluate the treatment modalities for neurosensory disturbances (NSDs) of the inferior alveolar nerve occurring after retromolar bone harvesting for bone augmentation procedures before implant placement. METHODS: One hundred four patients, of which 49 and 55 exhibited vertical or horizontal alveolar ridge defects in the mandible and maxilla, respectively, were enrolled. Nineteen patients underwent block bone grafting, 38 underwent guided bone generation or autogenous bone grafting combined with titanium mesh reconstruction, and 47 underwent sinus floor augmentation. Using a visual analog scale, we examined subjective symptoms and discomfort related to sensory alteration within the area of the NSDs in these patients. NSDs were clinically investigated using a two-point discrimination test with blunt-tipped calipers. In addition, neurometry was used for evaluation of trigeminal nerve injury. We tested three treatment modalities for NSDs: follow-up observation (no treatment), medication, and stellate ganglion block (SGB). RESULTS: A week after surgery, 26 patients (25.0%) experienced NSDs. Five patients received no treatment, 10 patients received medication, and 11 patients received SGB. Three months after surgery, patients in the medication and SGB group achieved complete recovery. Current perception threshold values recovered to near-baseline values at 3 months: recovery was much earlier in this group than in the other two groups. SGB can accelerate recovery from NSDs. CONCLUSIONS: Our results justify SGB as a reasonable treatment modality for NSDs occurring after the harvesting of retromolar bone grafts.

Prognosis factors in the treatment of bisphosphonate-related osteonecrosis of the jaw - Prognostic factors in the treatment of BRONJ.

OBJECTIVES: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a relatively rare but serious side effect of bisphosphonate (BP)-based treatments. This retrospective study aimed to investigate the risk factors and predictive markers in cases where patients were refractory to a recommended conservative treatment offered in our hospital. PATIENTS AND METHODS: This single-center study collated the medical records of all patients treated for BRONJ between 2004 and 2011. A complete medical history, including detailed questionnaires, was collected for all patients, focusing on identifying underlying risk factors, clinical features, location and bone marker levels of BRONJ. RESULTS: The mean BRONJ remission rate was 57.6%, and the median duration of remission was seven months. Eighteen patients (34.6%) had persistent or progressive disease with a recommended conservative treatment for BRONJ. Notably, urinary cross-linked N-terminal telopeptide of type 1 collagen (NTX) levels in those resistant to conservative treatment tended to be lower than in patients that healed well. CONCLUSIONS: We confirm that a significant proportion of BRONJ sufferers are refractory to a recommended conservative treatment and find that anticancer drugs, periodontal disease, the level of bone exposure and the dosage of intravenous BPs (e.g. zoledronate) represent specific risk factors in BRONJ that may determine the success of a recommended conservative treatment. Additionally, the NTX levels might be able to be a prognostic factor for the conservative treatment of BRONJ; additional research is necessary. Key words:Bisphosphonate, osteonecrosis, jaw, prognostic, retrospective.

Mechanisms involved in suppression of ADAMTS4 expression in synoviocytes by high molecular weight hyaluronic acid.

Aggrecan degradation is considered to play a key role in the progression of osteoarthritis (OA). Aggrecanases are members of a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) family, and degrade aggrecan in OA cartilage. The aim of this study was to clarify the mechanisms of expression of ADAMTS4 induced by IL-1ß in human fibroblast-like synoviocyte (HFLS) cells by high molecular weight hyaluronan (HMW-HA), a therapeutic agent used for OA. Monolayer cultures of HFLS cells were incubated with IL-1ß and HMW-HA. In some experiments, cells were pretreated with the CD44 function-blocking monoclonal antibody or inhibitors of signaling pathways prior to addition of IL-1ß and HMW-HA. The expressions of ADAMTS4 mRNA and protein were monitored using real-time RT-PCR, Western blotting, and immunofluorescence microscopy. To further determine the role of HMW-HA in IL-1ß-induced ADAMTS4 expression, activation of p38 mitogen-activated protein kinase (MAPK), extracellular signal-regulated kinase (ERK), c-jun NH2-terminal kinase (JNK), Akt, and NF-κB were analyzed by Western blotting. HMW-HA suppressed ADAMTS4 mRNA and protein expressions induced by IL-1ß. Pretreatment with the anti-CD44 monoclonal antibody recovered the inhibitory effect of HMW-HA on expression of ADAMTS4 mRNA induced by IL-1ß. Western blotting analysis revealed that IL-1ß-induced phosphorylation of p38 MAPK and JNK protein were diminished by HMW-HA. Furthermore, inhibition of the p38 MAPK and JNK pathways by chemical inhibitors suppressed ADAMTS4 mRNA expression stimulated by IL-1ß. These results suggest that HMW-HA plays an important role as a regulatory factor in synovial tissue inflammation.

Horizontal alveolar distraction osteogenesis for dental implant: long-term results.

OBJECTIVES: The aim of the present study was to present the results of patients followed for at least 3 years who underwent horizontal distraction osteogenesis DO and a final implant prosthesis. MATERIAL AND METHODS: A total of 13 sites in 12 patients (three men, nine women; mean age 45.4 years, range 21-63 years) who presented with severe horizontal atrophy of a partially edentulous maxilla or mandible were treated using horizontal DO. The horizontal distraction device was set on the transport bone which was osteotomized as bone splitting method and fixed to the segment using microscrews. RESULTS: The median of latency period was 9 days (range: 7-17); the median of amount of device activation was 5.6 mm (range: 4.4-9.6); the median of distraction period was 14 days (range: 8-24); and the median of consolidation period, from the end of activation until implant placement, was 13 weeks (range: 11-20). The median of actual gain in bone width at the end of the consolidation period was 3.6 mm (range: 1.1-5.6). A total of 35 implants were inserted in the augmented area with primary implant stability. The median of follow-up from the start of prosthetic loading was 5.4 years. Consequently, the implant survival and success rates were 100% and 94.2%, respectively. CONCLUSION: This article reports the long-term results of horizontal alveolar DO using a mesh device for patients with an atrophic alveolar region. Our results confirm that this technique is a predictable and effective regenerative procedure for implant preprosthetic treatment in patients with severe horizontal atrophy of the alveolar ridge.

Mechanisms involved in inhibition of chondrogenesis by activin-A.

OBJECTIVES: Activin-A, a member of the TGF-ß family, is known to be present in bone and cartilage. Although, involvement of the TGF-ß family in chondrogenesis has been reported, the mechanism by which activin-A regulates chondrogenesis has not been fully elucidated. The aim of this study was to investigate the effects of activin-A on chondrocyte differentiation in vitro. MATERIALS AND METHODS: Monolayer cultures of mouse chondrocyte ATDC cells were pretreated with a variety of inhibitors of major signaling pathways prior to addition of activin-A. The expressions of sox9, runx2, and osterix mRNA were detected using real-time PCR. To determine chondrocyte differentiation, sulfated glycosaminoglycans were stained with Alcian blue. To further elucidate the role of activin-A on chondrogenesis regulation, phosphorylation of Smad2/3, ERK, JNK, and Akt proteins was determined by western blotting. RESULTS: Activin-A suppressed the transcription of sox9, runx2, and osterix mRNA, as well as sulfated glycosaminoglycans accumulation. Activin-A also inhibited constitutive phosphorylation of JNK and Akt proteins. Furthermore, inhibition of the JNK and PI3K-Akt pathways by chemical inhibitors suppressed chondrogenesis in ATDC5 cells. CONCLUSIONS: These results indicate that activin-A may suppress chondrocyte differentiation in ATDC5 cells via down-regulation of JNK and Akt phosphorylation.