Influence of Age on Leukemia Mortality Associated with Exposure to γ rays and 2-MeV Fast Neutrons in Male C3H Mice.

The relative biological effectiveness (RBE) of densely ionizing radiation can depend on the biological context. From a radiological perspective, age is an important factor affecting health risks of radiation exposure, but little is known about the modifying impact of age on the effects of densely ionizing radiation. Herein, we addressed the influence of age on leukemogenesis induced by accelerator-generated fast neutrons (mean energy, ∼2 MeV). Male C3H/HeNrs mice were exposed to 137Cs γ rays (0.2-3.0 Gy) or neutrons (0.0485-0.97 Gy, γ ray contamination 0.0105-0.21 Gy) at 1, 3, 8, or 35 weeks of age and observed over their lifetimes under specific pathogen-free conditions. Leukemia and lymphoma were diagnosed pathologically. Hazard ratio (HR) and RBE for myeloid leukemia mortality as well as the age dependence of these two parameters were modeled and analyzed using Cox regression. Neutron exposure increased HR concordant with a linear dose response. The increase of HR per dose depended on age at exposure, with no significant dose dependence at age 1 or 3 weeks but a significant increase in HR of 5.5 per Gy (γ rays) and 16 per Gy (neutrons) at 8 weeks and 5.8 per Gy (γ rays) and 9 per Gy (neutrons) at 35 weeks. The RBE of neutrons was 2.1 (95% confidence interval, 1.1-3.7), with no dependence on age. The development of lymphoid neoplasms was not related to radiation exposure. The observed increasing trend of radiation-associated mortality of myeloid leukemia with age at exposure supports previous epidemiological and experimental findings. The results also suggest that exposure at the susceptible age of 8 or 35 weeks does not significantly influence the RBE value for neutrons for induction of leukemia, unlike what has been documented for breast and brain tumors.

Predictive validity of the Questionnaire for Medical Checkup of Old-Old for functional disability: Using the National Health Insurance Database System.

AIM: To enhance health services that can address multifaceted issues, the Questionnaire for Medical Checkup of Old-Old (QMCOO) was strategically developed to ascertain frailty status. Using the National Health Insurance database system, we aimed to clarify whether the QMCOO can predict new certifications for long-term care for disabilities. METHOD: Of 20 151 adults aged ≥75 years who underwent health checkups in Kashiwa City, Japan, in fiscal year 2020 (examination rate 36.8%), 18 130 persons were included (mean age 80.1 ± 4.1 years, 55.1% women). The outcome was the new certification of long-term care until January 2022. From the medical care receipt data, QMCOO, age, sex, living arrangement, body mass index, comorbidity, and musculoskeletal and connective tissue diseases were evaluated. RESULT: During the follow-up period, 727 (4.0%) participants had an incident disability (median follow up 457 days [quartile range 408-519 days]). The QMCOO's predictive accuracy for new long-term care needs was optimal when the total score of 3/4 was used as the threshold. Older adults with scores ≥4 had a higher adjusted hazard ratio for incident disability (adjusted hazard ratio 2.5, 95% confidence interval 2.1-2.9). Furthermore, the adjusted hazard ratio was greatly enhanced with comorbidity (6.6, 95% confidence interval 4.8-8.9). CONCLUSION: The QMCOO, which reflects multifaceted frailty, might be predictive of incident disability, and its predictive accuracy could be improved by considering comorbidities. The comprehensive QMCOO could contribute to extending healthy life expectancy through efficiently assessing health care and preventing long-term care, even among the old-old in the latter stage who tended to suffer from multimorbidity. Geriatr Gerontol Int 2023; 23: 124-130.

Comparison of the lower limit of benchmark dose confidence interval with no-observed-adverse-effect level by applying four different software for tumorigenicity testing of pesticides in Japan.

The benchmark dose (BMD) approach is updated to create an international harmonizing process following rapid theoretical sophistication. We calculated the lower limit of BMD confidence interval (BMDL) for carcinogenicity based on 193 tumorigenicity bioassay data published in 50 pesticide risk assessment reports by the Food Safety Commission of Japan (FSCJ) to validate the appropriateness and necessity for the refinement of the FSCJ-established BMD guidance. Three well-known BMD software, PROAST, BMDS, and BBMD were used to compare their BMDLs with no-observed-adverse-effect levels (NOAELs) for carcinogenicity. Recently implemented methodologies such as model averaging or Bayesian inference were also used. Our results indicate that the BMD approach provides a point of departure similar to the NOAEL approach if the data used exhibit a clear dose-response relationship. In some cases, particularly in software with a frequentist approach, the calculation failed to provide BMDL or provided considerably lower BMDLs than NOAELs. However, most of the datasets that resulted in failed calculations or extremely low BMDLs exhibited unclear dose-response relationships, i.e., non-monotonous and sporadic responses. The expert review on the shape of the dose-response plot would help better apply the BMD approach. Furthermore, we observed that Bayesian approaches provided fewer failed or extreme BMD calculations than the frequentist approaches.

