Kanagawa Dental University

The somal distributions of orexigenic orexin‐A, anorexigenic corticotropin‐releasing factor (CRF) and melanin‐concentrating hormone (MCH) were immunohistochemically investigated in the whitespotted conger eel ( Conger myriaster ) brain, with particular focus on the preoptic nuclei and hypothalamus. Immunoreactive somata of these three neuroactive peptides were categorised into large (around 30 μm in diameter) and small (around 10 μm in diameter) types. Large‐type orexin‐A‐, CRF‐ and MCH‐immunoreactive (ir) somata were present in the magnocellular preoptic nucleus. Large‐type MCH‐ir somata were also seen in the lateral tuberal nucleus (TL). Fibres of these large‐type somata may penetrate the neurointermediate lobe of the pituitary. In contrast, the small‐type immunoreactive somata of these three neuroactive peptides showed differential distributions in the hypothalamus. Small‐type orexin‐A‐ir somata were mainly seen in the paraventricular organ. CRF‐ir somata were seen in the posterior parvocellular preoptic nucleus, around the dorsal and ventral areas of the anterior lateral recesses, and around the dorsal area of the posterior lateral recesses. MCH‐ir somata were seen in the TL and around the medial region of the posterior lateral recesses. Based on the hypothalamic differential localisations of these peptides, of which association with feeding behaviour is suggested, the presence of intra‐hypothalamic functional localisation related to feeding is likely.

3D visualization tools have been developed to assist in the anatomical learning of medical students, but the evidence on the effectiveness of these tools is inconsistent. Conventional 3D materials are often displayed on 2D screens, which can limit their educational impact. This study evaluates the effectiveness of the presentation of 3D learning materials using 3D displays compared to 2D displays in a randomized controlled trial. We developed glasses‐free 3D learning materials for the anatomy of abdominal organs and blood vessels, which are compatible with the 3D spatial reality tabletop display EFL‐SR1 developed by Sony. We assessed the effectiveness of these materials in a randomized controlled trial. Fifty‐six medical students were randomly divided into two groups to learn using either 2D or 3D displays. The improvement in understanding of the spatial arrangement of anatomical structures was measured before and after the learning sessions using a novel 3D puzzle‐like method. Both groups demonstrated improvements in understanding of the spatial arrangement of anatomical structures; there were no significant differences in overall performance between the 2D and 3D display groups. The 3D display group exhibited less variability in improvement indices, suggesting more consistent learning outcomes. The study indicates that glasses‐free 3D displays can minimize learning disparities among medical students and provide a more universally effective learning environment for all students. The 3D learning materials compatible with glasses‐free 3D displays and the innovative 3D puzzle‐like method used in this study offer a novel approach to teaching and evaluating anatomy education.

Background: This systematic review aimed to evaluate the efficacy of immunoenhancing nutritional therapy compared to conventional nutritional care in reducing perioperative complications in adult patients undergoing surgery for oral cancer. Given the unclear role of immunonutrition in this specific surgical setting, we synthesized available randomized controlled trials to assess outcomes such as surgical site infections, wound healing complications, hospital stay, and adverse events. Methods: Patients who underwent planned oral cancer surgery were included. The intervention group received oral or enteral immunoenhancing nutritional agents preoperatively, postoperatively, or both, while the control group received standard care (intravenous fluids) and/or macromolecular nutritional supplements. PubMed, Cochrane CENTRAL, and Central Medical Journal were comprehensively searched for randomized controlled trials (RCTs); eight RCTs were included. The primary outcomes were mortality, suture/healing failure, surgical site infection (SSI), and hospital stay length, with evidence certainty assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Results: Although mortality estimation was not feasible, hazard ratios from the meta-analysis showed that the intervention significantly improved suture/healing failure, SSI, and hospital stay length. The certainty of evidence was “low” for suture/healing failure and SSI and “moderate” for hospital stay length. Conclusions: Perioperative management with enteral nutritional agents fortified with immunonutrients should be considered in adult patients scheduled for (advanced) oral cancer surgery.

