Shigehiro Tamaki

Association between soluble MICA levels and disease stage IV oral squamous cell carcinoma in Japanese patients

The soluble form of major histocompatibility complex class I-related chain A (MICA) is released from the surface of tumor cells of epithelial origin. Although MICA expressed on the cell surface stimulates the immunoreceptor natural killer (NK) group 2, member D (NKG2D), the secreted form downregulates NKG2D activity, thus allowing the tumor to escape immunosurveillance by NKG2D-expressing cells. In this study, we examined the association between serum levels of soluble MICA and the severity of disease in patients with oral squamous cell carcinoma (OSCC). We used enzyme-linked immunoabsorbent assay to measure serum levels of soluble MICA in OSCC patients and normal control individuals. Among patients categorized according to most disease parameters tested (tumor size, location, grade of differentiation, regional lymph node status, disease stage), soluble MICA levels in sera did not statistically differ from those in normal control individuals. Patients with stage IV disease and/or regional lymph node metastasis did, however, exhibit significantly higher serum levels of soluble MICA than control individuals (95% confidence interval (CI), 0.65-2.45, p = 0.021, and 95% CI, 0.62-4.42, p = 0.031, respectively). Overall survival rates were significantly higher for OSCC patients with low soluble MICA levels (<50 pg/ml) than for those with high soluble MICA levels (>50 pg/ml) (95% CI, 0.43-2.75, p = 0.03). Serum levels of soluble MICA may be useful in the diagnosis of advanced stage OSCC and as an indicator of regional lymph node metastasis.

Relationship between soluble MICA and the MICA A5.1 homozygous genotype in patients with oral squamous cell carcinoma.

NK and cytotoxic T cells play an important role in the elimination of virus-infected and tumor cells through NKG2D activating receptors, which can promote the lysis of target cells by binding to the major histocompatibility complex class I-related chain A (MICA) proteins. Polymorphisms in MICA may influence its binding to the NKG2D. The soluble form of MICA is released from the surface of tumor cells of epithelial origin. Whereas MICA expressed on the cell surface stimulates the immunoreceptor natural killer group 2, member D (NKG2D), the secreted form down-regulates NKG2D activity, thus allowing the tumor to escape immunosurveillance by NKG2D-expressing cells. In this study, we examined the association between MICA gene microsatellite polymorphisms and serum levels of soluble MICA in patients with oral squamous cell carcinoma (OSCC). We found that patients with OSCC were more likely to have the A5.1 allele when compared to healthy subjects and also more likely to be homozygous for this allele (p=0.041). Patients with the homozygous A5.1 genotype had higher levels of soluble MICA (p=0.031) and a lower survival rate (p=0.026).

Mandibular reconstruction with vascularised fibular osteocutaneous flaps using prefabricated stereolithographic mandibular model

modifications to avoid transverse scars. The resulting method is very simple because it requires no manipulation of flaps. Tight stitches are essential for prevention of scar widening, however, if that should occur then later correction is facilitated by the straight line of closure. Further follow-up is necessary, however the initial scar contracture is minimal in comparison with other conventional methods after more than one year follow-up.

Estimating the Time after Death on the Basis of Corneal Opacity

Estimation of the time after death (TAD) is an important aspect of forensic science. The cornea becomes increasingly opaque with an increase in TAD and corneal opacity is used for TAD estimation. However, previous methods are subjective, and there is a risk of human error. To establish an objective method, we propose a new method for TAD estimation. We applied RGB image analysis to the corneal color of cadavers. We then examined if there was a correlation between these color parameters and actual TAD, age, position at death, and environmental temperature. We found that corneal opacity was affected only by TAD. The method described here is objective and easy to use, and TAD can be estimated within a very short period of time, making this method particularly useful. To further increase the accuracy of TAD estimation, other quantifiable parameters could also be evaluated.

Asphyxial death related to postextraction hematoma in an elderly man

We here report an autopsy case of a man in his seventies who died from asphyxia due to compression of the trachea caused by postextraction bleeding after extraction of his left mandibular third molar by a dentist in private practice. On the morning after the tooth extraction, he had complained of dyspnea and became unconscious at home. Although he was brought to the emergency room by ambulance, he died 7 days later without regaining consciousness. Autopsy examination revealed that the lingual side of the alveolar bone was fractured at the extraction socket. Moreover, subcutaneous bleeding that extended from the extraction socket to the thyrohyoid ligament in the cervical region and deviation of the epiglottis due to the bleeding were observed. Histological findings revealed liver cirrhosis; there were no significant findings in other organs. On the basis of these findings, we concluded that alveolar bone fracture occurred during the extraction and that the bleeding spread to the cervical region. Thus, the patient had died from asphyxia resulting from airway obstruction caused by cervical subcutaneous bleeding derived from postextraction bleeding. We emphasize that tooth extraction may cause fatal complications in patients with bleeding tendencies, particularly in the elderly.