[Important Points at Interpretation ofNongenotoxic-Carcinogenicity Induced by Pesticidesin Rodent Bioassays].

Assessment of carcinogenicity is important for human health at dietary risk assessment of pesticide residues. This article indicated important points on interpretation of carcinogenicity in toxicological evaluation of pesticide residues based on principles of risk analysis in foods by CODEX to be a guide for risk assessors. This guidance was referred from the guidance on carcinogenicity evaluation by international and/or national organizations, and the interpretations of Food Safety Commissions of Japan (FSCJ) published in their risk assessment reports. We focused on carcinogenicity obtained from routine carcinogenicity bioassays in rodents. The guidance includes the purpose and usefulness of the bioassay studies, consideration points to be carcinogenicity and influencing factors to carcinogenicity in the test to judge carcinogenic hazard at hazard identification. Considering on human relevance as carcinogenic hazard also was proposed using practical case examples. Next, a carcinogenic hazard is evaluated on dose-response relationship to judge points of departure on carcinogenicity. At the end of this article, we challenged our recommendation on future assessment of carcinogenicity to progress from hazard to risk.

Basidiomycetous Yeast, Glaciozyma antarctica, Forming Frost-Columnar Colonies on Frozen Medium.

The basidiomycetous yeast, Glaciozyma antarctica, was isolated from various terrestrial materials collected from the Sôya coast, East Antarctica, and formed frost-columnar colonies on agar plates frozen at -1 °C. Thawed colonies were highly viscous, indicating that the yeast produced a large number of extracellular polysaccharides (EPS). G. antarctica was then cultured on frozen media containing red food coloring to observe the dynamics of solutes in unfrozen water; pigments accumulated in frozen yeast colonies, indicating that solutes were concentrated in unfrozen water of yeast colonies. Moreover, the yeast produced a small quantity of ice-binding proteins (IBPs) which inhibited ice crystal growth. Solutes in unfrozen water were considered to accumulate in the pore of frozen colonies. The extracellular IBPs may have held an unfrozen state of medium water after accumulation in the frost-columnar colony.

Chloroacetanilide herbicide-induced rat enterochromaffin cell tumors: a case study within the context of the IPCS framework, for analyzing the relevance of a cancer mode of action for humans.

The WHO International Programme on Chemical Safety (IPCS) framework for analyzing the relevance of a cancer mode of action (MoA) for humans (IPCS cancer-HRF) is an application to assess human relevance of tumorigenic hazards found through rodent bioassays. The chloroacetanilide herbicides, butachlor and alachlor, induced enterochromaffin-like (ECL) cell tumors in rat stomachs, at the highest doses. This study analyzed the human relevance of this tumor by applying the IPCS cancer-HRF using published data. In a postulated MoA, early key events (KEs) included decreased mucosal thickness in the fundic region, due to reduced parietal cells. The following KEs included increased pH of gastric acid and hypergastrinemia, leading to enhanced cell proliferation and hyperplasia, and resulting in the outcome of an ECL cell tumor. The data showed consistencies in dose-response and temporal concordance with the KEs and specificity in the tumor response, providing strengthened evidence of the KEs. While the early KE was not the same, similar MoAs have already been established for omeprazole and ciprofloxacin. The integrated data indicated that the postulated MoAs were biologically plausible. Alternative MoAs were excluded.. Based on sufficient evidence, an MoA was established in rats. When addressing chemically inducible MoAs of human relevance, KEs of hypergastrinemia and trophic ECL cell hyperplasia were judged to not be qualitatively and quantitatively plausible in humans. The MoA in rats is unlikely to be present in humans; however, the potential effects on parietal cells cannot be excluded. Thus, the IPCS cancer-HRF is very useful for assessing human relevance.

Refinement of decision tree to assess the consequences of increased serum ALP in dogs: Additional analysis on toxicity studies of pesticides evaluated recently in Japan.

