Job shadowing for early undergraduate dental students: Evaluation and validation of educational effectiveness using structural equation modelling.

INTRODUCTION: This study aimed to evaluate and validate the educational effectiveness of a job shadowing class as a dental teaching programme for preclinical dental students through a questionnaire that assessed related student perceptions. MATERIALS AND METHODS: A total of 124 preclinical (second year) dental students at Tokushima University participated in job shadowing placements from 2017 to 2019. Each student observed dental practice or surgery for 1 day in the university hospital. After shadowing, the students were requested to fill out a nine-item questionnaire based on a five-point scale. The first analysis was performed to calculate the correlation for each item. Furthermore, regression analysis for the categorical data was performed to show the relationship between eight questions (Items 1-8) and one question (Item 9: comprehensive evaluation). Next, factor analysis was performed to determine students' perceptions regarding the shadowing class. RESULTS: Ninety-eight students (response rate: 79%) completed the questionnaire. There was a strong relationship amongst Items 1, 8 and 9 ("interested in dentistry as a job," "learning motivation" and "comprehensive evaluation" respectively) based on the results of the correlation and regression analysis. The factor analysis led to three student perceptions as latent factors, namely, "Interesting," "Self-awareness" and "Future Goal," which had a relatively close inter-factor correlation (0.465-0.772). CONCLUSION: The finding suggests that job shadowing may increase a students' interest in a dentistry career at an early stage of their education and learning motivation, along with generating self-awareness. This programme may present possible educational effectiveness in dental education.

Safety evaluation of substituting clopidogrel for ticlopidine in Japanese patients with ischemic stroke--Hiroshima ticlopidine, clopidogrel safe exchange trial.

BACKGROUND: Clopidogrel is sometimes substituted for ticlopidine when cerebrovascular or cardiovascular patients develop hematologic abnormalities after ticlopidine treatment. However, the adverse event rate after the substitution to clopidogrel remains undetermined. Therefore, in this study, we aimed to define the risk of adverse events after substituting clopidogrel for ticlopidine without a washout period. METHODS: We prospectively enrolled patients older than 20 years who had a history of noncardioembolic strokes, including transient ischemic attacks, were treated with ticlopidine for at least 6 months. This study was conducted from August 26, 2008, when the first patient was enrolled, to January 16, 2012, the date of the last patient examination, at 8 active stroke centers in Hiroshima, Japan. We excluded patients who had severe disabilities, evidence of cardioembolic stroke, or history of a bleeding event. Each patient received clopidogrel (either 50 mg or 75 mg) once a day in place of ticlopidine without a washout period. Follow-up exams were scheduled within 12 months after the medication substitution. The primary end point of this study was adverse events of interest, including clinically significant reduced blood cell counts, hepatic dysfunction, bleeding, and other serious side effects. RESULTS: In this study, 110 patients were enrolled and analyzed in an intent-to-treat manner (modified intent to treat). Within the scheduled follow-up periods, 9 primary end point events were observed in separate patients. The primary end point events were observed at a rate of 8.4% per year (Kaplan-Meier method). At the time of enrolment, 16 patients met the exclusion criteria, of which 8 recovered from their abnormal hematologic results to the institutional normal limit after the substitution of ticlopidine for clopidogrel (57.4% per year). CONCLUSIONS: The adverse event rates after the substitution of ticlopidine for clopidogrel is similar to the adverse event rates of patients who were initially treated with clopidogrel. The substitution of clopidogrel for ticlopidine should be considered for patients who develop hematologic abnormalities from ticlopidine treatment.

A Simple Method to Estimate the Trajectory to the Genu of the Corpus Callosum in the Interhemispheric Approach for Distal Anterior Cerebral Artery Aneurysms.

In the interhemispheric approach (IHA) for the distal anterior cerebral artery (DACA) aneurysms, the surgical trajectory to a DACA aneurysm is very important because surgeons sometimes encounter the intraoperative disorientation and the premature rupture. The purpose of this study was to clarify the anatomical landmarks indicating the trajectory to the genu of the corpus callosum (GCC) at the early stage of dissection for the correct intraoperative orientation. "Point A" was defined as the crossing point between the frontal bone and the line connecting the projected external acoustic opening (EAO) and the GCC on the midline slice of the sagittal three-dimensional computed tomography angiography (3D-CTA) images. We measured the distance from the nasion to Point A using midline sagittal slice images from 50 patients who underwent 3D-CTA at our institution. The average distance was 7.0 cm (±0.3 cm). Therefore, the direction of the spatula inserted in the direction of the EAO from Point A (7 cm above the nasion) corresponds to the trajectory to the GCC. In DACA aneurysms of the A3 segment, the pericallosal artery distal to the aneurysm can be safely identified by dissecting the interhemispheric fissure distal to the trajectory to the GCC. In DACA aneurysms of the A4 or A5 segment, the parent artery of the aneurysm can be safely identified by dissection along the trajectory to the GCC. Point A and the EAO can be used as landmarks indicating the trajectory to the GCC for the correct intraoperative orientation in the IHA for DACA aneurysms.

