Risk factors for oral frailty among community-dwelling pre-frail older adults in Japan: A cross-sectional analysis.

OBJECTIVES: Oral frailty is a well-established risk factor for frailty and plays a significant role in progression to frailty. However, the association between oral frailty and pre-frailty in elderly individuals remains unclear. This cross-sectional study aimed to clarify the characteristics and risk factors of pre-frailty in elderly individuals with oral frailty. METHODS: A total of 377 elderly individuals participated. Oral examinations comprised simple and non-invasive measures of chewing function, self-reported swallowing function, and oral moisture. The frailty screening index was used to assess frailty phenotypes. RESULTS: The overall prevalence of pre-frailty was 63.1%, after excluding 40 frail and 99 robust individuals. The mean age of the pre-frail participants was 76.6 ± 5.8 years; 70.6% were women. 10.5% of the pre-frail elderly participants had oral frailty. In multivariate analysis diabetes mellitus, history of cancer, denture wearing, and malnutrition were independently associated with oral frailty among pre-frail elderly individuals (adjusted odds ratio (OR) 3.8, 95% confidence interval (CI) 1.06-13.54; OR 4.5, CI 1.32-15.36; OR 8.8, CI 1.76-43.78; and OR 3.6, CI 1.30-9.67; respectively). CONCLUSIONS: The prevalence of oral frailty was low among community-dwelling pre-frail elderly individuals. Early interventions involving oral, nutritional, and disease management may prevent or improve oral frailty in pre-frail elderly individuals and may prevent progression to frailty. Further studies are required to elucidate the underlying mechanisms.

Amyloid-Producing Odontogenic Tumors of the Facial Skin in Three Cats.

Amyloid-producing odontogenic tumors (APOTs) of the facial skin were diagnosed in 3 domestic cats. The neoplasms had the histopathological characteristics of the odontogenic tumor. The neoplastic cells were present in irregular islands, strands, and sheets. The peripheral neoplastic cells of the islands and strands were arranged in a palisading fashion, while the central cells were polyhedral to stellate and randomly arranged. Multiple spherules of homogeneous eosinophilic material were closely apposed to the neoplastic epithelial cells. The spherules stained with Congo red and produced an apple green birefringence under polarization microscopy, indicative of amyloid. Immunohistochemically, amyloid materials of the neoplasms reacted with polyclonal antibodies for ameloblastin, amelogenin, and sheathlin antibodies. Neoplastic epithelial cells also reacted with antiameloblastin, amelogenin, and sheathlin antibodies, with varied intensity. The histopathological and immunohistochemical characteristics of dermal neoplasms of the 3 cats were analogous to those of APOTs reported in the dog and the cat.

Biochemical and immunohistochemical characterization of the amyloid in canine amyloid-producing odontogenic tumor.

The amyloid of canine amyloid-producing odontogenic tumor (APOT) was evaluated biochemically and immunohistochemically. The N-terminal amino-acid sequence of purified amyloid protein from a canine APOT was strikingly similar to the sequence in both rat ameloblastin and porcine sheathlin. Immunohistochemically, the amyloid in APOT from 9 dogs was strongly reactive with anti-rat ameloblastin, anti-porcine sheathlin, and anti-canine APOT amyloid and weakly reactive with anti-porcine amelogenin but negative for antibodies to cytokeratins, vimentin, desmin, alpha-smooth muscle actin, amyloid A, glial fibrillary acidic protein, or S100 protein. The neoplastic epithelial cells of APOT were focally reactive with antibodies to ameloblastin, sheathlin, amelogenin, and canine APOT amyloid. The similarity in amino-acid sequence of the amyloid protein of canine APOT to that of enamel proteins, such as ameloblastin, sheathlin, and amelogenin, and the expression of these antigens in both APOT amyloid and in the neoplastic cells suggest that the amyloid of canine APOT is derived from enamel proteins secreted by ameloblasts.

Cheiro-oral topography of sensory disturbances due to lesions of thalamocortical projections.

Sensory disturbance in the unilateral hand and ipsilateral mouth region, the cheiro-oral syndrome, may be due to cortical, thalamic, or brainstem lesions. We report five patients with this syndrome due to infarction at the border of the posterior limb of the internal capsule and the corona radiata. The sensory fibers from the mouth area and hand probably travel to the cortical sensory areas in close proximity after leaving the posterior ventral thalamic nucleus.

Crossed linguo-buccal reflex in post-stroke patients.