Recently we provided a new interpretation that increased serum ALP in dogs is not adverse if no hepatotoxic finding coexists in the analysis of toxicity studies of over 200 pesticides evaluated in Japan (Yokoyama et al., 2019). We also proposed a decision tree to evaluate the adversity of the increased ALP. The present analysis was conducted to validate the reliability of this interpretation with 129 pesticides more recently evaluated. Before applying, the decision tree was revised to be consistent in all steps. The pesticides showed similar characterization of increased ALP to the previous analysis in that the increase was more frequent than in rats and that liver hypertrophy and hepatotoxicity commonly coexisted with an increase in ALP in dogs. When short- and long-term studies of 58 pesticides inducing ALP activity in dogs were applied to the revised tree, the increased ALP in 8 pesticides was judged not adverse in either study. The revision of the tree did not affect the NOAEL judgment of these pesticides; however, the revised routes contributed to the judgment more robustly. This study showed the reliability of our interpretation and applicability of the decision tree to evaluate the adversity of increased ALP in dogs.

Fructan Structure and Metabolism in Overwintering Plants.

In northern regions, annual and perennial overwintering plants such as wheat and temperate grasses accumulate fructan in vegetative tissues as an energy source. This is necessary for the survival of wintering tissues and degrading fructan for regeneration in spring. Other types of wintering plants, including chicory and asparagus, store fructan as a reserve carbohydrate in their roots during winter for shoot- and spear-sprouting in spring. In this review, fructan metabolism in plants during winter is discussed, with a focus on the fructan-degrading enzyme, fructan exohydrolase (FEH). Plant fructan synthase genes were isolated in the 2000s, and FEH genes have been isolated since the cloning of synthase genes. There are many types of FEH in plants with complex-structured fructan, and these FEHs control various kinds of fructan metabolism in growth and survival by different physiological responses. The results of recent studies on the fructan metabolism of plants in winter have shown that changes in fructan contents in wintering plants that are involved in freezing tolerance and snow mold resistance might be largely controlled by regulation of the expressions of genes for fructan synthesis, whereas fructan degradation by FEHs is related to constant energy consumption for survival during winter and rapid sugar supply for regeneration or sprouting of tissues in spring.

Case analysis of kinetics investigations in toxicity studies of pesticides to identify the nonlinearity of internal exposure and the influences of nonlinearity on the toxicological interpretation of pesticide residue.

The nonlinearity of internal exposure to 8 pesticides was investigated in toxicity studies using kinetics to identify nonlinearity visually and to investigate the influence of nonlinearity on toxicological evaluation. Data were obtained from risk assessment reports published by the Food Safety Commission (FSCJ). Nonlinearity was defined using 2 indicators: the lowest visual inflection point (LVIP) and the second lowest visual inflection point (SVIP) of kinetics by drawing a linear distribution chart. The area under the curve and 24-h urine concentrations were stable parameters used to identify the LVIP/SVIP. The sampling timing affected the blood concentrations, and the LVIP/SVIP was detected for 6 pesticides using the parent compounds or their metabolites as analytes. The subproportional nonlinearity was significant for these pesticides. The LVIP/SVIP values were consistent in the same species up to a 1-year period, but the values showed species-specific differences in several compounds. In all compounds found to be nonlinear, apical outcomes were observed at the SVIP or above. The presence of nonlinearity was recognized by the FSCJ. The recognition influenced their judgment of no-observed-adverse-effect levels (NOAELs) for carcinogenicity or health-based guidance values, indicating the importance of appropriate kinetics to identify the nonlinearity for toxicological evaluation of pesticide residue.

Adversity Considerations for Thyroid Follicular Cell Hypertrophy and Hyperplasia in Nonclinical Toxicity Studies: Results From the 6th ESTP International Expert Workshop.

The European Society of Toxicologic Pathology organized an expert workshop in May 2018 to address adversity considerations related to thyroid follicular cell hypertrophy and/or hyperplasia (FCHH), which is a common finding in nonclinical toxicity studies that can have important implications for risk assessment of pharmaceuticals, food additives, and environmental chemicals. The broad goal of the workshop was to facilitate better alignment in toxicologic pathology and regulatory sciences on how to determine adversity of FCHH. Key objectives were to describe common mechanisms leading to thyroid FCHH and potential functional consequences; provide working criteria to assess adversity of FCHH in context of associated findings; and describe additional methods and experimental data that may influence adversity determinations. The workshop panel was comprised of representatives from the European Union, Japan, and the United States. Participants shared case examples illustrating issues related to adversity assessments of thyroid changes. Provided here are summary discussions, key case presentations, and panel recommendations. This information should increase consistency in the interpretation of adverse changes in the thyroid based on pathology findings in nonclinical toxicity studies, help integrate new types of biomarker data into the review process, and facilitate a more systematic approach to communicating adversity determinations in toxicology reports.

