Relationship between office blood pressure and actual antihypertensive drug use in patients with hypertension following the promulgation of the guidelines for hypertension (JSH2019).

To achieve appropriate blood pressure control in the treatment of hypertension in Japan, this study examined the relationship between office blood pressure and actual antihypertensive drug use in general hospitals following the promulgation of the guidelines for hypertension (JSH2019). This study focused on blood pressure levels and drug use in outpatients on antihypertensive treatment from June to July 2020. The subjects were 2,537 patients classified into four groups based on their medical history, patients with: hypertension only; hypertension and cardiovascular disease; hypertension and dyslipidaemia; and hypertension and diabetes mellitus. The results showed a significant difference in systolic blood pressure (SBP) between patients with hypertension only and those with hypertension and cardiovascular disease (138.3±17.9 mmHg vs 135.6±19.9 mmHg, p<0.05). Regarding actual drug use, it was found that diuretics were prescribed more frequently in patients with hypertension and cardiovascular disease than in those with hypertension alone (15.5% vs 37.9%, p<0.05), even though the number of drugs for hypertension did not differ significantly. In addition, the dose of diuretics was greater only in patients with cardiovascular disease. These results show the actual drug use and blood pressure for each comorbidity. Furthermore, they suggest that the results of antihypertensive treatment may differ by changing the combination and dosage of antihypertensive drugs without changing the number of antihypertensive drugs used. The study also shows the problem of using less diuretics depending on the risk the patient has, and solving the problem may lead to achieving further antihypertensive goals.

Poor Oral Health Is a Factor that Attenuates the Effect of Rehabilitation in Older Male Patients with Fractures.

BACKGROUND: Poor oral health can lead to poor general health. We hypothesized that poor oral health might be a factor that attenuates the effect of rehabilitation in older patients with fractures. OBJECTIVES: This study aimed to evaluate the relationship between oral health in elderly patients with fractures and improvement in activities of daily living (ADL) through rehabilitation. In addition, we assessed factors associated with ADL improvement among older patients with fractures. METHODS: This case-control study was conducted at a rehabilitation hospital among 178 men aged ≥65 years who underwent fracture rehabilitation. Patients were divided into two groups based on the oral health assessment tool (OHAT) score on admission (≥4 and <4). Analysis of comparison between the two groups and multivariate linear regression analyses were performed, with respect to functional independence measure (FIM) gain during rehabilitation. RESULTS: FIM gain was significantly lower in the group with OHAT score ≥4 (26.2±17.5) than that in group with OHAT score <4 (31.1±16.1, p=0.044). There were also significant differences between the two groups in body mass index values, Mini Nutritional Assessment Short Form (MNA-SF) scores, and fracture types. OHAT score on admission was significantly associated with FIM gain during hospitalization (coefficient: 6.350, 95% confidence interval: 1.043-11.658, p=0.019). FIM on admission, Mini-Mental State Examination score, and period of rehabilitation were significantly associated with FIM gain. CONCLUSIONS: We demonstrated that the group with poor oral health had lesser ADL improvement than the group with good oral health. In addition, oral health and period of rehabilitation were independent factors that significantly affected ADL improvements. Older patients with poor oral health should be encouraged to undergo further rehabilitation, and to not refrain from exercise because of old age and fractures.

Radiation doses of workers engaged in decontamination of the environment.

After the accident at Fukushima Daiichi nuclear power plant on 11 March 2011, radioactive materials were released into the atmosphere resulting in environmental contamination. Following the implementation of environmental decontamination efforts, the Radiation Dose Registration Centre of the Radiation Effects Association established the radiation dose registration system for decontamination and related workers to consolidate and prevent the loss of radiation records. This article presents statistics on the radiation doses of decontamination and related workers using official records. Since approximately 10 years have passed since the accident in Fukushima, the types of work conducted in the affected restricted areas have changed over time. Therefore, changes in radiation dose for each type of work and comparisons with nuclear workers are presented.

Antibacterial and Osteoinductive Implant Surface Using Layer-by-Layer Assembly.