Purpose To evaluate the effects of prophylactic sequential argon- Nd:YAG laser peripheral iridotomy (pLPI sequential ) on the corneal endothelial cell density (CECD) over 5 years in Japanese eyes with narrow angles (NA-eyes). Study design Prospective observational study Methods The CECD of NA-eyes before and after pLPI sequential and of untreated NA-eyes were assessed annually over 5 years with non-contact specular microscopy. Routine ophthalmic examinations and measurements using anterior-segment imaging devices were performed at baseline. The time courses of the CECD were analyzed using a multivariable linear mixed-effect model and factors obtained at baseline. Results Sixty-nine pLPI sequential -treated NA-eyes (69 subjects; mean age, 68.9 years) and 67 pLPI sequential -untreated NA-eyes (67 subjects; mean age, 64.4 years) were enrolled. In the pLPI sequential -untreated NA-eyes, no baseline factors were correlated significantly with the time course of the CECD, and its decline rate − 4.7 (95% Confidence interval (I: − 13.3 to 4.0) cells/mm ² was not significant (p = 0.267). In the pLPI sequential -treated NA-eyes, the CECD declined with marginal significance − 12.2 (− 24.7 to 0.3) cells/mm ² /year (p = 0.0513) over 5 years. Higher laser energy used, thicker iris, and shallower central anterior chamber depth (cACD) at baseline were significantly negatively correlated with the post-laser CECD (p = 0.0092, 0.0119, and 0.0158). No significant difference was seen in the baseline factors-adjusted CECD decline rate (p = 0.262) between both the groups. Conclusion Prophylactic sequential argon-Nd:YAG pLPI sequential had no clinically significant effects on the time course of the CECD over 5 years in Japanese NA eyes. However, higher laser energy used, thicker iris, and shallower cACD significantly negatively affected the post-laser CECD.

Purpose: This guideline aimed to make evidence-based clinical practice guidelines for the primary treatment of temporomandibular disorders (TMDs) for general practitioners who do not specialize in TMD. Review process: Following the principles of evidence-based medicine, a systematic review and network meta-analysis (NMA) of multiple treatments was conducted, assessing the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Randomized controlled trials published between January 2000 and December 2020 were included. Patients diagnosed with TMD according to the Diagnostic Criteria for Temporomandibular Disorders were considered. Myalgia, arthralgia, and maximal mouth opening were selected as outcomes, and 12 treatments were included in the NMA. The modified Delphi method was used to reach a consensus on recommendations during clinical guideline panel meetings of the Japanese Society for the Temporomandibular Joint. Results: Self-administered mouth opening exercises, stabilization-type oral appliances, and low-level laser therapy (LLLT) were recognized as effective primary treatments, although the evidence level was graded as “very low” (Grade 2D). During the clinical guideline panel meetings, decisions were developed based on the NMA results, and recommendations for clinical practice guidelines were finalized following consensus. Conclusions: This guideline recommends mouth opening exercises and the use of stabilization-type oral appliances as primary treatments for TMD. Additionally, it suggests that LLLT be a conditional recommendation, supplemented with additional considerations.

Purpose Dynamic navigation systems and surgical guides have been reported to be equally accurate. However, the accuracy of dynamic navigation systems is affected by the movement of the patient tracker fixed to the tooth. We hypothesized that fixing the patient tracker to the oral appliance could improve accuracy. Therefore, this study aimed to compare accuracy between a dynamic navigation system with a patient tracker fixed to an oral appliance and a surgical guide. Methods This observational study was conducted on patients who had undergone complete implant treatment at Kanagawa Dental University from 2020 to September 2024. Fifty implant bodies were placed in 42 patients with anterior tooth defects in both the dynamic navigation and surgical guide groups (25 implants each). DTX Studio™ (Nobel Biocare AG, Kloten, Switzerland) was used to overlay planning data on postoperative Digital Imaging and Communications in Medicine data to calculate entry point, apex point, and angular deviation accuracy. Results The entry point, apex point, and angular deviation values were 0.99 ± 0.33 mm, 0.97 ± 0.43 mm, and 2.64 ± 0.87° in the dynamic navigation group and 1.33 ± 0.26 mm, 1.38 ± 0.3 mm, and 3.42 ± 1.03° in the surgical guide group, respectively, differing significantly at all measurement sites ( P < 0.01). Conclusions The fixation of the X-clip to the oral appliance improved intra-oral stability and inhibited intraoperative movement of the X-clip, resulting in high accuracy. These results suggest that dynamic navigation by oral appliance fixation is more accurate than surgical guides.