Decreased expression of fructosyltransferase genes in asparagus roots may contribute to efficient fructan degradation during asparagus spear harvesting.

Asparagus (Asparagus officinalis L.) accumulates inulin and inulin neoseries-type fructans in root, which are synthesized by three fructosyltransferases-sucrose:sucrose 1-fructosyltransferase (1-SST, EC 2.4.1.99), fructan:fructan 1-fructosyltransferase (1-FFT, EC 2.4.1.100), and fructan:fructan 6G-fructosyltransferase (6G-FFT, EC 2.4.1.243). Fructans in roots are considered as energy sources for emerging of spears, and it has been demonstrated that a gradual decrease in root fructan content occurs during the spear harvesting season (budding and shooting up period). However, the roles of certain three fructosyltransferases during the harvest season have not yet been elucidated. Here, we investigated the variation in enzymatic activities and gene expression levels of three fructosyltransferases and examined sugar contents in roots before and during the spear harvest period. Two cDNAs, aoft2 and aoft3, were isolated from the cDNA library of roots. The respective recombinant proteins (rAoFT2 and rAoFT3), produced by Pichia pastoris, were characterized: rAoFT2 showed 1-FFT activity (producing nystose from 1-kestose), whereas rAoFT3 showed 1-SST activity (producing 1-kestose from sucrose). These reaction profiles of recombinant proteins were similar to those of native enzymes purified previously. These results indicate that aoft2 and aoft3 encoding 1-FFT and 1-SST are involved in fructan synthesis in roots. A gradual downregulation of fructosyltransferase genes and activity of respective enzymes was observed in roots during the harvest period, which also coincided with the decrease in fructooligosaccharides and increase in fructose due to fructan exohydrolase activity. These findings suggest that downregulation of fructosyltransferases genes during harvest time may contribute to efficient degradation of fructan required for the emergence of spears.

Knowledge and risk perception of radiation for Japanese nursing students after the Fukushima Nuclear Power Plant disaster.

BACKGROUND: The Japanese have had three experiences of radiation disasters: the atomic bombs dropped on Hiroshima and Nagasaki in 1945, and the 2011 Fukushima Nuclear Power Plant disaster. The former two experiences have been covered in compulsory education programs. In light of these incidents, a strong fear of radiation has pervaded people of several generations. In such a situation, the role of nurses is important. When nurses treat residents, their attitudes change depending on how they understand and feel about radiation. The foundations of these attitudes are formed through student education. Hence, it is necessary to explore nursing students' understanding and risk perception of radiation, and the nature of radiation education received. OBJECTIVES: To assess the levels of understanding and risk perception of nursing students regarding radiation. DESIGN: Cross-sectional survey. METHODS: A questionnaire survey was administered to all students (74 first-year, 79 second-year, 65 third-year, and 69 fourth-year students) in the nursing department of a Japanese national university. The response rate was 84%. Respondents were asked to rate their level of understanding of 50 phrases chosen from two supplementary texts about radiation for elementary school students and for middle and high school students, prepared by the Japanese Ministry. Further, they were asked to rate their risk perception for 30 events, and to answer six questions about radiation. RESULTS: It was found that knowledge about radiation among Japanese nursing students was poor, because sufficient radiation education had not been provided. Hence, they displayed a greater fear of X-rays as compared to American students and members of the League of Woman Voters. However, it was also found that an increase in understanding might decrease risk perception. CONCLUSIONS: It was concluded that nursing students require adequate education about radiation, in order to reduce their fear of X-rays and to mitigate their risk perception.

Toxicological significance of increased serum alkaline phosphatase activity in dog studies of pesticides: Analysis of toxicological data evaluated in Japan.