Morphological Analysis of the Sylvian Fissure Stem to Guide a Safe Trans-sylvian Fissure Approach.

The sylvian fissure stem and its deep cisternal part (SDCP) consist mainly of the orbital gyrus (OG) and anterior medial portion of the temporal lobe. SDCP's adhesion has been found to make a trans-sylvian approach difficult due to the various patterns of adhesion. Thus, in this study, we aim to clarify the morphological features of the SDCP, and to guide a safe trans-sylvian approach. We retrospectively classified the morphology of the SDCP in 81 patients into 3 types (tight, moderate, loose type) according to the degree of adhesion of the arachnoid membrane and analyzed the morphological features of the OG and the temporal lobe using intraoperative video images. In addition, we have retrospectively measured each width of the SDCP's subarachnoid space at the three points (Point A, lateral superior portion; Point B, downward portion; Point C, medial inferior portion of SDCP) and analyzed their relationship to the degree of adhesion using the preoperative coronal three-dimensional computed tomography angiography (3D-CTA) images of 44 patients. As per the results, SDCP's adhesions were determined to be significantly tighter in cases with large OG and young cases. The temporal lobe had four surfaces (posterior, middle, anterior, and medial) that adhered to the OG in various patterns. The tighter the adhesion between the OG and each of the three distal surfaces of the temporal lobe, the narrower the width of the subarachnoid space at each point (A, B, C). Understanding of the morphological features of the SDCP, and estimating its adhesion preoperatively are useful in developing a surgical strategy and obtaining correct intraoperative orientation in the trans-sylvian approach.

Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein.

The superficial middle cerebral vein (SMCV) is one of the main factors that can impede a wide opening of the sylvian fissure. To reveal the most efficient SMCV dissection for a wide operative field while preserving the veins in the trans-sylvian approach, we retrospectively investigated the SMCVs through intraoperative video images. We characterized the SMCV as composed of the frontosylvian trunk (FST; receiving frontosylvian veins [FSVs] or parietosylvian veins [PSVs]), the temporosylvian trunk (TST; receiving temporosylvian veins [TSVs]), and the superficial middle cerebral common trunk (SMCCT; receiving both FSV/PSV and TSV), and classified the SMCVs of the 116 patients into 5 types based on the morphological classification of the SMCV. Type A SMCV (60.4%) with the SMCCT anastomosed to the frontal side had few bridging veins (BVs) between the SMCCT and the temporal side during dissection. Type B (7.8%) had the SMCCT with no anastomoses to the frontal side. In Type C (17.2%) consisting of the FST and TST and Type D (12.9%) with a merging of the vein of Trolard and Labbé posteriorly and the SMCVs dividing into the FST and the TST again proximally, there were few BVs between the FST and the TST during dissection. Finally, in Type E (1.7%) showing an undeveloped SMCV, there were no BVs between the frontal and the temporal lobes. Postoperative venous infarction occurred in 2.6%. Morphological classification of the SMCV can inform appropriate dissection line to create a wide operative field while preserving the veins in the trans-sylvian approach.

[Regional medical support by management of Percutaneous Endoscopic Gastrostomy(PEG)].

Percutaneous endoscopic gastrostomy(PEG)is useful for not only enteral nutrition but an early rehabilitation of oral intake. We perform PEG and rehabilitation consistently, and we also exchange a catheter after the patient is discharged from our hospital. Most patients undergo changing a PEG catheter at our hospital. So we can follow them for a long-term. There are four techniques to exchange a PEG catheter. We performed exchanging a catheter for 156 patients. There were no major complications to the patients. Merit of the first method, sky-blue method, is that we could change by bed side with almost no invasion. However, we could not get an image of a catheter in the stomach. By the second method, fluoroscopy, we could make an exact image, but a patient had little invasion of moving to an X-ray room, accepting contrast medium, and having Xray exposure. The third method, oral endoscopy, is most reliable for a confirmation of a catheter, but it is most invasive. The fourth method, battery type endoscopy, is less invasive than the third method. We could change a catheter by bed side and use an endoscope as a guiding introducer, and get an image of inside the stomach. We need an imaging diagnosis for getting a confirmation. A battery type endoscopy, which is easily manipulated, is expected to be widely used both in the hospital care and the home nursing care.

Development of clinical application for a nutritional prescription support system for total parenteral/enteral nutrition.

