Diagnosis and treatment for obstructive sleep apnea: Fundamental and clinical knowledge in obstructive sleep apnea.

Purpose: This review article covers the diagnosis and treatment of obstructive sleep apnea (OSA) from a dental perspective. It addresses the issue of when and how to screen for and then, if indicated, refer the patient for a more comprehensive.

Study Selection: Our focus in this article was on identifying current unanswered questions that relevant to OSA problems that dental scientists have to pursue and on providing valuable information on that problems, consequently the previous studies which investigated or reviewed the diagnosis and treatment of OSA were included.

Age-adjusted level of circulating elastin as a cardiovascular risk factor in medical check-up individuals.

Aims: The level of circulating soluble elastin (CSE) is reported to increase proportionally with the degree of clinical atherosclerosis; however, its diagnostic use is limited because CSE also increases with age. We aimed to investigate whether alterations in CSE concentrations are implicated in potential cardiovascular dysfunctions (indicated by standard physiological parameters) in medical check-up individuals, taking age into consideration.

Methods: In a total of 531 individuals (age 20-89 years), CSE levels were correlated most significantly with age.

Effects of implant surgery on blood pressure and heart rate during sedation with propofol and midazolam.

Purpose: Intravenous (IV) sedation is commonly used in dentistry. However, no report has yet been published regarding age, hypertension, and antihypertensive drugs during implant surgery and their relationship with changes in blood pressure (BP) and heart rate in implant surgery under IV sedation with propofol and midazolam.

Materials And Methods: Medical records of 252 patients who underwent implant surgery were retrospectively analyzed.

Acute effects of intravenous nicorandil on hemodynamics in patients hospitalized with acute decompensated heart failure.

Background: Nicorandil injection, a potent vasodilator with K(ATP) channel opening action and nitrate-like action, has been used for treatment of unstable angina. In the present investigation, we examined the effect of intravenous nicorandil on hemodynamics in patients with acute decompensated heart failure (ADHF).

Methods: ADHF patients admitted to hospital with pulmonary artery wedge pressure (PAWP)≥18 mm Hg were enrolled.

The development and clinical application of novel connectors for oral appliance.

Purpose: Currently, over 40 different types of oral appliances (OA) are available to dentists to treat sleep disordered breathing. OA can be classified by mode of action or design. One of the major categories is tongue retaining device; the other is a mandibular advancement device (MAD).

Acute decompensated heart failure syndromes (ATTEND) registry. A prospective observational multicenter cohort study: rationale, design, and preliminary data.

Acute heart failure syndromes (AHFS) are likely to increase in the future, and the high readmission rate of patients with AHFS is an important issue in Western countries. However, there are very few published epidemiological studies on AHFS in the Asia Pacific region. Because AHFS are heterogeneous, the characteristics, clinical profile, and management of AHFS should be clarified in an epidemiological study.

Investigation of trends and characteristics in patients with obstructive sleep apnea.

Background: Oral appliance (OA) therapy for obstructive sleep apnea (OSA) has only been part of Japan's National Health care coverage plan since 2004. Subsequently, not enough time has passed to establish the medical trends and characteristics of OSA patients in Japanese Dental Hospitals.

Aim: The aim of this study was to investigate the medical trends and the characteristics in patients with OSA who visited our clinic, and to compare our findings with previous studies.

Dynamics and source of endothelin-1 and interleukin-6 following coronary reperfusion in patients with acute myocardial infarction.

Objectives: The goals of this study were to determine the source of circulating endothelin-1 (ET-1) and interleukin-6 (IL-6) in acute myocardial infarction (MI) and to study the effects of coronary reperfusion (CR) on plasma levels of ET-1 and IL-6.

Methods: We serially measured plasma concentrations of ET-1 and IL-6 at different sampling sites before and after CR in patients with acute MI. A femoral vein (FV) catheter, a Swan-Ganz catheter, and a femoral artery (FA) catheter were placed in 25 patients with acute MI who were admitted within 12 hours after onset.

Chronic direct stimulation of adenylyl cyclase induces cardiac desensitization to catecholamine and beta-adrenergic receptor downregulation in rabbits.

Chronic stimulation of beta-adrenergic receptors (betaARs) induces betaAR downregulation. However, it is not known whether continuous activation of adenylyl cyclase without direct stimulation of betaARs leads to receptor downregulation. This study investigated the effects of chronic stimulation of adenylyl cyclase with colforsin, on hemodynamic variables, and on myocardial betaAR density.

A case of massive left atrial lipoma occupying pericardial space.

We report a rare case of massive left atrial lipoma occupying pericardial space. A 52-year-old male was admitted because of cardiomegaly of unknown etiology. Computed tomography showed a large epicardial mass located along the anterior surface of the heart, from the diaphragm level through the aortic arch level.

Effects of the patent false lumen on the long-term outcome of type B acute aortic dissection.

Objective: To determine the most effective treatment, we performed a detailed comparative study of the clinical course of patients with type B aortic dissection with a patent or thrombosed false lumen who did not undergo surgery in the acute period. We examined the effect of patency of the false lumen on outcome.

Methods: Computed tomography scans of 138 patients with type B acute aortic dissection were reviewed.

Internal medicine education in dentistry: knowledge required varies according to dental specialty.

Background: With recent increases in the number of elderly and medically compromised patients, dentists are required to have a more comprehensive understanding of medical problems. There is, however, little awareness of the importance of internal medicine at dental schools in Japan.

Objective: The aims of the present study were to examine whether dentists need medical knowledge, to examine how often they experience difficulties regarding internal medicine in dental practice, and to determine whether their specialty or career influences their needs or difficulties.

Limitation of infarct size and ventricular remodeling in patients with completely reperfused anterior acute myocardial infarction--the potential role of ischemia time.

Background: Experimental studies suggest that coronary reperfusion does not result in appreciable myocardial salvage beyond 3 to 4 h.

Hypothesis: The present study was undertaken to examine the potential role of ischemia time as a determinant of infarct size and cardiac function in humans.

Methods: Ninety patients (69 men, 21 women, aged 61 +/- 1 years) presented within 24 h of onset of a first anterior infarct had ST-segment elevation on electrocardiogram.

[Potential role of leptin and insulin resistance assessed by the glucose clamp technique in coronary artery disease].

Objectives: Leptin may correlate with insulin resistance and be an important factor in patients with coronary artery disease. Therefore, we examined whether plasma leptin levels and insulin resistance are linked with coronary artery disease.

Methods: Plasma leptin levels and insulin resistance, assessed by the hyperinsulinemic euglycemic clamp technique, were measured in control subjects (n = 12, mean age 62 +/- 10 years), and in patients with obstructive coronary artery disease (n = 15, mean age 64 +/- 8 years) or vasospastic angina (n = 12, mean age 62 +/- 12 years).

[Left ventricular peak systolic pressure/end-systolic volume ratio change after dobutamine infusion for predicting left ventricular contractile reserve: comparison with Emax].

Objectives: Genuine left ventricular contractile function is difficult to assess in the clinical setting. Left ventricular peak systolic pressure/end-systolic volume (Pps/Ves) ratio may be misleading because this index takes no account of the left ventricular end-systolic point and V0 intercept in the pressure-volume relation geographic curve. End-systolic pressure-volume relation and maximum chamber elastance derived from left ventricular pressure-volume loops can provide reliable estimates of contractile function.