Increased serum alkaline phosphatase (ALP) activity is an indicator of hepatobiliary damage in humans and experimental animals. Practically, increased ALP accompanied by no other hepatotoxic changes is often encountered in toxicity studies of pesticides in dogs. Here, we analyzed the toxicological significance of increased ALP in response to 206 pesticides evaluated by the Food Safety Commission of Japan as toxicological evaluation reports in their risk assessment process. Our analysis indicated that increased ALP was more frequent in dogs (108/206) than in rats (36/206). In 87 of 108 pesticides, increased ALP was observed with hepatotoxicity in dogs. However, increased ALP had no specific relationship with certain types of hepatotoxicity and was not a sensitive marker of hepatotoxicity. Approximately 50% of 87 pesticides showing hepatotoxicity also induced liver hypertrophy. No hepatotoxic changes were seen with the remaining 21 pesticides, other than increases in liver weight and/or liver hypertrophy. Most of these 21 pesticides were phenobarbital-like liver metabolism enzyme inducers in rodents. These results suggested that increased ALP was not an indicator of hepatotoxicity in dogs if hepatotoxic findings were absent. This analysis provided a new interpretation of the toxicological significance of ALP in dogs and could contribute to toxicological evaluation of pesticides.

Comparison of radiation risk perception and knowledge of radiation between Indonesian and Japanese dental students.

The purpose of the study was to obtain basic data to identify problems in radiation education in a situation where confidence in nuclear power has fluctuated over time and fear of nuclear power has increased globally due to nuclear power plant disasters at Chernobyl and Fukushima. We conducted a questionnaire survey on understanding and risk perception of radiation and atomic power, before and after lectures, for 107 Japanese and 137 Indonesian dental students. Thirty-six phrases were extracted from two supplementary texts about radiation created by the Japanese Ministry of Education, Culture, Sports, Science and Technology, and 30 events commonly used in research on risk perception were used. The students were asked to rate their level of understanding of 36 phrases and risk perception of 30 events. Moreover, the students were asked to answer 6 general questions about radiation. For Japanese students, understanding of radiation increased and risk perception for both nuclear power and X-rays decreased after lectures (p < 0.05). Concerning nuclear power, the risk-value declined as the level of understanding increased (p < 0.01). However, for Indonesian students, who had lectures on only radiation excluding nuclear power in dental radiology, risk perception increased for X-ray after lectures (p < 0.05). This indicates that thought and custom, in the absence of knowledge, are influenced by lectures. In general, it is said that increase in knowledge will lower risk perception, but even if radiation education is imparted, risk perception may rise if the lectures are not understood properly. It was concluded that educators need to incorporate sufficient knowledge in their teachings, and correct thinking, to mitigate the risk of future radiation education giving the opposite of the intended effect.

Principles of the magnetic resonance imaging movie method for articulatory movement.

Magnetic resonance imaging (MRI) has become a critical tool for dental examination. MRI has many advantages over radiographic examination methods, including the lack of a requirement for patient exposure and the ability to capture high-contrast images of various tissue and organ types. However, MRI also has several limitations, including long examination times and the existence of metallic or motion artifacts. A cardiac imaging method using cine sequences was developed in the 1990s. This technique allows for analysis of heart movement and functional blood flow. Moreover, this method has been applied in dentistry. Recent research involving 3 T MRI has led to the achievement of a temporal resolution of < 10 ms, surpassing the frame rate of typical video recording. The current review introduces the history and principles of the cine sequence method and its application to the oral and maxillofacial regions.

Purification, characterization, and functional analysis of a novel 6G&1-FEH mainly hydrolyzing neokestose from asparagus.

Asparagus (Asparagus officinalis L.) accumulates inulin- and inulin neoseries-type fructans. Fructose released by the hydrolysis of fructans is an energy source for emerging asparagus spears. Plant fructans are hydrolyzed by fructan exohydrolases (FEHs), whose presence in asparagus has not yet been fully characterized. Here, we describe for the first time the purification and characterization of an FEH from asparagus, and the functional analysis of its gene. The purified enzyme was predicted to exist as a dimer (approximately 130 kDa) consisting of two polypeptides with a molecular mass of approximately 68 kDa. N-terminal sequences of the purified enzyme were matched with the amino acid sequences of aoeh4a and aoeh4b cDNAs isolated from asparagus (cv. Gijnlim and Taihouwase). Native enzymes obtained from asparagus roots and recombinant enzymes produced by Pichia pastoris showed fructan 1-exohydrolase (1-FEH) activity via the hydrolysis of inulin-type fructan. Unlike other 1-FEHs, these enzymes showed minimal hydrolysis of 1-kestose but efficiently hydrolyzed neokestose. Therefore, the enzyme was termed 6G&1-FEH. Gene expression studies in asparagus roots showed that aoeh4 increased during root storage at 2 °C and spear harvesting. These findings suggest that 6G&1-FEH may be involved in fructan hydrolysis in asparagus roots to provide an energy source for emerging asparagus spears.

