Establishment of indicator for screening of child abuse and neglect in primary school-age children.

AIM: In Japan, elementary schools are committed to early discovery of child abuse and neglect. Under Japanese law, dentists are required to be involved in child welfare and early detection of child abuse. However, the extent to which dental practitioners cooperate for prevention of child abuse with schools remains limited to date. Therefore, we undertook a community-based project that aimed to develop screening indicators to identify potentially abused children based on their oral health condition and behavioural characteristics in education settings. We have already reported on the relationship between oral health condition and child abuse. The present study established an indicator that can facilitate identification and prevention of child abuse/neglect. METHODS: Study design: Cross-sectional study. Questionnaires were given to teachers at an elementary school to ascertain behavioural characteristics observed in children who experienced abuse. CONCLUSION: We developed a check sheet for proper assessment, which requires as little effort as possible, and an index for screening children in need based on teaching staff's observation of students' daily behaviour in school settings. Highly selected items are advantageous as they lead to a decrease in non-response or responses, which can help in improving the accuracy of the response to each question.

Pathological factors involved in local failure in squamous cell carcinoma of the oral cavity: retrospective study and proposal of a new clinical classification.

The control of local failure (LF) is essential to improve outcomes in patients with squamous cell carcinoma of the oral cavity (OSCC). In this study, LF of OSCC was classified into three clinical types: deep recurrence (type 1R), adjacent superficial recurrence (type 2R), and distant primary tumour (type 3R). LF was analyzed after surgical resection of OSCC to determine the validity and usefulness of this classification system. Of 257 patients with OSCC, 58 experienced LF; 21 had type 1R, 23 had type 2R, and 20 had type 3R. Clinical factors influencing LF were analyzed by log-rank test and Cox test. Type 1R was significantly related to the TN classification, resection margin status, and invasive pattern. Type 2R was strongly associated with the grade of epithelial dysplasia at the surgical margins. Type 1R rarely developed more than 1year after surgery, whereas type 2R did not develop within 2 years. Type 1R may be caused by residual cancer cells in the deep margins, and type 2R by precancerous cells remaining in the marginal epithelium and gradually becoming invasive cancer. Type 3R may be considered an independent tumour. The newly proposed clinical classification is convenient and roughly reflects the causes and mechanisms of relapse.

An assessment of oral self-care among Romanian dental students using the Hiroshima University--Dental Behavioural Inventory.

OBJECTIVE: To determine the differences in oral self-care levels between 322 Romanian dental students. MATERIALS AND METHODS: The design of the study was a cross-sectional survey of dental students in Romania. The examination was based upon responses to a questionnaire entitled 'Hiroshima University--Dental Behavioural Inventory' (HU-DBI) and three additional questions. RESULTS: Statistically significant differences of the mean HU-DBI scores were observed between year 1 and 2 (level of basic science course) and year 5 and 6 (level of clinical course) and between genders (p < 0.001). Statistically significant differences were notable in 10 items out of 20 between three levels of dental education (basic, preclinical and clinical levels). The most striking results were that year 5 and 6 students were less likely to use a toothbrush with hard bristles (p < 0.001), and less likely to worry about the colour of their teeth (p < 0.01). While 20% of year 1 and 2 students reported daily flossing, almost 46% was reported in year 5 and 6 students (p < 0.001). A significant difference was also observed on flossing behaviour between genders (p < 0.001). Of 205 year 1-4 students, 176 (85.9%) were correctly predicted by the models, and 177 of 193 female students (91.7%) were correctly predicted. CONCLUSIONS: There were considerable differences in dental health attitudes/behaviour between the three levels of dental education and between genders.

Relationship between the Peripheral Lymphocyte Response to Mycophenolic Acid in vitro and the Level of ATP in Peripheral CD4+ Lymphocytes before and after Renal Transplantation.