Two Autopsy Cases of Water Intoxication

We here report two autopsy cases of men with an intellectual disability who died from water intoxication. (Case 1) A 22-year-old man was found dead in a prone position in his room. Autopsy and histological findings revealed the edema of brain and lung. The serum Na value was 108 mEq/L. (Case 2) A 23-year-old man suddenly fell and was found unconscious. Autopsy and histological findings revealed the edema of brain and lung. In lung tissue, deposition of fibrin around the vessels, was found. The serum Na value was <100 mEq/L. On the basis of these findings, we concluded that they were died from water intoxication and hyponatremia as a result of massive drinking. We also discuss new autopsy findings that support the diagnosis of water intoxication and we investigate the serum Na value of autopsy cases (N=17) in order to analyses the postmortem change of serum Na value.

MICA gene polymorphism not associated with nonsyndromic cleft lip with or without cleft palate in the Japanese population

UNLABELLED Nonsyndromic cleft lip with or without cleft palate (NSCLP) is one of the most common birth defects. Despite its frequency, the etiology remains largely unknown. Most likely, both genetic and environmental factors contribute to this malformation. A polymorphic gene family, the major histocompatibility complex class I chain-related gene A (MICA), is located about 40 kb centromeric to the HLA-B gene. In this study, we analyzed the association between MICA gene polymorphisms and NSCLP in Japanese patients. METHODS The (GCT)n polymorphism of the MICA gene was investigated in 94 patients with NSCLP and 180 normal controls using polymerase chain reaction amplification and denaturing polyacrylamide gel electrophoresis. RESULTS Our results demonstrate that there are no differences in microsatellite allele frequency between NSCLP patients and controls. However, the microsatellite allele frequency of the MICA-A6 (p = 0.045) allele was increased in male patients, as compared with controls. Further, the MICA-A5 (p = 0.359) allele was also increased in female NSCLP patients. CONCLUSION These results suggest that the microsatellite allele frequencies of the MICA-A6 allele increased in male NSCLP patients. Although the MICA-A5 allele increased in female NSCLP patients, the increase was not statistically significant. These results suggest that the MICA gene could be one of the candidate genes for NSCLP.

Autopsy case of a patient with 13q− syndrome

Partial deletion of the long arm of chromosome 13 results in 13q(-) syndrome, and phenotypes of affected patients vary widely. We describe an autopsy case of the sudden, unexpected death of a 17-year-old boy with 13q(-) syndrome. He had severe psychomotor retardation and had been receiving follow-up care. One day he was found dead in his house and autopsy was performed to elucidate the cause of death. Autopsy findings revealed lobulation anomalies of the lungs, hypoplasia of the adrenal and thyroid glands, and apituitarism due to hyperplasia of bone in the hypophyseal fossa. No other pathological lesions were observed. Chromosomal analysis confirmed interstitial deletion from the long arm of chromosome 13. Karyotype was 46,XY, del(13)(q14.3q32). We concluded that the patient died of multi-organ dysfunction due to apituitarism. Autopsy cases of 13q(-) syndrome are rare. Furthermore, lobulation anomalies and apituitarism associated with 13q(-) syndrome have not previously been described. This case report offers novel clues to elucidating critical regions of chromosome 13 associated with malformations of the lungs and pituitary gland.

Risk Factors Affecting Duration of Management of Odontogenic Maxillofacial Cellulitis

Abstract Purpose: To elucidate the risk factors influencing the duration of management of odontogenic maxillofacial cellulitis. Patients and Methods: Forty five consecutive patients with odontogenic maxillofacial cellulitis were enrolled. By a retrospective chart review, the duration of surgical drainage was investigated in relation to the following variables: age, body temperature at presentation, underlying medical conditions (diabetes mellitus and liver disease), number and location of involved surgical spaces, duration from the onset of inflammatory swelling to surgical drainage, and laboratory findings. Results: Age, body temperature, number and location of involved spaces, and duration from the onset of inflammatory swelling to surgical drainage strongly correlated with duration of surgical drainage. Furthermore, patients older than 50 years with a body temperature of 37.8°C or higher, 4 or more involved spaces, deep site infection, duration from the onset of inflammatory swelling to surgical drainage of 6 days or more, and diabetes mellitus indicated significantly longer duration of surgical drainage than other patients. Conclusion: These results contribute to predicting the duration of management of odontogenic maxillofacial cellulitis based on the correlations reported.