A pathological crossed orofacial reflex, called crossed linguo-buccal reflex in the present study, was observed in approximately 1/3 of post-stroke patients with central facial palsy. Stroking with pressure two or three times with a split wooden tongue-blade to the tongue or palate contralateral to the central facial palsy elicited a reflex movement consisting of retraction of the angle of mouth and medio-posterior withdrawal of the buccal mucosa on the paretic side. Seventy-seven patients with central hemifacial palsy caused by a unilateral cerebral lesion were examined clinically, electromyographically and by computed tomography (CT) and magnetic resonance imaging (MRI). In addition, three men with bilateral cerebral lesions and bilateral crossed linguo-buccal reflexes were electromyographically examined. Twenty-two patients with unilateral cerebral lesions had this reflex. It was found that this reflex was most frequently observed in patients with a capsulo-caudate lesion involving the head of the caudate nucleus, the anterior limb and genu of the internal capsule. The electromyogram of the reflex showed increased activity in the orbicularis oris, depressor anguli oris, risorius, zygomaticus major and buccinator muscles on the paretic side with a long latency (254-856 ms), and a prolonged after-discharge after the stimulation. Reciprocal inhibition was observed in patients with bilateral positive reflexes. These findings suggest that liberation of the polysynaptic brainstem reflex in the medulla oblongata and pons from the indirect corticobulbar inhibition may underlie the occurrence of the crossed linguo-buccal reflex in post-stroke patients.

Simultaneous determination of phenolic xenoestrogens by solid-phase extraction and high-performance liquid chromatography with fluorescence detection.

A highly sensitive and selective method for simultaneous determination of some hydroxyl group-containing endocrine disruptors, including bisphenol A (BPA), bisphenol B (BPB), bisphenol E (BPE), bisphenol F (BPF) and 4-nonylphenol (4-NP), was developed. The method consists of precolumn derivatization of the analytes, solid-phase extraction (SPE) and subsequent chromatographic analysis by high-performance liquid chromatography (HPLC) with fluorescence detection. 4,4'-Cyclohexylidenebisphenol (BPZ) was used as an internal standard. Derivatization was carried out using 4-(4,5-diphenyl-1H-imidazol-2-yl)benzoyl chloride (DIB-Cl) as a label. Parameters of the derivatization reaction (temperature, time, concentration of reagent, stability, etc.) and of the solid-phase extraction (recovery, solvent, etc.) were studied in detail. Detection limits of compounds studied in standard solutions ranged from 0.08-1.3 ppb (ng/ml). The proposed method was successfully applied to plastic samples; BPA was found in both polycarbonate and polyvinyl chloride plastics, while 4-NP was found in plastics made of polyvinyl chloride and another polymer.

Histoplasmosis in the skin and gingiva in a dog.

An 8-year-old, female mongrel dog had granulomatous lesions in the skull skin and gingiva of the left mandible. The lesions were macroscopically seen as grayish white papular granulomas, and microscopically consisted to numerous swollen macrophages and a few neutrophils without fibrocaseous necrosis. Macrophages contained many small oval or round-shaped yeast-like cells and a few rod-shaped organisms indicating a narrow based budding in their cytoplasm. The yeast-like cells were 2-5 microns (average 3.5 microns) in diameter, and appeared as a central, spherical, lightly basophilic body surrounded by a clear zone or "halo". The cell wall and central body were stained by the periodic acid-Shiff, Grocott's methenamine silver impregnation, or Gridley fungus method. Immunohistochemically, yeast-like cells were positive to anti-histoplasma yeast antibody, and rod-shaped organisms were positive to anti-histoplasma mycelial antibody. The present paper describes the first case of canine histoplasmosis in Japan.

[Motor paresis with cheiro-oral topography due to small infarct in the internal capsule or the corona radiata].

We reported five patients having presented only with clumsy hand and dysarthria which resulted from motor paresis confined to one side of the fingers and the ipsilateral face and tongue. All of them were right-handed, and their manifestation was transient. They had no abnormalities of muscle tonus and sensation, and no ataxia. The features of these cases differed from those of the dysarthria-clumsy hand syndrome because of absence of ataxia, and could be distinguished from pure motor hemiplegia by a motor paresis with cheiro-oral topography. MRI examinations showed a localized lesion at the border between internal capsule and corona radiata (two cases), or in the corona radiata just over this region (three cases). In the former cases in which the internal capsule was involved, we confirmed the lesion in the genu and anterior half of the posterior limb of the internal capsule. The lesion was on the left side in all five patients. It has been known that the pyramidal tract consists of the large and small fibers. The large ones are localized in the posterior part of the posterior limb of the internal capsule, and the damage of them produces sustained and serious motor paralysis. The small ones are widely distributed in the genu and the posterior limb of the internal capsule. The findings of our study suggest that the small fibers have adjacent somatotopy for the hand and mouth in the region of the genu and the anterior part of the posterior limb of the internal capsule, and that the damage of them may lead to mild, transient motor paresis without spasticity.