OBJECTIVE: The lymphocyte immunosuppressant sensitivity test has been used to predict the pharmacodynamics of immunosuppressive drugs for the purpose of preventing acute rejection and infection after renal transplantation. On the other hand, measuring the ATP levels in peripheral CD4+ lymphocytes is also able to monitor the risks of rejection and infection in transplant recipients. In the present study, we examined the relationship between the mycophenolic acid pharmacodynamics and the ATP levels in peripheral lymphocytes before and after renal transplantation. METHODS: We examined both the pharmacological efficacy of mycophenolic acid and the lymphocyte ATP levels before and 2, 4 and 6 weeks after the operation in 20 renal transplant recipients. The drug's pharmacological efficacy was evaluated by the 50% inhibitory concentration of the drug against the in vitro proliferation of peripheral blood lymphocytes activated by T cell mitogen. The ATP levels in peripheral CD4+ lymphocytes were measured by the Immuknow assay kit. The relationships between the mycophenolic acid pharmacodynamics and ATP levels in peripheral lymphocytes were examined in these recipients. RESULTS: The immunosuppressive effects of mycophenolic acid against mitogen-activated lymphocyte proliferation were significantly and positively correlated with the lymphocyte ATP levels, but only at 6 weeks after transplantation. The relationship was not significant before or at 2 or 4 weeks after the operation. CONCLUSION: Our present data raised the possibility that evaluating the pharmacological efficacy of mycophenolic acid pre-transplantation and monitoring the ATP level 6 weeks after transplantation can predict the risk of rejection and/or infection in renal transplant recipients.

Caffeine enhances the expression of the angiotensin II Type 2 receptor mRNA in BeWo cell culture and in the rat placenta.

Although chronic caffeine exposure during pregnancy has been shown to affect fetal growth, adverse effects of caffeine on embryogenesis are not only well understood, but also controversial. We have used gene chip technology in an attempt to identify to what extent, if any, caffeine could possibly alter gene expressions in the cytotrophoblast-like cell line BeWo. Few down-regulated genes were found; most of the genes were up-regulated, suggesting that chronic caffeine exposure during the gestational period could exert certain influences on embryogenesis. The highest up-regulated gene expression of BeWo cells by caffeine was angiotensin II type 2 (AT(2)) receptor gene. We focused the genes of the renin-angiotensin system (RAS), angiotensin II type 1 (AT(1)) and AT(2)receptors and angiotensin I converting enzyme, for study on caffeine's responsive gene expression in BeWo cells and in the placentae of pregnant rats that were fed a diet supplemented with caffeine (2 mg/100 g body weight) during gestation, and analysed the gene expressions using RT-PCR and LightCycler system. A significantly increased AT(2)receptor gene expression and a slight decreased AT(1)receptor gene expression demonstrated the caffeine's effect to the placental RAS.

Inhibition of CN (protein phosphatase-2B) suppresses Ca2+-mediated acid secretion in rats.

BACKGROUND AND AIM: It has been suggested that CN (calcineurin, protein phosphatase-2B) regulates signal transduction, particularly in various secretory cells. In this study, we examined whether CN plays a role in stimulus-secretion coupling of gastric parietal cells. MATERIALS AND METHODS: Localization of CN in gastric epithelial cells was examined immunohistochemically. The role of CN in the acid secretion pathway of gastric parietal cells was assessed by evaluating the effect of FK506, a specific inhibitor of CN, on gastric acid secretion in pylorus-ligated rats. In addition, the effect of FK506 on secretagogue (carbachol, tetragastrin and histamine)-stimulated acid secretion was investigated in lumen-perfused rats. RESULTS: CN was specifically expressed in gastric parietal cells and chief cells of the gastric mucosal epithelium immunohistochemically. FK506 dose-dependently inhibited gastric acid secretion in pylorus-ligated rats. In lumen-perfused rats, FK506 completely inhibited acid secretion prestimulated by carbachol and tetragastrin, agonists known to increase cytosolic Ca2+, but did not affect acid secretion prestimulated by histamine. CONCLUSIONS: Our findings demonstrate that FK506 has a potent antisecretory effect in parietal cells through inhibition of only Ca2+-mediated acid secretion pathways. As FK506 is known to specifically inhibit CN, which plays an important role in signal transduction in various secretory cells, protein dephosphorylation signalling might also be crucial for gastrin and M3 muscarine receptor-mediated stimulation of proton pump.