Osseointegration of dental, craniofacial, and orthopedic implants is critical for their long-term success. Multifunctional surface treatment of implants was found to significantly improve cell adhesion and induce osteogenic differentiation of dental-derived stem cells in vitro. Moreover, local and sustained release of antibiotics via nanolayers from the surface of implants can present unparalleled therapeutic benefits in implant dentistry. Here, we present a layer-by-layer surface treatment of titanium implants capable of incorporating BMP-2-mimicking short peptides and gentamicin to improve their osseointegration and antibacterial features. Additionally, instead of conventional surface treatments, we employed polydopamine coating before layer-by-layer assembly to initiate the formation of the nanolayers on rough titanium surfaces. Cytocompatibility analysis demonstrated that modifying the titanium implant surface with layer-by-layer assembly did not have adverse effects on cellular viability. The implemented nanoscale coating provided sustained release of osteoinductive peptides with an antibacterial drug. The surface-functionalized implants showed successful osteogenic differentiation of periodontal ligament stem cells and antimicrobial activity in vitro and increased osseointegration in a rodent animal model 4 wk postsurgery as compared with untreated implants. Altogether, our in vitro and in vivo studies suggest that this approach can be extended to other dental and orthopedic implants since this surface functionalization showed improved osseointegration and an enhanced success rate.

Postoperative intensive care unit admission does not affect outcomes in elective surgical patients with severe comorbidity / El ingreso postoperatorio en la unidad de cuidados intensivos no afecta a los desenlaces en pacientes con comorbilidades graves sometidos a cirugías programadas

OBJECTIVE: The impact of postoperative intensive care upon patient outcomes was evaluated by retrospectively investigating the rate of poor outcomes among miscellaneous elective surgical patients with severe comorbidities. DESIGN: A retrospective cohort study was carried out. SETTING: University hospital. PATIENTS: Surgical patients with severe comorbidities. Intervention: The outcomes of 1218 surgical patients treated in intensive care units (ICUs) and postsurgical wards (ICU group vs. non-ICU group) were reviewed for poor outcomes (i. e. , no discharge or death). A propensity score analysis was used to generate 248 matched pairs of ICU-admitted patients and controls. Variables of interest: Poor outcome rates on postoperative day 90 and mortality on postoperative days 30 and 90. RESULTS: No significant between-group differences were observed in terms of poor outcomes on postoperative day 90 [ICU vs. non-ICU: 33/248 (13%) vs.28/248 (11%), respectively; ICU odds ratio (OR): 1.19, 95% confidence interval (CI), 0.71-2.01, p = 0.596] or in between-group differences in terms of mortality on postoperative days 30 and 90 [ICU vs. non-ICU: 4/248 (1.6%) vs.2/248 (0.8%) on postoperative day 30 and 5/248 (2.0%) vs.3/248 (1.2%) on day 90, respectively; ICU OR (95% CI), 2.00 (0.37-10.9) and 1.67 (0.40-6.97) for postoperative 30- and 90-day mortality, respectively (p = 0.683 and 0.724)]. Low preoperative body weight was negatively correlated to patient outcomes [OR (95% CI): 0.82/10 kg (0.70-0.97), p = 0.019], whereas regional analgesia combined with general anesthesia was positively correlated to patient outcomes [OR (95% CI): 0.39 (0.69-0.96), p = 0.006]. Extra ICU admission was correlated to poor patient outcomes [OR (95% CI): 4.18 (2.23-7.81), p < 0.0001]. CONCLUSIONS: Postoperative ICU admission failed to demonstrate any meaningful benefits in patients with severe comorbidities undergoing miscellaneous elective surgeries