[Orthostatically induced epileptoid attack].

An epileptoid attack induced by orthostatic hypotension seen in a 72-year-old man was reported. The patient had been suffering from progressive autonomic failure with parkinsonism for six years and he had severe orthostatic hypotension, syncope and generalized convulsion when he stood up. The convulsion sometimes associated with urinary incontinence, ceased immediately when he lay down although he remained drowsy for a while. Occasionally the seizure ceased spontaneously and he regained consciousness even while he was kept standing. On lying position his blood pressure was 167/88 mmHg and no abnormality was seen in electroencephalogram. When he was tilted up to 50 degrees his blood pressure fell to 70/46 mmHg, and he became unconscious followed by jaw twitching and generalized clonic seizure. Electroencephalogram during seizure showed sharp wave and rhythmic spikes. Other laboratory examination revealed diffuse and severe autonomic dysfunction and slight cerebral atrophy on brain CT scanning. He was treated with diphenylhydantoin 300 mg/day and the seizure responded partially. The reasons why the patient's seizure was thought to be epileptic rather than the convulsive syncope were as follows: the type of the seizure was similar to an epileptic generalized convulsion, the seizure and unconsciousness ceased spontaneously even during standing position, the seizure and impaired consciousness partially responded to diphenylhydantoin administration. The underlying pathophysiology of the seizure was thought to be transient cerebral hypoperfusion induced by orthostatic hypotension.

[Contents of phthalate in polyvinyl chloride toys].

The presence of plasticizers in PVC toys obtained in October 1998 was investigated. Diisononyl phthalate (DINP), di-2-ethylhexyl phthalate (DEHP), di-n-butyl phthalate (DBP), dinonyl phthalate (DNP), diheptyl phthalate (DHP), and di-2-ethylhexyl adipate (DEHA) were detected. The phthalates were found in all of the 68 samples. The principal phthalate found in toys was DINP, which was present in 48 of 68 samples. The DINP content ranged from 15 mg/g to 580 mg/g, and mean content was 308 mg/g. The highest content was found in a pacifier toy. DEHP was present in 20 of 68 samples and the content ranged from 2.0 mg/g to 380 mg/g. The mean content was 162 mg/g. It was found in 60% of domestic toys.

Optic atrophy, sensorineural hearing loss and polyneuropathy--a case of sporadic Rosenberg-Chutorian syndrome.

We report on a 41-year-old woman with slowly progressive motor dominant polyneuropathy, optic atrophy and sensorineural deafness, but without any known familial feature. These neurological manifestations were in accordance with the syndrome reported by Rosenberg and Chutorian in 1967 (Rosenberg-Chutorian syndrome), a unique form of Charcot-Marie-Tooth disease. The syndrome was first reported to be autosomal dominant in trait, but subsequently recessive forms and sporadic ones have also been described. Nerve biopsy and neurophysiological studies including electromyography, nerve conduction velocities, somatosensory evoked potentials, auditory brainstem responses, and visual evoked potentials revealed the axonopathic involvement of the central nervous system as well as the peripheral nervous system. Since neurophysiological aspects of this particular syndrome have not been well studied, these results would provide some insight into the understanding of this disorder.

Effect of pectin enhancement on plasma quercetin and fecal flora in rutin-supplemented mice.

Few reports have considered the effects of dietary fiber on plasma quercetin and the intestinal flora. We investigated the effects of pectin on the plasma and fecal flora of mice fed a diet supplemented with the quercetin glycoside rutin. Male mice were randomly divided into 2 groups, which were fed a pectin-rutin (PR) or cellulose-rutin (CR) diet for 14 d. Plasma quercetin and isorhamnetin metabolites were measured by high-performance liquid chromatography. Feces were immediately processed with bacteriological procedures. The fecal flora was investigated. Plasma quercetin and isorhamnetin concentrations were significantly higher in the PR diet group, as was the plasma isorhamnetin/quercetin ratio. The composition of the intestinal flora differed between the 2 dietary groups. The total number of fecal bacteria was significantly larger in the PR group, in which most types of bacteria were more abundant, with the exceptions of bifidobacteria, fusiform-shaped bacteria, and staphylococci. The lower gut seemed to be the major absorption site for rutin. Pectin might thus enhance the bioavailability of quercetin from rutin by altering the metabolic activity of the intestinal flora and/or gut physiological function.

Effects of guar gum and cellulose on cecal enzyme activity and cecal short-chain fatty acids in young and aged mice.