Effect of pre-induction of heat shock proteins on indomethacin-induced small-intestinal lesion in rats.

Systemic hyperthermia induces the synthesis of heat shock proteins (HSPs) in several organs. However, the mechanism of induction and the functions of HSPs in the small-intestinal mucosa have not been established. We examined the expression of HSPs in the small-intestinal mucosa after systemic hyperthermia, and evaluated the cytoprotective function of pre-induced HSPs on experimentally induced mucosal damage. HSP expression was investigated by Western blot and densitometric analysis before and after hyperthermia (42.5 degrees C; 20 min). Expression of a 72-kDa heat shock protein (HSP72) and a 73-kDa heat shock protein (HSP73), both of which are endogenous cytoprotectants in vitro significantly increased, peaking 6-9 h after hyperthermia, without any pathologic alterations, whereas the expression of a 60-kDa heat shock protein (HSP60) did not increase. To investigate the influence of pre-induction of HSPs on small-intestinal damage, rats received indomethacin (10 mg/kg; orally) with or without pre-treatment with hyperthermia. Small-intestinal damage caused by indomethacin was not influenced by pre-induction of HSP72 and HSP73. We demonstrated that systemic hyperthermia induced HSP72 and HSP73, although pre-induction of these proteins did not have a cytoprotective function in the small-intestinal damage caused by indomethacin.

Alteration of femoral structure in later life by chronically feeding caffeine during rapid growing period in newborn female rats.

The effects of caffeine intake in early life on bone structure later in life were studied in rats. At day 9 of gestation, dams were divided into 2 groups. Group 1 (control) received a 20% protein diet; group 2 received the 20% protein diet supplemented with caffeine (2 mg/100 g body weight). After birth pups were continuously fed their respective diets until day 93, when the diet of group 2 was replaced with a noncaffeine 20% protein diet. On day 388 animals from both groups were weighed, killed, and femora and mandibles were removed. Calcium, phosphorus, magnesium, zinc, hydroxyproline, and hexosamine concentrations were measured. Radiographs of some femora were taken and paraffin cross sections were made at the midshaft of others. Femora in the caffeine group were wider, periosteal bone area/total bone area was greater, the cross sectional area of femoral bone was smaller, and there were fewer osteocytes/bone area than in controls. Calcium, phosphorus, zinc, and hydroxyproline concentrations in the caffeine group were less in both bones of the caffeine group. These results indicate that if animals are exposed to caffeine during the rapidly growing period, changes occur in femoral bone which are similar to those that occur with aging.

Health behaviors and their relation to metabolic control and periodontal status in type 2 diabetic patients: a model tested using a linear structural relations program.

BACKGROUND: Although it has been reported that diabetic control is beneficial in managing periodontal disease, there are few studies in the literature where the relationship between singular behavioral factors and periodontal status has been examined. The aim of this study was to examine the simultaneous interrelationships among selected medical/dental variables and 5 behavior components with general health behavior (GHB), perceived fatigue (PF), diet control (DC), regular diet (RD), and dental behavioral inventory (HU-DBI) scores, using data from a study of 102 type 2 diabetic patients. METHODS: A hypothesized model was tested by a linear structural relations program (LISREL). RESULTS: There was a significant correlation between oral health behavior and calculus accumulation (r = 0.399; P<0.001). Correlations were found between calculus and periodontal status measured by gingivitis index and probing depth (r = 0.232; P<0.05, r = 0.279; P<0.01, respectively). The final model was found to be consistent with the data (chi2 = 55.0, df = 47, P = 0.197; GFI = 0.922). Oral health behavior affected periodontal status through its effect on calculus but not plaque accumulation. General health behavior had significant effects on oral health behavior and diet behavior (P<0.05 and P<0.001, respectively). Diet behavior affected both plaque accumulation and metabolic control (P<0.05 and P<0.01, respectively). However, the result was the virtual absence of a significant pass coefficient between metabolic control and periodontal status. CONCLUSIONS: The severity of the 2 diseases seemed to be connected indirectly through health behaviors such as diet behavior and oral health behavior.

Effects of maternal caffeine with zinc intake during gestation and lactation on bone development in newborn rats.

