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A 56-year-old man diagnosed with multiple myeloma was treated with CBD (cyclophosphamide, bortezomib, and dexamethasone; DEX), which was discontinued because of bortezomib-associated adverse events. Thereafter, he was treated with Ld (lenalidomide; LEN+DEX) followed by high-dose chemotherapy with autologous stem cell rescue, resulting in a complete response. Ld as maintenance therapy was discontinued because of immune thrombocytopenia, resulting in disease progression. Although treatment was switched to Pd (pomalidomide+DEX), DLd (daratumumab+LEN+DEX), and IRd (ixazomib+LEN+DEX); the patient's M protein level continued to increase and the extramedullary disease expanded despite radiotherapy. He was treated with E-Ld (elotuzumab+LEN+DEX) after 3 cycles of short VAD (vincristine, doxorubicin, and DEX). The extramedullary disease disappeared after 8 cycles of E-Ld. To the best of our knowledge, this is the first report showing the effectiveness of E-Ld treatment for extramedullary disease of a heavily treated patient for multiple myeloma. We believe that the clinical course of this patient provides useful insights about the antimyeloma mechanism of elotuzumab.Refractory viremia/viral disease is a major life-threatening complication that may arise among patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT). This study aimed to clarify the therapeutic effect of high-dose polyclonal intravenous immunoglobulin (IVIG) against viremia/viral diseases after allo-HCT. We conducted a pilot study to investigate the therapeutic effect of 400 mg/kg of IVIG given for 5 consecutive days against refractory viremia/viral disease after allo-HCT. Overall, 7 patients were drug-resistant and the other 7 had not previously received any drug for their viremia/viral disease. All patients completed the 5-day therapy regimen of IVIG. A complete response at Day 56 was observed for 8 of 14 patients (57.1%). Additionally, 10 of 14 patients (71.4%) were alive at Day 56, although only one death occurred due to the viremia/viral disease. Remarkably, all 3 cases who developed exogenous viremia/viral diseases including respiratory syncytial virus pneumonia/bronchitis and human parvovirus B19 viremia achieved a complete response, suggesting that high-dose polyclonal IVIG may be more effective against exogenous viruses rather than endogenous ones. Congestive heart failure was observed in 1 patient. High-dose polyclonal IVIG could be an effective and feasible therapy for refractory viremia/viral disease after allo-HCT.BACKGROUND Although left bundle-branch block (LBBB) is a known conduction disorder that occurs after transcatheter aortic valve implantation (TAVI), its clinical impact in the Japanese population remains unclear.Methods and ResultsOf the 298 consecutive patients who underwent TAVI from January 2016 to December 2018 in a high-volume center in Japan, 68 with prior or periprocedural permanent pacemaker implantation (PPI), pre-existing LBBB, death during hospitalization, aborted procedure, or incomplete data were excluded. Among the final cohort of 230 patients, new-onset LBBB occurred in 90 (39%) after TAVI and persisted at 1-month follow up in 29 patients (13%; persistent new-onset LBBB, PN-LBBB). On multivariable analysis, self-expandable valve (SEV) use was found to be the only predictor of PN-LBBB (odds ratio 4.39, 95% confidence interval 1.69-11.41, P=0.002). There were no differences between patients with and without PN-LBBB in terms of overall mortality (18.8% vs. 26.0%, log-rank P=0.90) or need for late PPI (4.0% vs. 3.5%, log-rank P=0.74), yet there was an increased re-admission rate for heart failure (HF) in the PN-LBBB group (15.6% vs. 8.0%, log-rank P=0.046) at a median follow up of 431 (interquartile range, 271-733) days. CONCLUSIONS PN-LBBB following TAVI was not associated with mortality or late PPI, but with a higher incidence of HF-related re-hospitalization at the mid-term follow up.When the sinus is enlarged, it may be necessary to elevate the floor of the maxillary sinus using the crestal or lateral approach. This report presents a case where sinus floor elevation was performed using tricalcium phosphate (TCP) plates supported by implant bodies, and only the blood clot was present around the implant bodies. Cone-beam computed tomography images, taken one year after the lateral approach, revealed the presence of a TCP-like radio-opacity, which almost disappeared after two years. About seven years after the surgery, the patient's superstructure and occlusion were stable. Furthermore, the grafted TCP was completely absorbed, and the implant body appeared to be in good condition, with no signs of bone resorption around the implant.Polypharmacy in elderly persons living at home or in a nursing home is an issue. In the field of dentistry, strategies to reduce polypharmacy must be promoted; however, there is insufficient basic data on medications received by elderly persons with dysphagia living at home or in a nursing home. The subjects were 106 elderly persons with dysphagia living at home or in a nursing home. Based on their medical records, the presence of disease and number/type of drugs being administered were investigated. Stroke, dementia, and hypertension were common. The mean number of drugs per person was 6.3 (minimum 0, maximum 15). Drugs for digestive ulcers were the most frequently prescribed medication, followed by hypotensive drugs, anti-parkinsonism drugs, and other central nervous drugs. Fifty-nine patients (52.8%) had taken drugs that may cause dysphagia, and 19 (17.9%) had taken drugs that may cause aspiration. Of the subjects, 68.9% had taken ≥5 drugs, demonstrating polypharmacy in elderly persons with dysphagia living at home or in