The effects of cellulose or guar gum on cecal enzyme activity and cecal short-chain fatty acids (SCFAs) in young and aged mice were studied. Male Crj:CD-1 (ICR) mice were fed an MF diet for 4 (young mice) or 23 months (aged mice). The MF diet was then replaced with a semisynthetic diet supplemented with 5% guar gum or 5% cellulose. The mice were fed the guar gum or cellulose diet for 3 weeks. There was no significant difference in cecal content between the two diet groups. There were no significant differences in total short-chain fatty acid production between the young mice fed the cellulose and those fed the guar gum diet, and between the aged mice fed the cellulose and guar gum diet. There were significant differences in cecal enzyme activity between the young mice fed the cellulose and those fed the guar gum diet. Beta-glucuronidase activity was significantly higher in the young mice fed the guar gum diet than in those fed the cellulose diet. There were also significant differences in cecal enzyme activity between the aged mice fed the cellulose diet and those fed the guar gum diet. Beta-glucuronidase activity was significantly higher in the aged mice fed the guar gum diet than in these fed the cellulose diet. Beta-glucosidase activity was significantly lower in the aged mice fed the guar gum diet than in those fed the cellulose diet. The effect of cellulose on the microflora between the young and aged mice might be different from the effect of guar gum. The degree of adaptation to the diet of microflora in young and aged mice fed the cellulose diet might differ from that in those fed the guar gum diet. The higher enzyme activities of microflora in aged animals compared to young animals, might have some relation with the incidence of colon cancer in aged animals.

A clinical study on the removal of gingival melanin pigmentation with the CO(2) laser.

BACKGROUND AND OBJECTIVE: In a previous study, the possibility of removal of dog gingival melanin pigmentation with CO(2) laser therapy was reported. The present study was designed to investigate the effect of the CO(2) laser on human gingival pigmentation and evaluate the clinical outcome. STUDY DESIGN/MATERIALS AND METHODS: A CO(2) laser (output: 6-8 W, pulse duration: 0.2 seconds) was irradiated on the melanin pigmented gingival surface of 10 patients, aged 20-49 years. Follow-up clinical and histopathological evaluations were performed. RESULTS: The CO(2) laser was effective in removing melanin pigmentation in all patients. In the histopathological study, no pigmented-laden cells nor any inflammatory cell infiltration was observed following laser irradiation. No re-pigmentation was seen in any case in the first year. However, four of seven cases showed re-pigmentation at 24 months. The re-pigmentation was almost equal to the preoperative state. CONCLUSIONS: The CO(2) laser has proved to be another effective, safe, and easily applicable therapy for the removal of gingival melanin pigmentation.

Site-specific modification of interleukin-2 by the combined use of genetic engineering techniques and transglutaminase.

Exploring a new method for the site-specific incorporation of functional groups into proteins, we have studied the combined use of genetic engineering techniques and enzymatic methods. Specifically, a short peptide for use as a substrate of guinea pig liver transglutaminase (TGase) is introduced at the N terminus of human interleukin-2 (hIL-2). The expressed chimeric protein (rTG1-IL-2) is chemically modified at a glutamine site in the appended sequence by TGase-catalyzed transamination with two amines, monodansylcadaverine (MDC), or a constructed derivative of poly (oxyethylene) (POE3). For the TGase-catalyzed modifications with MDC and POE3, 1 mol of donor was incorporated per mole of rTG1-IL-2, respectively. N-Terminal sequence analysis of MDC-modified rTG1-IL-2 (MDC-rTG1-IL-2) showed that the Gln-4 residue in the chimeric protein was site specifically modified with MDC. On the other hand, tryptic mapping of POE3-modified rTG1-IL-2 (POE3-rTG1-IL-2) by matrix-assisted laser desorption/ ionization time-of-flight mass spectrometry (MALDI-TOFMS) suggested that one of the Gln sites in the appended sequence was modified with POE3. The POE3-rTG1-IL-2 retained full bioactivity relative to the unmodified molecule and rhIL-2. This methodology could be a new and general route for the site-specific modification of proteins.

A case of an odontogenic cutaneous sinus tract.

CASE REPORT: A 22-year-old female presented with a draining sinus tract on her left cheek. The tooth responsible was examined clinicopathologically. On clinical examination, the mandibular left first molar tooth was restored with an amalgam filling. Radiographic examination revealed base or pulp capping material below the restoration and a radiolucent periapical lesion surrounding the distal root apex. Conservative non-surgical root canal treatment was performed; 10 months later, the sinus had healed completely and the periapical lesion had resolved. Histopathological examination of pulp tissue recovered during treatment revealed foreign bodies, made up of capping material and amalgam, associated with chronic inflammation. These findings suggested that chronic inflammation in the pulp tissue had resulted in a draining sinus tract.