How school life with international students develops the intercultural competence of domestic dental students.

INTRODUCTION: Reflecting multicultural society, the diversity of the healthcare professional students' ethnicities and cultures is promoted around the world. However, most of the healthcare professional education in Japan had been targeted mainly at students who follow the Japanese language and culture. The aim of this study is to clarify what Japanese dental students have culturally experienced and how they developed intercultural competence during their school life with international dental students in Japan. MATERIALS AND METHODS: We conducted semi-structured interviews with 18 of the sixth-grade students in standard Japanese undergraduate dental programmes who shared required classes in Japan with non-Japanese-speaking international dental students in preclinical programmes. Based on the qualitative analysis of the interviews, we administered a questionnaire survey to 82 dental trainees (the seventh grade) in clinical training programmes who just graduated from various Japanese dental schools. Then, the answers of the questionnaire were statically analysed. RESULTS: The interview identified a total of 37 constituent elements regarding "students' attitudes and experiences in school days" and "perceptions and motivations." Analysis of the questionnaire showed that the group experiencing a learning environment with international students had various communication with and respect for their various classmates and had the ambition to develop themselves. Especially, the participants who had international experiences both in and out of classrooms showed more active attitude on intercultural communication. CONCLUSIONS: Overall, for Japanese dental students, daily contact with international students gave direct and indirect cross-cultural experiences and recognitions. In particular, the Japanese students were stimulated active perceptions. The findings of this study can be used for future discussion about the cross-cultural education and collaboration of healthcare professionals not only within Japan but also around the world.

Rapid detection of the Streptococcus mutans cnm gene by loop-mediated isothermal amplification.

This study investigated a method using loop-mediated isothermal amplification (LAMP) for the rapid detection of cnm-positive Streptococcus mutans (S. mutans) associated with cerebral microhemorrhage. LAMP amplified the cnm gene plasmid vector, but not human or microbial genomic DNA. The cnm DNA of the cnm-positive S. mutans strain was detected in saliva without DNA extraction after 1 day of culture. This method resulted in a cnm-positive rate of 26.4% in 102 samples, which was higher than that obtained with conventional PCR. In conclusion, LAMP may be used for the detection of cnm-positive S. mutans in a large number of samples.

Carbon monoxide-releasing molecule, CORM-3, modulates alveolar macrophage M1/M2 phenotype in vitro.

Alveolar macrophages are key contributors to both the promotion and resolution of inflammation in the lung and are categorized into pro-inflammatory (M1) and anti-inflammatory (M2) phenotypes. The change in M1/M2 balance has been reported in various pulmonary diseases and is a target for therapeutic intervention. The aim of this study was to assess the modulation of M1/M2 phenotype in alveolar macrophages by water-soluble carbon monoxide-releasing molecule-3 (CORM-3). Rat alveolar macrophages (AM) (NR8383) in culture were stimulated with LPS (5 ng/ml)/IFN-γ (10 U/ml) or IL-4 (10 ng/ml)/IL-13 (10 ng/ml) to induce M1 and M2 phenotypes, respectively. Expression of M1 phenotype markers, iNOS and TNF-α, and M2 phenotype markers, CD206 and Ym-1, was assessed by western blotting after 1, 3, 6, or 24 h in the absence or presence of CORM-3 (0.15 mM) treatment. Inactive CORM-3 (iCORM-3) was used as a control. Treatment of naïve (unstimulated) AM with CORM-3 promoted progression of the M2 phenotype as evidenced by the increased expression of CD206 (at 1 h; 1.8-fold) and Ym-1 (at 3 h; 1.9-fold), respectively. Surprisingly, CORM-3 treatment also upregulated the expression of iNOS protein as assessed 6 h following stimulation of AM with CORM-3 (2.6-fold). On the contrary, CORM-3 effectively reduced LPS/IFN-γ-induced expression of iNOS protein (0.6-fold); however, it had no effect on TNF-α expression. Finally, CORM-3 acutely (1-3 h) upregulated CD206 (1.4-fold) and Ym-1 (1.6-fold) levels in IL-4-/IL-13-treated (M2-stimulus) macrophages. These findings indicate that CORM-3 modulates macrophage M1 and M2 phenotypes in vitro with respect to continuous suppression of iNOS expression in M1-polarized macrophages and transient (early-phase) upregulation of CD206 and Ym-1 proteins in M2-polarized macrophages.