a nursing home. Many drugs that may cause dysphagia or aspiration had been prescribed, suggesting the importance of dentists' reducing polypharmacy from the viewpoint of swallowing.Early detection of oral disease is important to reduce its severity and increase the likelihood of successful treatment. This study aimed to perform a quantitative assessment of the saliva components as a first stage of the research to screen oral homeostasis. Here, saliva secretions collected from children were evaluated, and their constituents were analyzed to investigate the potential correlations between the buffering capacity and a range of salivary factors. Subjects aged 3-16 years in the primary, mixed, or permanent dentition stage, were selected for this study. The following salivary factors were analyzed flow rate, total protein, total sugar quantifications, and constituent analyses using RT-PCR and western blotting. The associations between each factor and the buffering capacity were then analyzed using multiple regression analysis. Flow rate, BPIFA2 RNA level, histatin 1 and BPIFB1 protein levels as well as female sex were positively associated with buffering capacity. In contrast, total sugar concentration and MUC7 RNA levels showed a negative relationship with the buffering capacity. Some of these constituents may indicate oral homeostasis and are therefore potential biomarkers of oral health status. These results suggest that the analyses of the correlations between oral homeostasis and salivary factors are an effective strategy for identifying the susceptibility to oral diseases.The present study was done to develop a useful experimental model for analysis of the effects of physiologically active substances on atrophy and regeneration of salivary gland acinar cells. Resection wounds (diameter, 3 mm) were made in the submandibular glands of 8-week-old Wistar rats (n = 24) for histochemical examination on Days 3, 5, 7, 10, 14, and 21 after implantation of a gelatin-based hydrogel sheet. The results showed that the sheet had nearly disappeared by Day 10. Regions around the resection wounds were classified as normal, atrophic, or necrotic. In atrophic regions, acinar cells atrophied after resection, and few acinar cells were observed on Day 7. On Days 5-7, striated and granular ducts resembled duct-like structures. On Day 10, newly formed acinar cells were confirmed by increased periodic acid-Schiff staining, and a greater number of mature cells was present thereafter. In necrotic regions, acinar and ductal cells were destroyed, and scattered enucleated acinar cells and duct-like structures were present, on Day 3; newly formed acinar cells were observed on Day 10. Thus, the experimental model demonstrated atrophy and regeneration of the submandibular gland and enabled analysis of the effects of sustained release of physiologically active substances contained within an implanted sheet.Magnetic resonance imaging (MRI) was used to observe growth of the mandibular condyle, mandibular fossa, and articular disc as a single unit. Changes in each component's relative position and size were observed using 7-tesla MRI. Mandibular condyle chondrocytes' growth was evaluated with immunohistochemistry, using the expression of zinc transporter ZIP13. Three-dimensional T1-weighted (T1w) MRI was used to obtain images of the TMJ of Sprague Dawley rats at 4-78 days old (P4-78) with a voxel resolution of 65 μm. Two-dimensional T1w MR images were acquired after a subcutaneous injection of the contrast reagent gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA). The T1w MR images showed that the mandibular condyle was located posterior to the mandibular fossa until P20; however, it then moved to a location underneath the mandibular fossa. In the Gd-DTPA enhanced images, the articular disc was identified as a region with lower signal intensity from P20. The number of ZIP13-positive chondrocytes at P6 was larger than the number at P24. In conclusion, the mandibular condyle with cartilage and disc grows on the posterior side of the mandibular fossa until P20, which was the weaning age. Then, the condyle fit into the mandibular fossa and completed the functional unit.This study aimed to evaluate the prevalence of internal symmetry (the number and morphology of root canals) in the mandibular incisors using cone beam computed tomography (CBCT). A total of 302 CBCT scans involving 1,208 mandibular incisors were evaluated using the Vertucci's classification regarding the number and configuration of root canals. The central mandibular incisors exhibited two root canals in 22.6% of patients and lateral incisors in 24.3% of patients. Most teeth (76.4%) had a type I configuration (a single root canal, 1-1), 21.7% had type II (2-1), 1.1% had type V (1-2), and 0.8% had type IV (2-2). [https://www.selleckchem.com/products/tak-875.html Fasiglifam cost] Teeth with a type-III configuration (1-2-1) were not found. In total, 17.5% of patients had a symmetric appearance of the two-canalled central mandibular incisors and 20.5% had a bilateral appearance of the two-canal lateral incisors. Moreover, in 12.3% of the patients, all four incisors showed two root canals. The highest degree of symmetry was found in incisors that had one root canal (central incisors 217 of 302, lateral incisors 229 of 302), followed by type 2-1 incisors (central incisors 50, lateral incisors 58). The influence of sex and age on the prevalence of symmetries was not significant. Concluding, the internal anatomy of the mandibular incisors cannot not be sufficiently predicted from the root canal anatomy of the contralateral tooth. Thorough clinical and radiographic inspection of each tooth remains mandatory to address the internal anatomy of the mandibular incisors correctly.