Shiro Yamada

Clinicopathological significance of carbonic anhydrase 9, glucose transporter-1, Ki-67 and p53 expression in oral squamous cell carcinoma.

Carbonic anhydrase 9 (CA9) is a glycoprotein present on the surface of cell membranes. It is expressed in 90% of renal cancer cells, but not in normal kidney tissue. Immunotherapy targeting CA9 is underway, and our group has also conducted a clinical trial using CA9 as a cancer vaccine and confirmed the induction of cytotoxic T lymphocytes, with efficacy in some cases. Expression of CA9 antigen in oral cancer has not been reported in Japan, but our results indicate that immunotherapy targeting CA9 might be possible. We immunohistochemically observed the expression of antigens such as CA9, Ki-67, glucose transporter-1 (GLUT-1) and p53 in 107 subjects with oral squamous cell carcinoma, and examined their correlation with clinicopathological parameters. Immunostaining analysis showed expression of CA9 in 98% of oral cancer subjects, and the survival rate was significantly lower in subjects with CA9 antigen expression in 50% or more cells (P<0.05). Subjects with poorly differentiated, T4 and lymph node metastasis, or Stage IV cancer with high CA9 expression (≥50%) had a worse outcome than those with low CA9 expression. Although GLUT-1 expression was observed in 98% of subjects, similarly to CA9 expression, no significant correlation between its expression and the survival rate was seen. However, subjects with lymph node metastasis had significantly higher GLUT-1 expression, demonstrating that GLUT-1 could be an indicator of lymph node metastasis. Ki-67 was expressed in 92% of subjects, but no correlation with outcome was observed. Expression of p53 was noted in 78% of subjects, and it was found that many oral cancers have p53 genetic abnormalities, but no correlation between p53 and outcome was observed. It was confirmed that CA9 antigen is expressed in most oral cancer subjects, suggesting the possibility of immunotherapy targeting CA9 antigen in oral cancer.

Effective three-dimensional evaluation analysis of upper airway form during oral appliance therapy in patients with obstructive sleep apnoea

The oral appliance (OA) is considered to be an effective treatment modality for obstructive sleep apnoea (OSA). Upper airway enlargement during OA therapy is critical, and lateral cephalometry has been used for the two-dimensional evaluation of upper airway form during this therapy. However, this method cannot provide an accurate three-dimensional (3D) view of upper airway form. To confirm the effects of OA on the upper airway in patients with OSAS, we performed CT in the presence and absence of OA in 15 Japanese patients (12 males, 3 females) who responded to OA therapy. CT in the presence and absence of OA was consecutively performed for each patient, and upper airway cross-sectional area in six arbitrary planes parallel to the palatal plane was measured. Next, 3D image reconstruction was performed; morphological changes in upper airway form were evaluated, and upper airway volume at three levels from the palatal plane to the deepest point of the epiglottis was measured. The cross-sectional area of two planes in the posterior soft palate region significantly increased in the presence of OA compared with that in the absence of OA. In the presence of OA, upper airway cross-sectional area and volume significantly increased in the posterior soft palate region compared with those in the posterior tongue region. 3D CT image reconstruction accurately confirmed morphological changes in the upper airway during OA therapy. Continued use of this 3D evaluation is expected to improve the results of OA therapy in the future.

Minimally invasive endoscopic osteosynthesis for frontozygomatic fracture: a new approach.

Abstract Miniplate fixation on the lateral face of the orbital rim using existing endoscopic methods for frontozygomatic fracture still has some disadvantages, such as cosmetic disturbance from the lateral brow incision for the trocar, and abnormal palpability of the miniplate. We applied a new method of endoscopic osteosynthesis by access through temporal incisions alone and miniplate fixation on the lateral temporal face of the frontozygoma. Postoperative courses were uneventful in all four cases treated, and we achieved cosmetic improvement (minimizing incision and scars) as well as decreased palpability of the miniplate.

Oral Appliance Therapy for Mild Obstructive Sleep Apnoea Syndrome

Abstract We report a 42-year-old man who was admitted to the Aichi Medical University Hospital, Aichi, Japan, following cardiac arrest and was successfully revived using an automated external defibrillator. Percutaneous catheter intervention was performed and a cardioverter-defibrillator was implanted. The patient was also diagnosed with mild obstructive sleep apnoea syndrome and treated using an oral appliance. His apnoea-hypopnoea index improved from 13.5/ hour to 2.7/hour following the oral appliance treatment, which was continued for more than 3 years after his discharge.

Fundamental Studies on Tissue Reaction after Low Power Laser Irradiation

It is generally recognized that the lower power Nd: YAG laser provides some therapeutic effects on tissue without irreversible changes. On the other hand, high power laser causes irreversible changes. The criterion about low and high power laser is, however, not established. The aim of this study is to verify the effect of lower and high power laser on wound healing of rat skin by measuring blood flow and histomorphologic findings with HE and SEM. Each laser were irradiated to the center of 6mm round full-thickness skin defect at the back of the rat at either (1) 300mW×3min, (2) 500mW×3min, (3) 700mW×3min, (4) 300mW×20min, (5) 500mw×20min, (6) 700mW×20min.The results obtained are as follows;1) The histological findings showed that irradiation time caused more tissue damage in the deeper layer, whereas irradiation power caused more damage to the surrounding tissue.2) Small craters were starred on the bottom of the damaged tissue by laser irradiation at 700 mW x 20min. The formation of these craters was related to the absorption of laser irradiation.3) On the irradiated area, blood volume decreased significantly as irradiation power increased. However, both blood flow and tissue damage increased as irradiation time increased. As for the surrounding tissue, the findings showed an increase in the blood flow and tissue damage as irra diation power increased.4) High power laser at 700mW caused tissue damage regardless of irradiation time. On the other hand, 500mW irradiation power caused minimum damage to the tissue. Therefore, the range between 300 to 500mW and the irraditation time over 3min to less than 20min are classified as a lower power laser.