OBJETIVO: Se evaluó el impacto de los cuidados intensivos postoperatorios sobre los desenlaces de los pacientes investigando de forma retrospectiva la tasa de desenlaces desfavorables en un grupo variado de pacientes con comorbilidades graves que se sometieron a cirugías programadas. DISEÑO: Estudio retrospectivo de cohortes. Ámbito: Hospital universitario. PACIENTES: Pacientes quirúrgicos con comorbilidades graves. INTERVENCIONES: Se revisaron los desenlaces de 1.218 pacientes quirúrgicos tratados en unidades de cuidados intensivos (UCI) y plantas posquirúrgicas (grupo UCI frente a grupo no UCI) en busca de desenlaces desfavorables (esto es, ausencia de alta o muerte). Se llevó a cabo un análisis de puntuación de la propensión para generar 248 parejas de pacientes ingresados en la UCI y sus respectivos pacientes de control. Variables de interés: Tasas de desenlaces desfavorables al día 90 tras la intervención y mortalidad a los 30 y 90 días de la intervención. RESULTADOS: No se observaron diferencias significativas entre los grupos en cuanto a desenlaces desfavorables el día 90 tras la intervención (UCI frente a no UCI: 33/248 [13%] frente a 28/248 [11%], respectivamente; oportunidad relativa [OR]: 1,19; intervalo de confianza [IC] del 95%: 0,71-2,01; p = 0,596) ni diferencias entre los grupos en términos de mortalidad al cabo de 30 y 90 días tras la intervención (UCI frente a no UCI: 4/248 [1,6%] frente a 2/248 [0,8%] el día 30 tras la intervención y 5/248 [2,0%] frente a 3/248 [1,2%] el día 90, respectivamente; OR UCI [IC del 95%]: 2,00 [0,37-10,9] y 1,67 [0,40-6,97] para la mortalidad a los 30 y 90 días de la intervención, respectivamente [p = 0,683 y 0,724]). El bajo peso preoperatorio presentó una correlación negativa con los desenlaces de los pacientes (OR [IC del 95%]: 0,82/10 kg [0,70-0,97]; p = 0,019), mientras que la analgesia regional combinada con anestesia general y el ingreso fuera de la UCI presentó una correlación positiva con los desenlaces de los pacientes (OR [IC del 95%]: 0,39 [0,69-0,96]; p = 0,006). El ingreso extra en la UCI se correlacionó con malos resultados para el paciente (OR [IC del 95%]: 4,18 [2,23-7,81], p < 0,0001). CONCLUSIONES: El ingreso posoperatorio en la UCI no demostró asociarse con ningún beneficio significativo en un grupo variado de pacientes con comorbilidades graves sometidos a cirugías programadas

Safety of tapering tacrolimus dose in patients with well-controlled anti-acetylcholine receptor antibody-positive myasthenia gravis.

BACKGROUND AND PURPOSE: Tapering immunosuppressants is desirable in patients with well-controlled myasthenia gravis (MG). However, the association between tapering of calcineurin inhibitor dosage and reduction-associated exacerbation is not known. The aim of this study was to clarify the frequency of reduction-associated exacerbation when tacrolimus is tapered in stable patients with anti-acetylcholine receptor antibody-positive MG, and to determine the factors that predict exacerbations. METHODS: We retrospectively analyzed 115 patients in whom tacrolimus dosage was tapered. The reduction-associated exacerbation was defined as the appearance or worsening of one or more MG symptoms <3 months after the reduction. RESULTS: Tacrolimus dosage was successfully tapered in 110 patients (96%) without any exacerbation. Five patients (4%) experienced an exacerbation, but symptoms were reversed in all patients when the tacrolimus dose was increased to the previous maintenance level. No patient developed an MG crisis. The age at onset was significantly earlier (30 vs. 56 years, P = 0.025) and the reduction in dosage was significantly larger (2.0 vs. 1.0 mg/day, P = 0.002) in patients with reduction-associated exacerbation than in those without exacerbation. The cut-off values determined in a receiver-operating characteristic curve analysis were 52 years (sensitivity, 57%; specificity, 100%) for the age at onset and 1.5 mg (sensitivity, 80%; specificity, 100%) for the dose reduction. CONCLUSION: Tapering of tacrolimus was possible in most patients with well-controlled anti-acetylcholine receptor antibody-positive MG. Early age at onset and a large reduction from maintenance dosage were associated with exacerbation. Reductions ≤1.5 mg/day from the maintenance dosage should be considered for patients with late-onset disease.