One of the important roles of pharmacists as members of a nutrition support team is nutritional prescription support. We developed a nutritional prescription support system (NPSS) that facilitates prescription support and analysis and evaluated its usefulness in nutritional therapy. An NPSS for prescription support and the management of patient information was created. With this NPSS, the nutritional status was assessed, and, on the basis of the results, such variables as the total energy expenditure were calculated. This system allows prescription support for parenteral nutrition (PN) therapy, enteral nutrition (EN) therapy, and the transition period between them. This system was used for 2 representative patients and evaluated. In a malnourished patient receiving oral warfarin, EN solutions were compared by means of the NPSS, and an appropriate EN solution was selected. In addition, the prothrombin time-international normalized ratio was monitored, and favorable results were obtained regarding the adjustment of the warfarin dose and nutritional management. In a patient with aspiration pneumonia, continuous nutritional management to EN from PN therapy was straightforwardly performed with the NPSS. This NPSS allows rapid, comprehensive nutritional management during the transition period to EN from PN therapy, despite these therapies being considered separately in conventional nutritional management. The NPSS is useful for simplifying prescription support and facilitating information sharing among members of a nutrition support team.

Local administration of calcitonin inhibits alveolar bone loss in an experimental periodontitis in rats.

Calcitonin (CTN), a calcium regulatory hormone, promotes calcium diuresis from the kidney and suppresses bone resorption. The objective of this study was to evaluate whether the topical and intermittent application of CTN inhibits alveolar bone resorption using ligature-induced experimental periodontitis in rats. Experimental periodontitis was induced by placing a nylon ligature around maxillary molars of 8-week-old male Wistar rats for 20 days. Thirty-two rats were divided into four groups: basal sham control group, periodontitis group, periodontitis plus 0.2 U CTN (low dose), and periodontitis plus 1.0 U CTN (high dose) group. To investigate the effects of CTN on alveolar bone resorption, CTN was topically injected into the palatal gingivae every 2 days after ligature removal (day 0). Micro-computed tomography (CT) analysis was performed for linear parameter assessment of alveolar bone on day 5 and day 14. Periodontal tissues were examined histo-pathologically to assess the differences among the study groups. Micro-CT images showed that alveolar bone resorption was induced statistically around the molar of ligatured rats on day 5 and day 14. The amount of bone resorption was more severe on day 14 than that on day 5. On day 5, only high-dose CTN treatment significantly suppressed bone resorption. In addition, both doses of CTN significantly suppressed bone resorption on day 14. Histological examination clarified that there were fewer TRAP-positive cells in the CTN treatment groups than in the periodontitis group on day 5. Local administration of CTN decreased alveolar bone resorption by regulating osteoclast activation in rats with periodontitis.

[Symmetrical bilateral epidural hematoma after head injury in the mid parietooccipital region: case report].

The authors presented a patient with acute symmetrical bilateral epidural hematomas, which are rare but life threatening. A 72-year-old male accidentally fell from the roof at a height of about 3 meters and hit his head against the ground. He was transferred to the emergency ward in our hospital. On admission, he was alert and had no neurological deficits. Skull X-ray film revealed a depressed fracture in the mid parietoocipital region and bilateral linear fractures extending from the parietal regions to the temporal regions. CT scan showed symmetrical bilateral epidural hematomas in the both parietotemporal regions. His consciousness deteriorated to be drowsiness about one hour after admission. An additional CT scan revealed enlargement of the both epidural hematomas and impending tentorial herniation. Therefore, an emergency operation was called for. For rapid decompression of the brain, bilateral craniotomies were carried out simultaneously by the two neurosurgeon-groups involved and bilateral epidural hematomas were also simultaneously removed. Injury of both of the middle meningeal arteries was revealed to be the cause of the bilateral epidural hematomas. Clinical course after operation was uneventful and the patient was discharged without any neurological deficit. Simultaneous bilateral craniotomies and removal of the epidural hematomas would have contributed to obtaining the good result in this patient.

Regulation of the physiological effects of peroxidovanadium(V) complexes by the electronic nature of ligands.

Although the physiological effects of peroxidovanadium(V) complexes (pVs) have been extensively investigated both in vitro and in vivo with regard to their pharmacological activity, such as insulin-mimetic and antitumor activities, the relationship between the chemical and pharmacological properties of pVs is still unclear. Rational drug design with pVs depends on a full understanding of this relationship. Toward this end, the current report evaluates the physiological effects of 13 pVs were evaluated bound to a variety of ligand. Six of these ligands are tripodal tetradentate ligands, one is a linear tetradentate ligand, one boasts two pendant groups, three are tridentate ligands, and two are alkoxido-bridging, dinucleating ligands. The cytotoxicities of these pVs could be classified into three groups: significantly toxic, moderately toxic, and non- or negligibly toxic. Further, IC50 values could be related with the LMCT transition energies of the peroxido group, particularly among complexes with similar ligands. This relation indicates that the electronic properties of the peroxido group affected the physiological activity of the pV complex. We also investigated the insulin-signaling intensity of each pV. Phosphorylation of protein kinase B and extracellular signal-regulated kinase 1/2, two major insulin-signaling proteins, was observed after treating cells with pV for 30 min. Phosphorylation was particularly remarkable for complexes that exhibited high cytotoxicity. The present results demonstrate that the toxicity and physiological effects of pVs can be controlled by selecting an appropriate ancillary ligand. These findings provide a guide for synthesis of new pVs that may be used as candidate therapeutic agents.