On day 9 of gestation, pregnant dams were randomly divided into 3 groups. Dams of group 1 were fed a 20% protein diet as a control. Dams of group 2 were fed a 20% protein diet supplemented with caffeine. Dams of group 3 were fed a 20% protein diet supplemented with caffeine and zinc. The amount of caffeine added to the maternal diet was 2 mg/100 g body weight; the amount of zinc was 0.6 g/kg of diet. At birth, pups were mixed within each group, and 8 randomly selected pups from each group were assigned to each dam of the respective group and were continuously fed the same diet. On day 15, the pups were killed and cranial bones, mandibles and femurs removed. The bones were measured, and the mineral content of the mandibles and femurs was determined. Although there were no differences in the dimensions of the cranial bones among the groups, the measurements and mineral content of the mandibles and femurs were consistently affected by the caffeine in the diet. On the other hand, supplementation of the caffeine-added diets with zinc led to greatly improved bone development, reaching values up to or beyond control levels. Thus zinc supplementation of a caffeine diet given to the dams during gestation and lactation can favourably influence the otherwise impaired bone development of their offspring.

Role of Porphyromonas gingivalis 40-kDa outer membrane protein in the aggregation of P. gingivalis vesicles and Actinomyces viscosus.

Porphyromonas gingivalis, an important pathogen in periodontitis, produces extracellular vesicles that aggregate with Actinomyces viscosus cells. A 40-kDa outer membrane protein (OMP)-coding gene from P. gingivalis was cloned and the protein was found to be localized in these vesicles. The recombinant 40-kDa OMP did not show aggregation activity. However, affinity-purified antibody against the recombinant protein significantly inhibited aggregation of P. gingivalis vesicles with A. viscosus cells. The antibody also inhibited cellular coaggregation of several strains of P. gingivalis with A. viscosus cells, but not with other periodontal pathogens. Moreover, aggregation of A. viscosus cells with P. gingivalis vesicles was inhibited in a dose-dependent manner by pre-treatment of the A. viscosus cells with the recombinant protein. These findings suggest that the 40-kDa OMP may be an important aggregation factor of P. gingivalis.

Production of D-iditol from D-sorbose by Rhodotolura rubra RY10 isolated from miso paste.

The yeast strain RY10 that can convert D-sorbose to D-iditol was isolated from miso paste and identified as Rhodotolura rubra. The cells grown on D-fructose were found to have relatively high conversion potential. Addition of ethanol to the reaction mixture significantly accelerated the conversion rate of D-sorbose to D-iditol. During the conversion reaction, ethanol was added to the reaction mixture at 48 h intervals to maintain the concentration of ethanol at 1.0%. The final conversion ratios were 82.7%, 95.0%, 93.7%, and 78.0% using washed cells when the concentration D-sorbose were 1.0%, 2.0%, 3.0% and 5.0%, respectively. The product produced from D-sorbose was identified as D-iditol by high performance liquid chromatography analysis, infrared spectrum, optical rotation and melting point measurements.

Production of D-lyxose from D-glucose by microbial and enzymatic reactions.

D-arabitol was first prepared from D-glucose using Candida famata R28. The reaction gave 5.0% D-arabitol from 10.0% D-glucose. D-arabitol was then almost completely converted to D-xylulose using Acetobacter aceti IFO 3281. Finally, D-lyxose was prepared from D-xylulose enzymatically using L-ribose isomerase from toluene-treated cells of Acinetobacter sp. strain DL-28. The isomerization reaction progressed steadily and the concentration of D-xylulose increased from 1.0 to 10.0%. About 70% of D-xylulose was converted to D-lyxose in all cases. Separation of residual D-xylulose from the reaction mixture is very difficult to achieve by column chromatography, but D-xylulose could be selectively degraded easily using Saccharomyces cerevisiae IFO 0841. The product was crystallized and was confirmed to be D-lyxose by HPLC, 13C-NMR spectra, IR spectra analysis, and optical rotation measurement.

Comparison of objective methods for determining ventilatory threshold.