Pirfenidone suppresses polarization to M2 phenotype macrophages and the fibrogenic activity of rat lung fibroblasts.

Pirfenidone is a representative medication to treat interstitial pulmonary fibrosis. Researchers reported pirfenidone (>100 µg/ml) significantly suppressed fibroblast growth in vitro. However, clinically, the maximum concentration of pirfenidone in the blood is approximately 10 µg/ml. We hypothesized there might be an additional mechanism of pirfenidone to fibroblasts indirectly. Macrophages are known to control the activation of fibroblasts via the regulation of inflammatory M1 and suppressive M2 polarization. The aim of this study was to investigate the effects of pirfenidone on alveolar macrophage polarization. Rat alveolar macrophages (NR8383) were stimulated in vitro with lipopolysaccharide (LPS) + interferon (IFN)-γ, or interleukin (IL)-4 + IL-13. Expression of M1 and M2 markers and supernatant's levels of TGF-ß1 were assessed after pirfenidone treatment (0-100 µg/ml). Treatment with LPS + INF-γ or IL-4 + IL-13 significantly increased the expression of M1 and M2 markers, respectively. In macrophage polarization assays, pirfenidone significantly reduced the expression of M2 markers at concentrations greater than 10 µg/ml but had no effect on the expression of M1 markers. At these concentrations, pirfenidone significantly reduced TGF-ß1 levels in NR8383 culture supernatants. In rat lung fibroblasts treated with NR8383 culture supernatants, pirfenidone significantly suppressed proliferation, and the collagen mRNA and protein levels. In conclusion, our results demonstrated that pirfenidone suppressed polarization to M2 macrophages at clinically relevant concentrations and suppressed the rat lung fibroblasts fibrogenic activity.

A proposed core curriculum for dental English education in Japan.

BACKGROUND: Globalization of the professions has become a necessity among schools and universities across the world. It has affected the medical and dental professions in terms of curriculum design and student and patient needs. In Japan, where medicine and dentistry are taught mainly in the Japanese language, profession-based courses in English, known as Medical English and Dental English, have been integrated into the existing curriculum among its 83 medical and 29 dental schools. Unfortunately, there is neither a core curriculum nor a model syllabus for these courses. METHODS: This report is based on a survey, two discussion forums, a workshop, and finally, the drafting of a proposed core curriculum for dental English approved by consensus of the participants from each university. RESULTS: The core curriculum covers the theoretical aspects, including dental English terms and oral pathologies; and practical aspects, including blended learning and dentist-patient communication. It is divided into modules and is recommended to be offered for at least two semesters. CONCLUSIONS: The core curriculum is expected to guide curriculum developers in schools where dental English courses are yet to be offered or are still in their early development. It may also serve as a model curriculum to medical and dental schools in countries in Asia, Europe, Africa, and Central and South America, where English is not the medium of instruction.

Characteristics of dental materials in the oral cavities of Asian individuals between their 20s and early 40s living temporarily in Japan based on 38 case studies.

Characterization of materials used in dental restorations and fixed prostheses is useful for personal identification. This study investigated the dental treatment trends and use of metal materials among non-Japanese Asian temporary residents and Japanese individuals aged from 20 to 40 years living in a city in Japan. Analysis of 38 participants from different Asian countries showed prominent use of resin fillings, with metal element analysis revealing nickel-chromium (Ni-Cr) or cobalt-chromium (Co-Cr) alloys. Among five Japanese participants of the same age with dental metal treatment scars, resin fillings and silver-palladium-copper-gold (Ag-Pd-Cu-Au) or silver-indium (Ag-In) alloys were observed. This study suggested some regional differences in dental material choices in Asia.