Introduction This study evaluated the efficacy of a resorbable l-lactide-ε-caprolactone copolymer (PLCL) membrane in promoting epithelial healing and preserving alveolar bone morphology using the open healing approach (OHA), compared to conventional membranes. Methods Extraction sockets in beagle dogs were filled with bone substitute material and covered with different membranes. Healing was assessed via histological analysis and micro-CT imaging. Results The PLCL membrane reduced bone resorption and preserved alveolar bone morphology better than conventional membranes. Histological analysis showed excellent epithelial healing and notable bone formation. Conclusions The PLCL membrane effectively prevents infection, supports epithelial healing, and preserves alveolar bone morphology in OHA procedures.

Autosomal recessive polycystic kidney disease (ARPKD) is a severe genetic disorder characterized by renal cystogenesis and hepatic fibrosis, primarily associated with PKHD1 mutations. While differential expression analysis (DEG) has identified key genes involved in ARPKD, their network-level interactions remain unclear. Recent studies have implicated WNT signaling in ARPKD pathogenesis, but a topological framework may provide additional insights into gene community structures. This study applied a network-based approach integrating single-sample gene set enrichment analysis (ssGSEA) and topological centrality analysis to investigate gene communities in ARPKD. We identified three key communities: Community 2, centered on IFT22, exhibited stable activation in both ARPKD and healthy samples, suggesting its role in ciliary function. Community 5, predominantly activated in ARPKD, included genes linked to tissue repair and immune regulation. In contrast, Community 3 was suppressed in ARPKD, indicating potential structural instability. Notably, PKHD1 was mathematically isolated, suggesting limited direct involvement in ARPKD-specific transcriptional networks, while the absence of WNT5A, CDH1, and FZD10 from defined communities in ARPKD may indicate potential alterations in their network associations compared to healthy individuals. These findings highlight the advantages of network topology over conventional DEG analysis in elucidating ARPKD pathophysiology. By identifying gene communities and regulatory hubs, this approach offers novel insights into disease mechanisms and potential therapeutic targets.

Efficient treatment strategies for stress urinary incontinence (SUI) in elite female athletes (EFAs) are crucial for their timely return to sports. This study evaluates the effectiveness and potential drawbacks of non-ablative Er: YAG laser therapy combined with pelvic floor muscle training (PFMT) in treating SUI among EFAs. We employ a discrete mathematics analytical approach using network graphs to identify key factors influencing treatment outcomes and to address the challenges of small sample sizes and unknown variables in this population. Our results demonstrate significant improvements in urinary incontinence symptoms and increased return rates to elite sports activities in the laser treatment group compared to the PFMT-only group. The discrete mathematics approach effectively visualizes the complex relationships between variables and supports the development of personalized treatment plans. This study highlights the potential of laser therapy as an effective treatment option for SUI in EFAs while emphasizing the importance of tailored treatment strategies.

Background Psychomotor impairments due to alcohol consumption may lead to a series of negative consequences. However, the influence of sex and ALDH2 polymorphism on psychomotor dysfunction has not yet been investigated. Methods One-hundred and three participants, genotyped for ALDH2 rs671, were administered a dose of 1.0 g/kg of white spirits. The blood ethanol concentration (BEC) and acetaldehyde concentration (BAAC) were measured at specific time intervals before and after alcohol consumption. Additionally, auditory simple reaction time (ASRT), visual choice reaction time (VCRT), pursuit tracking task (PTT) and digit-symbol substitution test (DSST) were used to evaluate psychomotor function. Linear mixed-effects model was used to analyze the effects of sex and the ALDH2 genotype on alcohol metabolism and psychomotor function.. Results Acetaldehyde metabolism depended on both ALDH2 genotype and sex. Women with ALDH2*1/*1 genotype exhibited 2.21 to 18.27 µmol/L higher BAAC levels than men with the same genotype. Conversely, among participants with ALDH2*1/*2 genotype, BAAC levels of women were 0.25 to 31.32 µmol/L lower than men. The impact of ALDH2 genotype on psychomotor function varied across the four tests. VCRT increased significantly in men with ALDH2*1/*2 genotype compared to those with ALDH2*1/*1 at 2–4 h post-consumption. In the PTT test, the percentage of time on target decreased by 3.83% and 3.11% in women relative to men at 1 and 2 h post-consumption, respectively. Notably, ASRT performance was significantly correlated with BAAC levels. No effects of ALDH2 genotype and sex were observed on DSST performance. Conclusions ALDH2 genotype and sex independently or interactively contribute to alcohol-related psychomotor impairment.

