Patients with Pierre Robin syndrome are characterized by micrognathia, retrognathia, glossoptosis, and respiratory obstruction and are prone to have a difficult-to-intubate airway. The McGrath® MAC video laryngoscope provides a better view of the glottis than a Macintosh laryngoscope, but it is not easy to insert an endotracheal tube through the vocal cords because a video laryngoscope has a much greater curvature than that of a conventional direct laryngoscope and an endotracheal tube has a different curvature. The Frova Intubating Introducer is used as a railroad for an endotracheal tube in cases of a difficult airway. We thought that a combination of these two devices would make it easy to insert an endotracheal tube through the vocal cords, as a McGrath® MAC video laryngoscope provides a better glottic view and the Frova Intubating Introducer is a useful device for placing an endotracheal tube through the glottis. We report a successful endotracheal intubation with use of the McGrath® MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome.
The increase of bone-resorbing osteoclast
activity in bone remodeling
is the major characteristic of various bone diseases. Thus, inhibiting
osteoclastogenesis and bone-resorbing function may be an effective
therapeutic target for bone diseases. Betulinic acid (BA), a natural
plant-derived pentacyclic triterpenoid compound, is known to possess
numerous pharmacological and biochemical properties including anti-inflammatory,
anticancer, and antiadipogenic activity. However, the effect of BA
on osteoclast differentiation and function in bone metabolism has
not been demonstrated so far. In this study, we investigated whether
BA could suppress RANKL-induced osteoclastogenesis and bone resorption.
Interestingly, BA significantly suppressed osteoclastogenesis by decreasing
the phosphorylation of Akt and IκB, as well as PLCγ2-Ca2+ signaling, in pathways involved in early osteoclastogenesis
as well as through the subsequent suppression of c-Fos and NFATc1.
The inhibition of these pathways by BA was once more confirmed by
retrovirus infection of constitutively active (CA)-Akt and CA-Ikkβ
retrovirus and measurement of Ca2+ influx. BA also significantly
inhibited the expression of osteoclastogenesis-specific marker genes.
Moreover, we found that BA administration restored the bone loss induced
through acute lipopolysaccharide injection in mice by a micro-CT and
histological analysis. Our findings suggest that BA is a potential
therapeutic candidate for bone diseases involving osteoclasts.
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