This study was undertaken to compare and re-examine the relation of lactate threshold (LT) and ventilatory threshold (VT), using six objective determination methods proposed previously. Twenty-one young male subjects performed a cycle exercise test in which the work rate was increased by 150 kg.m every 2 min up to his limit of volitional fatigue. Through each test, gas exchange parameter measurements were made every 1 min (every 30 s at nearly maximal level), and the venous blood samples were taken from a warmed ear lobe at each work rate for determining blood lactate concentration. LT and its variance were determined by the intersecting straight lines regression. LT ranged from 0.72 to 1.40 l/min in terms of VO2, and the mean value of S.D. for each LT was about 0.1 l/min. Each objective method for determining VT used in this study was based on the simple modelling of the criterion for visual detection of VT, that is the non-linear increase in VE or the systematic increase in VE/VO2. When the relationship between LT and VT was examined, VT by the objective methods based on determining minimum value of VE/VO2 showed relatively high consistency with LT. Of 16-20 individuals out of all 21 subjects, there were VT within LT +/- 0.2 in VO2. It is concluded that VE/VO2 is a more sensitive index for detecting VT than VE in the gas exchange parameters, and the objective VT determination method based on minimum value of VE/VO2 could facilitate estimation of LT within an error of +/- 0.2 l/min VO2 in most normal individuals.

Development of an oral health indicator in infants.

OBJECTIVE: To develop a simple predictive indicator for 1.5-year-old infants' oral health as an aid for maternal preventive efforts. DESIGN: The development of an indicator was based on the relationship between life style factors of the 1.5-year-old infants and the caries incidence of the same children at three years of age. Data gained at examination of the 3-year-old subjects were subjected to analysis with the caries-free information on the same subjects at 1.5 years. SETTING: A community health centre in Hiroshima Japan. SUBJECTS: 1575 children received an oral check-up at 3 years of age at a community health centre. OUTCOME MEASURES: The category scores of the six items which were extracted retrospectively from life style factors at 1.5 years affecting caries prevalence at 3 years of age were quantified and transformed into integral numbers so as to make up a total of 100. The sum of the six transformed scores was named an Infants Dental Index (IDI). RESULTS: The IDI score was associated significantly with the dmft score at 3 years of age (r = -0.18 P < 0.001). When the subjects were classified into four groups with respect to the IDI score these four groups were significantly related to the caries onset between 1.5 and 3 years of age (chi 2 = 36.74, P < 0.001 CONCLUSIONS: The IDI developed in this study appeared to be valid so that it could be applied in the field of the community dental health to identity higher risk infants and direct more effective health education to mothers.

Behavioral dental science: the relationship between tooth-brushing angle and plaque removal at the lingual surfaces of the posterior teeth in the mandible.

The aim of this study was to investigate the relationship between tooth-brushing angle and efficacy of plaque removal. The subjects in this study were 72 students (18-21 yrs.) from paramedical schools. They answered the questionnaire of the Hiroshima University-Dental Behavioral Inventory (HU-DBI) to assess dental health behavior, and then received examinations of tooth-brushing angle, efficacy of plaque removal and gingival condition. The examination sites of tooth-brushing angle and the efficacy of plaque removal were the lingual surfaces of the posterior teeth in the mandible. The tooth-brushing angle, efficacy of plaque removal, gingival condition and dental health behavior were significantly associated with each other. The subjects who directed the bristles of the toothbrush vertically toward the tooth surfaces had a high efficacy of plaque removal, good gingival condition and good dental health behavior. Thus, it is important to direct the bristles vertically toward the tooth surfaces for effective plaque removal. In addition, knowledge related to good dental health might be necessary to carry out effective tooth brushing.

Lotka's law and productivity index of authors in a scientific journal.

Lotka's law of scientific productivity is a bibliometric example: the number of authors against the number of contributions made by the authors was plotted on a logarithmic scale. The points were closely scattered around a straight line having a slope of -2. The purpose of this study was to apply information technology to real-world data and to quantify the extent of the bibliometric regularity that exists in the literature of dental science. We have analyzed the productivity index of authors (PI) in a scientific journal (Journal of American Dental Association). Details of a total of 4,088 papers published between 1966 and 1995 were extracted electronically from MEDLINE. The total number of authors was 5,589, responsible for 8,569 authorships. Only 0.8% of the authors presented a PI > = 1 (large producers), and 78.1% a PI = 0 (occasional authors). The number of authors publishing N papers was 1/N2.64 of those publishing one paper. The result suggested that repeated publications in the Journal were more difficult than those predicted by Lotka (1/N2).