The development and proceeding of atherosclerosis is based on chronic inflammatory changes. We injected 3 kinds of popular periodontal bacteria into the lightly ligated external iliac arteries of 31 mice. We then obtained 22 pieces of arterial thrombus and selected the same number of chronic-phase specimens for study. We then compared the early phase of human atherosclerosis of the aorta and the atheroma in the advanced atherosclerosis cases with each other pathologically. We observed the presence of lymphocytes, macrophages, and T cells (CD3) in both materials, mostly. These findings show that animal models and human specimens are both based on chronic inflammation and suggest the presence of an acquired immunity mechanism, which is probably related to primary immunity by Gram negative bacteria such as oral bacteria.

Purpose Computed tomography (CT) imaging is utilized during virtual surgical planning (VSP) in orthognathic surgery to simulate the surgical scenario, thereby aiding the actual surgery. Various surgical strategies exist to enhance accuracy in Le Fort I osteotomy, but an ideal planning and treatment approach has not yet been defined. The purpose of this study was to assess the accuracy of markerless Augmented Reality (AR), utilizing the iterative closest point algorithm for real-time tracking without 3D-printed surgical guides, wafers, or physical markers. The study explores the integration of VSP and an intraoperative markerless AR-assisted system for Le Fort I osteotomy in orthognathic surgery. Methods Six patients were enrolled in the study. We conducted a markerless AR-assisted orthognathic surgery utilizing VSP containing a virtual plate model. To assess accuracy, the postoperative 3-dimensional reconstructed CT image was compared to the VSP. Results Distance maps visualizing the distances between VSP and the postoperative CT scan revealed an accuracy with a standard deviation (SD) of 0.81 mm (81.0% within 1 mm) in terms of the maxillary position. Conclusions This approach facilitated the movement and positioning of the maxillary bone along with fixation and setting of titanium plates. The simulation of the surgical procedure made the process more straightforward, enabling us to perform the actual surgery with greater precision. The markerless AR-assisted surgery shows potential in orthognathic surgery, aiding surgeons to prepare and execute surgical procedures more accurately. The future studies anticipate the integration of artificial intelligence, robotic technology, and AR for further improvements in orthognathic surgery.

Introduction : Periodontitis-associated fibroblasts (PAFs) have recently been identified in the tissues of periodontal disease and the interaction between the fibroblasts and epithelial cells has been reported to promote collagenolytic activity. However, the characteristics and genetic background of fibroblasts involved in peri-implantitis have not yet been clarified. In this study, we evaluated the collagen resolution activity and gene expression in peri-implantitis-associated fibroblasts (PIAFs) and investigated the effect of the inhibition of vascular endothelial growth factor (VEGF) /hepatocyte growth factor (HGF) signaling on PIAFs. Materials and Methods : Human connective tissue was collected from 17 patients during implant removal or peri-implant debridement. The epithelium was collected from one healthy patient during implant placement surgery. The collected tissues were digested and subsequently cultured three-dimensionally. Gene expression in PIAFs and non-PIAFs was evaluated using next-generation sequencing (NGS) analysis. VEGF/HGF inhibitors were applied to evaluate the effect on collagen degradation of PIAFs. Results : The 43 highly expressed genes in PIAFs compared to non-PIAFs, including those encoding VEGF/HGF signaling molecules. Inhibition of VEGF/HGF signaling significantly reduces collagen degradation in PIAFs. Conclusion : PIAFs significantly degrade collagen. However, the collagenolytic activity of PIAFs is inhibited by VEGF/HGF signaling inhibition. Further studies are required to identify the genetic background of PIAFs to elucidate the relationship between genetic variation and the pathological progression of peri-implantitis.