Survival of geriatric patients after percutaneous endoscopic gastrostomy in Japan.

AIM: To examine the long term survival of geriatric patients treated with percutaneous endoscopic gastrostomy (PEG) in Japan. METHODS: We retrospectively included 46 Japanese community and tertiary hospitals to investigate 931 consecutive geriatric patients (≥ 65 years old) with swallowing difficulty and newly performed PEG between Jan 1st 2005 and Dec 31st 2008. We set death as an outcome and explored the associations among patient's characteristics at PEG using log-rank tests and Cox proportional hazard models. RESULTS: Nine hundred and thirty one patients were followed up for a median of 468 d. A total of 502 deaths were observed (mortality 53%). However, 99%, 95%, 88%, 75% and 66% of 931 patients survived more than 7, 30, 60 d, a half year and one year, respectively. In addition, 50% and 25% of the patients survived 753 and 1647 d, respectively. Eight deaths were considered as PEG-related, and were associated with lower serum albumin levels (P = 0.002). On the other hand, among 28 surviving patients (6.5%), PEG was removed. In a multivariate hazard model, older age [hazard ratio (HR), 1.02; 95% confidence interval (CI), 1.00-1.03; P = 0.009], higher C-reactive protein (HR, 1.04; 95% CI: 1.01-1.07; P = 0.005), and higher blood urea nitrogen (HR, 1.01; 95% CI: 1.00-1.02; P = 0.003) were significant poor prognostic factors, whereas higher albumin (HR, 0.67; 95% CI: 0.52-0.85; P = 0.001), female gender (HR, 0.60; 95% CI: 0.48-0.75; P < 0.001) and no previous history of ischemic heart disease (HR, 0.69; 95% CI: 0.54-0.88, P = 0.003) were markedly better prognostic factors. CONCLUSION: These results suggest that more than half of geriatric patients with PEG may survive longer than 2 years. The analysis elucidated prognostic factors.

Mononuclear and dinuclear monoperoxovanadium(v) complexes with a hetero ligand. 1.(1) Self-decomposition reaction, detection of reactive oxygen species, and oxidizing ability.

A mononuclear peroxovanadium(V) complex with histamine-N,N-diacetate (histada), K[VO(O(2))(histada)], and a dinuclear peroxovanadium(V) complex with 2-oxo-1,3-diaminopropane-N,N,N',N'-tetraacetate (dpot), Cs(3)[(VO)(2)(O(2))(2)(dpot)], were prepared and characterized. The self-decomposition reaction was examined for these peroxovanadium(V) complexes as well as for K[VO(O(2))(cmhist)] (cmhist = N-carboxymethylhistidinate). The reaction profiles depicted by the absorbance change in the UV-vis spectrum show a sigmoid shape with an induction period. The induction period is reduced by the addition of acid, fluoride, thiocyanate, VO(2+), VO(2)(+), and trolox compared to the solution containing perchlorate. On the other hand, the induction period was elongated by the addition of chloride, bromide, and 2-tert-butyl-p-cresol. These behaviors are discussed on the basis of a radical chain mechanism. The self-decomposition reactions have also been followed by the (1)H and (51)V NMR and EPR spectra. These spectral studies as well as the UV-vis spectral study indicate that vanadium(V) is partly reduced to vanadium(IV) in the self-decomposition process. The histada complex yields a mixed-valence dinuclear complex in a concentrated solution, and the dpot complex yields a mixed-valence tetranuclear complex. The reduction of vanadium ion suggests that the peroxo ligand may act as a reducing agent. In order to know the fate of the peroxo ligand, we tried to detect superoxide anion and hydroxyl radical, which were anticipated to be produced in the self-decomposition process. The formation of superoxide anion was spectrophotometrically confirmed using two independent methods, including the reduction of cytochrome c and the reduction of sodium 4-[3-(iodophenyl)-2-(4-nitrophenyl)-2H-5-tetrazolio]-1,3-benzene disulfonate (WST-1). The formation of hydroxyl radical was confirmed by an EPR spin trapping technique. The oxidizing abilities of the peroxovanadium(V) complexes toward bovine serum albumin (BSA) were also evaluated. In the protein carbonyl assay, it was found that the total amount of protein carbonyl in BSA was increased by the reaction with the peroxovanadium complexes in the concentration-dependent manner. In addition, the oxidation of sulfhydryl group in BSA induced by the peroxovanadium complexes was confirmed.