Metal component of dental restorations and fixed prostheses in the oral cavity of 43 cases of adults aged 55 years or older in forensic autopsy.

Characterization of the metal component of dental restorations and fixed prostheses is useful for the treatment of dental metal allergies and personal identification. This study aimed to describe the composition of metal elements in dental restorations and fixed prostheses in the oral cavity of 43 cadavers of Japanese adults aged 55 years or older in forensic autopsies conducted at a university. In this study, Ag-Pd-Au alloys were most frequently detected, and the percentage of Ni alloys was smaller than that reported in patients with dental metal allergies. Furthermore, alloys containing other elements, such as Fe or Hg, were also detected in some cases.

Hepatocellular carcinoma in Child-Pugh C cirrhosis: prognostic factors and survival benefit of nontransplant treatments.

A retrospective multicenter study was conducted to clarify the survival benefit of nontransplant treatments for patients with hepatocellular carcinoma (HCC) associated with Child-Pugh C cirrhosis. Data on 436 patients, including 203 treated patients with HCC, were collected from 20 institutions in Japan. Cox's proportional hazards model corrected for bias by propensity score analysis clearly showed the following as significant independent prognostic factors, including all four nontransplant treatments examined: transarterial chemoembolization, hepatic arterial infusion chemotherapy, percutaneous ethanol injection therapy, radiofrequency ablation, hepatitis B virus, number of tumors, log α-fetoprotein, encephalopathy, ascites and prothrombin time. The cumulative survival rate was significantly higher in the treated group than in the untreated group. The present findings suggest that prognosis can be improved by nontransplant treatments in patients with low Child-Pugh scores. Since this study was retrospective, the possibility of selection bias cannot be ruled out. Therefore, verification by a prospective controlled study is warranted.

Intraoperative mechanical and chemical pleurodesis with 50 % glucose solution for secondary spontaneous pneumothorax in patients with pulmonary emphysema.

PURPOSE: Secondary spontaneous pneumothorax is life-threatening for patients with pulmonary emphysema. To prevent recurrence, intraoperative pleurodesis is performed in addition to bullectomy. We report the therapeutic process and effectiveness of adding mechanical plus chemical pleurodesis, with a 50 % glucose solution, to bullectomy, for patients with pulmonary emphysema-related pneumothorax. METHODS: The subjects were 20 patients (19 men and 1 woman; mean age 68 years) with pulmonary emphysema-related pneumothorax. After bullectomy was completed, 500 mL of a 50 % glucose solution was injected into the pleural cavity, followed by mechanical pleurodesis performed via ablation of the parietal pleura. RESULTS: The volume of pleural effusion decreased on postoperative day (POD) 1, and the temperature decreased on POD 2. The blood sugar levels increased on the day of surgery but decreased on POD 1. The mean postoperative follow-up period was 521 days. One patient died of pneumonia on POD 24. All other patients survived without pneumothorax recurrence. CONCLUSIONS: These results demonstrated the effectiveness of our treatment process for pulmonary emphysema-related pneumothorax. The fact that no patient experienced pneumothorax recurrence suggests that mechanical and chemical pleurodesis with 50 % glucose solution might be effective prophylaxis.

A case report of allergic reaction with acute facial swelling: a rare complication of dental acrylic resin.