Objectives Obesity is a risk factor for periodontal disease and is associated with socioeconomic status (SES). However, it remains unclear whether SES modifies the relationship between obesity and periodontal disease. This study aimed to investigate the influence of SES on the association between obesity and periodontal disease. Material and Methods We used multilevel Poisson regression, adjusted for SES, to analyze the body mass index (BMI) and periodontal parameters of 962 participants (mean age 58.3 years; SD: 13.8). SES was assessed based on the average income and education levels of their residential areas. Results A significant association was observed between obesity and the proportion of teeth with probing pocket depth (PPD) ≥ 4 mm (ratio of means [RM]: 1.25, 95% confidence interval [CI]: 1.15, 1.38, p < 0.001), whereas the higher-income group exhibited a significantly lower proportion of teeth with PPD ≥ 4 mm (RM: 0.86, 95% CI: 0.77, 0.96, p = 0.007). Interaction analysis also revealed a significant interaction between obesity and the high-income group regarding the proportion of teeth with PPD ≥ 4 mm. The subgroup analysis demonstrated that the RM of obesity for the proportion of teeth with PPD ≥ 4 mm was higher in females than in males. Conclusions Income-related inequalities affect the association between obesity and periodontal disease. Among obese adults, those with low-to-middle-income levels may have a higher risk of periodontal disease than those with high-incomes. Clinical Relevance Comprehensive care and oral health education should be enhanced for obese individuals in low-income populations to mitigate their elevated risk of periodontal disease.

Individuals with metabolic-associated steatotic liver disease (MASLD) have a worse prognosis compared to patients without steatosis, and its prevalence is increasing. However, detailed risk factors based on obesity and sex remain unclear. We aimed to investigate the impact of cardiometabolic risk factors (CMRFs) on the risk of MASLD in individuals without pre-existing SLD. SLD was diagnosed by ultrasonography. Non-SLD individuals were followed 65,657 person-years. Incidence rates of MASLD were assessed by Kaplan–Meier analysis. Furthermore, independent factors associated with the development of MASLD were identified using Cox regression analysis, stratified by four groups: obese men, non-obese men, obese women, and non-obese women. The overall incidence rate of MASLD was 39.3/1,000 person-years. The cumulative incidence was highest in obese men, followed by obese women, non-obese men, and non-obese women. Two or more CMRFs increased the risk of MASLD in all groups. Low HDL cholesterol level was the strongest independent risk factor in both obese and non-obese women and hypertriglyceridemia for both obese and non-obese men. The impact of these CMRFs was stronger in non-obese individuals. (HR [95% CI]: women non-obese 1.9 [1.5–2.4], obese 1.4 [1.1–1.8]; men non-obese 2.3 [1.9–2.9], obese 1.5 [1.2–2.0]). Multiple CMRFs are important to MASLD development, regardless of sex and obesity. In this Japanese cohort, low HDL cholesterol in women and hypertriglyceridemia in men were the most significant risk factors, especially among the non-obese group. These findings suggest that sex-specific CMRFs may play a role in the development of MASLD.

Purpose To investigate changes in strabismus angles in children and young adult patients with recent onset of constant acquired comitant esotropia (ACE) following instructions on hand-held digital devices (DD). Study design Prospective multicenter non-randomized interventional study. Methods This study included subjects aged 5–35 years who developed ACE within 1 year. Subjects were divided into two groups: (i) subjects who used DD for an average of ≥120 minutes/day for junior high-school students and older and ≥60 minutes/day for primary-school students and younger (DD+); and (ii) subjects who used DD for less than that (DD-) based on the questionnaire at the study’s start. During the initial visit, glasses were prescribed when necessary; verbal instructions on DD use including time reduction and viewing-distance elongation were provided. For each group, strabismus angles at the initial visit and at 3 months were compared. Cure was defined as esophoria within 8 prism diopters without symptoms. Results In total, 181 cases were investigated. At baseline, strabismus angles in DD+ and DD- groups were 23±14 PD and 25±15 PD at near and 25±13 PD and 27±14 PD at distance, respectively. At 3 months, they were 22±16 PD and 25±15 PD at near and 23±14 PD and 27±13 PD at distance, respectively. Only in the DD+ group, reduction in strabismus angle was observed, but this was not clinically significant. Ten and 1 subjects in DD+ and DD- groups were cured. Conclusion Although changes in strabismus angles were not large enough, DD use instructions were beneficial for some ACE subjects.