Morphological and immunohistochemical diversity of endometrial stromal sarcoma in rats.

To clarify the histopathological characteristics of rat endometrial stromal sarcoma (ESS), we morphologically reviewed 12 malignant uterine tumors protruding into the lumen in previous rat carcinogenicity studies. The 12 cases were classified into the following 6 types based on their morphological features: spindle cell and collagen rich type, pleomorphic/spindle cell and compact type, decidual alteration type, histiocytic and multinucleated giant cell mixture type, Antoni A-type schwannoma type, and Antoni B-type schwannoma type. Immunohistochemically, tumor cells in all cases exhibited focal or diffuse positive reactions for vimentin, and 11 of the 12 cases were positive for S-100. Interestingly, 9 cases were positive for desmin or αSMA, indicating tumor cells expressing smooth muscle properties. Both Antoni A- and B-type schwannoma types showed low reactions for both muscle markers. Positive results for estrogen receptor α in the 11 cases suggested that they were derived from endometrial stromal cells. On the basis of their immunohistochemical profiles, they were considered to be derived from endometrial stromal cells while they showed morphological variation. The detection of a basement membrane surrounding tumor cells might not be a definitive indicator for differential diagnosis of ESS from malignant schwannoma. In conclusion, ESS could exhibit wide morphological and immunohistochemical variation including features of schwannoma or smooth muscle tumor.

In Silico Prediction of Chemical-Induced Hepatocellular Hypertrophy Using Molecular Descriptors.

In silico prediction for toxicity of chemicals is required to reduce cost, time, and animal testing. However, predicting hepatocellular hypertrophy, which often affects the derivation of the No-Observed-Adverse-Effect Level in repeated dose toxicity studies, is difficult because pathological findings are diverse, mechanisms are largely unknown, and a wide variety of chemical structures exists. Therefore, a method for predicting the hepatocellular hypertrophy of diverse chemicals without complete understanding of their mechanisms is necessary. In this study, we developed predictive classification models of hepatocellular hypertrophy using machine learning-specifically, deep learning, random forest, and support vector machine. We extracted hepatocellular hypertrophy data on rats from 2 toxicological databases, our original database developed from risk assessment reports such as pesticides, and the Hazard Evaluation Support System Integrated Platform. Then, we constructed prediction models based on molecular descriptors and evaluated their performance using independent test chemicals datasets, which differed from the training chemicals datasets. Further, we defined the applicability domain (AD), which generally limits the application for chemicals, as structurally similar to the training chemicals dataset. The best model was found to be the support vector machine model using the Hazard Evaluation Support System Integrated Platform dataset, which was trained with 251 chemicals and predicted 214 test chemicals inside the applicability domain. It afforded a prediction accuracy of 0.76, sensitivity of 0.90, and area under the curve of 0.81. These in silico predictive classification models could be reliable tools for hepatocellular hypertrophy assessments and can facilitate the development of in silico models for toxicity prediction.

Dental students' levels of understanding normal panoramic anatomy.

BACKGROUND/PURPOSE: In dentistry, panoramic radiography is an important examination technique. The Faculty of Dentistry at Tokushima University educates students about panoramic radiographic anatomical landmarks. The purpose of this study was to investigate differences in the understanding of each panoramic anatomical landmark among students. MATERIALS AND METHODS: This study analyzed the results of 40 fifth- and 79 sixth-year faculty students who had taken a written examination to clarify their knowledge of anatomical landmarks in 28 panoramic radiographic regions. Anatomical landmarks were classified into 3 categories: , , and  to compare correct answer rates. RESULTS: The mean overall correct answer rate by the 119 students for the 28 regions was 53%. The rate did not vary between the 2 academic years. On comparison of the 3 categories, significant differences were only observed between  and , as the values for the latter were lower. Among the anatomical landmarks, the rates for the condylar head, hyoid bone, panoramic innominate line, styloid process, and nasopalatine line were higher, and those for ghost images of the contralateral nasopalatine line, the cervical vertebrae, mandibular foramen, mastoid air cell, and posterior pharyngeal wall were lower. The values for , such as the dorsum of tongue, middle and inferior nasal conche, and middle and inferior nasal meatuses, were also lower. CONCLUSION: These results indicate the necessity of improving educational approaches for regions with lower rates of correct answers.