Resin components, such as methyl methacrylate (MMA) can cause allergic contact dermatitis (ACD). Allergic reactions to resin are usually delayed. Only a few studies have reported dental resin allergy with acute symptoms. Here, a case of ACD with acute facial swelling after dental treatment using resin material is reported. A 55-year-old woman with a history of periungual inflammation when using gel nail polish had repeated episodes of facial swelling after dental treatment with resin material. The resin temporary crown was removed, and symptoms were alleviated with antihistamines and corticosteroids. With the suspicion of resin allergy, skin tests were performed. Patch testing revealed positive reactions to self-adhesive resin cement (primer and polymerized), self-curing acrylic resin (liquid and polymerized), 2-hydroxyethyl methacrylate (2-HEMA), and ethylene glycol dimethacrylate (EGDMA), whereas the prick test was negative for all allergens. Complement C4 and C1 inhibitor activity were reference values in the tests for hereditary angioedema. Based on these findings, the patient was diagnosed with ACD to 2-HEMA and EGDMA. Since diagnosis, no similar symptoms have been observed in subsequent dental treatment with non-resin materials. The use of dental resin materials may cause ACD with an acute reaction. This report alerts dentists who routinely use resin materials.

Dental radiographic information of term newborn babies within the first month: Analyzing five radiographic cases along with physical attributes in Japan.

BACKGROUND: Although dental radiography is a valuable tool for age estimation in forensic anthropology and odontology, very limited radiological data are available regarding tooth development in healthy newborn babies during the first month of life. AIM: This study aimed to describe the radiological findings of tooth development in babies aged 0 days to 1 month. DESIGN: We analyzed the postmortem findings of five newborn babies with no known natural cause of death who had undergone autopsy, computed tomography (CT), and dental radiography. We estimated the gestational age for the babies aged 0 days and analyzed the condition of mandibular symphysis, existence of tooth germs, and presence or absence of calcification of the first permanent molars of all the babies. RESULTS: The calcified form of 20 deciduous teeth, tooth germs of the permanent upper and lower first molars, and non-calcified mandibular symphysis were observed in each case. However, calcification of the first permanent molar was observed in only two 1-month-old babies. CONCLUSION: The dental radiographic findings and anthropometric measurements of non-skeletonized, non-mummified term babies confirmed calcification of all the deciduous teeth and the first permanent molar at the age of 0 days and 1 month, respectively.

Age estimation using post-mortem computed tomography and fetal dental radiographic findings in an early to mid-pregnancy fetus: A case report.

Parameters for body size growth are essential to evaluate the relationship between fetal growth and accurate age estimation in forensics. Size values measured postmortem are also affected by the postmortem environment. On the contrary, when using hard tissue maturation criteria, age estimation remains unaffected by the degree of fetal preservation. In Japan, a fetus dying 12 weeks after pregnancy must be reported as a stillbirth. A Japanese stillborn infant buried without reporting to the authorities underwent a forensic autopsy. The gestational age was 4-5 months, based on the mother's description. The body was not fixed, and it was macerated and flattened along the sagittal plane; therefore it was difficult to correctly measure indicators involving soft tissue. The bone size and tooth development were evaluated using postmortem computed tomography (CT) images and intraoral radiography to estimate the age. Considering all the information, including age estimation based on bone sizes referenced in a Japanese study, calcified upper central incisors, we estimated fetal gestational age for our sample as 14-17 gestational weeks finally. However, there were discrepancies between age estimations based on bone size (20-25 gestational weeks, bone radiographic imaging standards; or 4-6 gestational months, an average of the extremity-bones by a Japanese study) and tooth development (14-17 gestational weeks). Deep discussions based on multiple indices with professionals should be applied to forensic age estimation since existing methods may be based on data for different races, use other measurement tools, or apply different sample conditions even if the targets are the same.

Effect of vitamin K2 on the recurrence of hepatocellular carcinoma.