Non-surgical approach to advanced chronic periodontitis: a 17.5-year case report.

This 17.5-year longitudinal case report details the treatment of advanced chronic periodontitis in a female patient commencing at 34 years of age. The woman was provided with periodontal care comprising of temporary fixation, scaling and root planing, intra-pocket irrigation using a root canal syringe and regular supervised maintenance. The patient presented with a 10-year history of bleeding gums. Therapy conducted in general practice had included simple curettage and irrigation. However, these treatments proved unsuccessful and the patient often changed dentists seeking better treatment. She presented to the University Dental Hospital, for diagnosis and treatment of her periodontal conditions after her mandibular lateral incisor had exfoliated. On presentation a purulent exudate could be expressed from all of the pockets. All anterior teeth, excluding the maxillary canines, demonstrated +2 to +3 mobility. The patient did not want any surgical treatment or her teeth extracted. It was decided to treat the patient conservatively without surgery. By postponing extraction, the authors were in a better position to determine the prognosis of the remaining teeth after the infection was under control. Although six teeth were extracted during the 17.5 years, this case report suggests that a non-surgical approach is a viable option while maintaining regular visits for periodontal care.

Relationship between CPITN and oral health behaviour in Japanese adults.

Many studies on toothbrushing have concentrated on clinically diagnosing plaque and measuring periodontal status as indicators of oral health behaviour. From a behavioural point of view, however, the more important objective is the health behaviour itself. To investigate the relationship of oral health behaviour to periodontal status, 517 urban employees in Japan (249 men and 268 women aged 20-59 years) responded to a 20-item dental health behaviour questionnaire, entitled the HU-DBI, and had their periodontal conditions examined using the CPITN. Only 1 per cent were found with a healthy periodontium (Code 0), and 9 per cent had bleeding on probing (Code 1). Calculus (Code 2) was the most prevalent condition with 51 per cent of subjects having this code as the worst condition, followed by shallow pockets (Code 3) in 30 per cent, and deep pockets (Code 4) in 9 per cent of the sample. The mean HU-DBI score was 4.2 (out of 12). Females had somewhat higher scores than males (4.4 vs. 4.0, p < 0.05). CPITN had a negative relationship with the HU-DBI (r = -0.26, p < 0.001), and a positive relationship with age (r = 0.40, p < 0.001). Similar relationships were observed in each gender. These data demonstrate the relationship of age with periodontal status, and periodontal status with oral health behaviour. A two-dimensional matrix of HU-DBI score by CPITN may provide a simple and effective means of identifying low and high risk individuals.

A pylorus-retaining pancreatic head-duodenectomy for cancers of the duodenal papilla and the lower bile duct.

With the development of diagnostic technology, the surgical methods of cancer therapy have been expanded, and operations have been performed using a procedure corresponding to the stage of cancer to improve the postoperative QOL. A 79-year-old man with cancer of the duodenal papilla and obstructive jaundice, and a 63-year-old woman with cholangiocarcinoma in the lower region complicated by cholangitis caused by Candida underwent resections of the pancreatic head and duodenum, and pancreaticogastrostomies retaining the pylorus. Satisfactory results were obtained in both cases. The merits of the procedure were that there were few complaints, sufficient food could be ingested and the QCL was maintained. The benefits of pancreaticogastrostomy are that the anastomosis procedure is simple, the gastric wall is thicker than the jejunum and blood flow is plentiful. The dorsal gastric wall is located close to the pancreatic cut-end, therefore tension is not created, and the pancreatic enzymes are not activated because the anastomosis site does not contact the intestinal fluid. These characteristics should decrease the rate of anastomosis failure which can be a fetal complication. A safer operation is desirable, particularly for elderly patients or patients who have complications.