UNLABELLED: Hepatocellular carcinoma (HCC) is characterized by frequent recurrence, even after curative treatment. Vitamin K2, which has been reported to reduce HCC development, may be effective in preventing HCC recurrence. Patients who underwent curative ablation or resection of HCC were randomly assigned to receive placebo, 45 mg/day, or 90 mg/day vitamin K2 in double-blind fashion. HCC recurrence was surveyed every 12 weeks with dynamic computed tomography/magnetic resonance imaging, with HCC-specific tumor markers monitored every 4 weeks. The primary aim was to confirm the superiority of active drug to placebo concerning disease-free survival (DFS), and the secondary aim was to evaluate dose-response relationship. Disease occurrence and death from any cause were treated as events. Hazard ratios (HRs) for disease occurrence and death were calculated using a Cox proportional hazards model. Enrollment was commenced in March 2004. DFS was assessed in 548 patients, including 181 in the placebo group, 182 in the 45-mg/day group, and 185 in the 90-mg/day group. Disease occurrence or death was diagnosed in 58, 52, and 76 patients in the respective groups. The second interim analysis indicated that vitamin K2 did not prevent disease occurrence or death, with an HR of 1.150 (95% confidence interval: 0.843-1.570, one-sided; P=0.811) between the placebo and combined active-drug groups, and the study was discontinued in March 2007. CONCLUSION: Efficacy of vitamin K2 in suppressing HCC recurrence was not confirmed in this double-blind, randomized, placebo-controlled study.

Usefulness of a semi-quantitative procalcitonin test and the A-DROP Japanese prognostic scale for predicting mortality among adults hospitalized with community-acquired pneumonia.

BACKGROUND AND OBJECTIVE: The solid-phase immunoassay, semi-quantitative procalcitonin (PCT) test (B R A H M S PCT-Q) can be used to rapidly categorize PCT levels into four grades. However, the usefulness of this kit for determining the prognosis of adult patients with community-acquired pneumonia (CAP) is unclear. METHODS: A prospective study was conducted in two Japanese hospitals to evaluate the usefulness of this PCT test in determining the prognosis of adult patients with CAP. The accuracy of the age, dehydration, respiratory failure, orientation disturbance, pressure (A-DROP) scale proposed by the Japanese Respiratory Society for prediction of mortality due to CAP was also investigated. Hospitalized CAP patients (n = 226) were enrolled in the study. Comprehensive examinations were performed to determine PCT and CRP concentrations, disease severity based on the A-DROP, pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age ≥65 (CURB-65) scales and the causative pathogens. The usefulness of the biomarkers and prognostic scales for predicting each outcome were then examined. RESULTS: Twenty of the 170 eligible patients died. PCT levels were strongly positively correlated with PSI (ρ = 0.56, P < 0.0001), A-DROP (ρ = 0.61, P < 0.0001) and CURB-65 scores (ρ = 0.58, P < 0.0001). The areas under the receiver operating characteristic curves (95% CI) for prediction of survival, for CRP, PCT, A-DROP, CURB-65, and PSI were 0.54 (0.42-0.67), 0.80 (0.70-0.90), 0.88 (0.82-0.94), 0.88 (0.82-0.94), and 0.89 (0.85-0.94), respectively. The 30-day mortality among patients who were PCT-positive (≥0.5 ng/mL) was significantly higher than that among PCT-negative patients (log-rank test, P < 0.001). CONCLUSIONS: The semi-quantitative PCT test and the A-DROP scale were found to be useful for predicting mortality in adult patients with CAP.

[Stage IV primary lung cancer treated with lobectomy because of refractory ipsilateral pneumothorax].

A 76-year-old man with dyspnea and left side chest pain was admitted to our hospital. Chest roentgenogram showed a left side pneumothorax. Chest computed tomography( CT) showed a mass shadow in S3 and a nodular shadow in S10 of left lung. Drainage of the pleural cavity and a trans-bronchial biopsy was performed, and primary lung adenocarcinoma was diagnosed. Abdominal CT showed a left enlarged adrenal gland. Because pneumothorax was resistant to the treatment by closed drainage, a surgical treatment was performed. Since the main tumor of left upper lobe was adjacent to emphysematous bullae, simple bullectomy was not possible. Accordingly, left upper lobectomy, partial resection of left lower lobe and lymph node dissection were performed. Positron emission tomography( PET)-CT after surgery strongly suggested adrenal gland metastasis and the pathological stage Ⅳ was established in combination with the histopathological examination. Appropriate surgical approach must be considered even for case with the advanced lung cancer, like present case.

Some tips on age estimation using DNA methylation in saliva samples as an index across the Japanese and Indonesian ethnicities.

Age estimation of unidentified bodies is of marked importance in forensic medicine. In previous studies, the analysis of DNA methylation in body fluids led to the identification of several age-related CpG sites in genes such as EDARADD and FHL2. However, limited information is available on whether interethnic differences may affect the age prediction results. In the present study, we examined the effect of ethnicity on the age prediction method based on methylation scores, which were determined via methylation-sensitive high-resolution melting. We found that there was a significant difference in methylation scores between Japanese and Indonesian participants of early 20 s group, and that the nationality coefficient was significant for age estimation when applying the existing method for the analysis of the methylation status of EDARADD and FHL2. This suggests that when using certain biochemical indicators as a predictor of age, the effects of ethnicity on DNA methylation should be considered to improve the accuracy of the estimation.

Four cases of cytokine storm after COVID-19 vaccination: Case report.

The global coronavirus disease 2019 (COVID-19) pandemic has led to the rapid development of vaccines against this disease. Despite the success of the international vaccination program, adverse events following vaccination, and the mechanisms behind them, remain poorly understood. Here we present four cases of death following receipt of a second dose of COVID-19 vaccine, with no obvious cause identified at autopsy. Using RNA sequencing, we identified genes that were differentially expressed between our post-vaccination cases and a control group that died of blood loss and strangulation. Three hundred and ninety genes were found to be upregulated and 115 genes were downregulated in post-vaccination cases compared with controls. Importantly, genes involved in neutrophil degranulation and cytokine signaling were upregulated. Our results suggest that immune dysregulation occurred following vaccination. Careful observation and care may be necessary if an abnormally high fever exceeding 40°C occurs after vaccination, even with antipyretic drugs.

Selective and easy detection of the Porphyromonas gingivalis fimA type II and IV genes by loop-mediated isothermal amplification.

Porphyromonas gingivalis fimbrillin (fimA) type II and IV, the definitive factors for periodontitis, are also found to be associated with systemic diseases. To detect the fimA type II and IV genes easily and rapidly, we used the loop-mediated isothermal amplification (LAMP) method. The LAMP method showed high specificity as DNA from the P. gingivalis HW24D1 strain could only be amplified by the type II-specific primers and that from the W83 strain could only be amplified by the type IV-specific primers. Pathogens, namely, Streptococcus sobrinus, S. mutans, and Candida species, lack the type II and IV genes, and hence, were not detected by the LAMP reaction. Both bacterial cells and purified DNA could be used in the LAMP reaction. The LAMP reaction was highly sensitive and both type II and type IV genes could be detected in 1000 DNA molecules. In the bacterial suspensions of HW24D1 and W83 strains, type II and type IV genes, respectively, could be detected in 100 bacterial cells. We examined the type II and type IV genes in the dental plaques from 22 P. gingivalis-positive patients using the LAMP method. Only one person was found to be positive for the type II gene (4.5%). For the type IV gene, 3 positive cases (13.6%) were identified. Moreover, type II and type IV genes could be detected simultaneously using a multiplex amplification primer of fimA type II and type IV, under visible light. Thus, we established a selective and easy method to detect P. gingivalis fimA type II and IV genes using LAMP.

[A case of hepatocellular carcinoma with portal vein thrombus(Vp3)and lung metastases(stage IVB),which responded completely to treatment with Tegafur/Uracil].

A 65-year-old woman who had diffuse hepatocellular carcinoma(HCC)with tumor thrombus of right portalvein(Vp3) and lung metastases(Stage IVB)was treated by single-agent therapy with tegafur/uracil(UFT). As a result, primary and metastatic tumors were not recognized by diagnostic imaging, with a noted decrease of AFP, AFP-L3 and PIVKA-II. Generally, oral chemotherapy for HCC is not recommended because of the low response rate. However, there have been some reports including the present case which have showed a marked response with UFT. We thus conclude that UFT can be an option with low risk of crucial adverse effects in the treatment of selected HCC patients.