Postoperative intensive care unit admission does not affect outcomes in elective surgical patients with severe comorbidity.

OBJECTIVE: The impact of postoperative intensive care upon patient outcomes was evaluated by retrospectively investigating the rate of poor outcomes among miscellaneous elective surgical patients with severe comorbidities. DESIGN: A retrospective cohort study was carried out. SETTING: University hospital. PATIENTS: Surgical patients with severe comorbidities. INTERVENTION: The outcomes of 1218 surgical patients treated in intensive care units (ICUs) and postsurgical wards (ICU group vs. non-ICU group) were reviewed for poor outcomes (i.e., no discharge or death). A propensity score analysis was used to generate 248 matched pairs of ICU-admitted patients and controls. VARIABLES OF INTEREST: Poor outcome rates on postoperative day 90 and mortality on postoperative days 30 and 90. RESULTS: No significant between-group differences were observed in terms of poor outcomes on postoperative day 90 [ICU vs. non-ICU: 33/248 (13%) vs. 28/248 (11%), respectively; ICU odds ratio (OR): 1.19, 95% confidence interval (CI), 0.71-2.01, p=0.596] or in between-group differences in terms of mortality on postoperative days 30 and 90 [ICU vs. non-ICU: 4/248 (1.6%) vs. 2/248 (0.8%) on postoperative day 30 and 5/248 (2.0%) vs. 3/248 (1.2%) on day 90, respectively; ICU OR (95% CI), 2.00 (0.37-10.9) and 1.67 (0.40-6.97) for postoperative 30- and 90-day mortality, respectively (p=0.683 and 0.724)]. Low preoperative body weight was negatively correlated to patient outcomes [OR (95% CI): 0.82/10kg (0.70-0.97), p=0.019], whereas regional analgesia combined with general anesthesia was positively correlated to patient outcomes [OR (95% CI): 0.39 (0.69-0.96), p=0.006]. Extra ICU admission was correlated to poor patient outcomes [OR (95% CI): 4.18 (2.23-7.81), p < 0.0001]. CONCLUSIONS: Postoperative ICU admission failed to demonstrate any meaningful benefits in patients with severe comorbidities undergoing miscellaneous elective surgeries.

Diagnostic role of mean platelet volume in tonsillitis with and without peritonsillar abscess.

OBJECTIVE: To assess the diagnostic role of mean platelet volume in tonsillitis with and without peritonsillar abscess. METHODS: Mean platelet volume and other laboratory data were retrospectively investigated. RESULTS: Mean platelet volume was significantly lower in the tonsillitis group (7.8 per cent ± 0.7 per cent) than in the control group (8.7 per cent ± 0.6 per cent; p < 0.0001), and it was significantly lower in the abscess group (7.5 per cent ± 0.6 per cent) than in the no abscess group (8.0 per cent ± 0.7 per cent; p = 0.0277). White blood cell counts and C-reactive protein levels were not significantly different between patients with an abscess and those without. The mean platelet volume cut-off values for the diagnosis of tonsillitis and peritonsillar abscess were 7.95 fl and 7.75 fl, respectively. CONCLUSION: Our results suggest that a decreased mean platelet volume is associated with the development and severity of tonsillitis. This finding provides useful diagnostic information for physicians treating patients with tonsillitis.

Differences in pain thresholds elicited by intraoral electrical stimuli between individuals with and without diabetes mellitus.

There is little evidence of sensation in individuals with diabetes mellitus (DM) in the dental research field. We investigated whether pain thresholds (PTs) differ between individuals with and without DM (non-DM; NDM). To this end, we assessed whether PTs obtained from the oral cavity, hands, and feet differed from each other and across groups, and whether PTs differed for the three current frequencies used for testing (2000 Hz, 250 Hz, and 5 Hz). Pain threshold measurements were obtained from the oral mucosa and the tips of the fingers and toes of 56 volunteers, including 21 individuals with DM (12 men and 9 women, average age: 72.1 ± 4.7 years) and 35 NDM individuals (17 males and 18 females, average age: 51.2 ± 23.9 years) using the Neurometer CPT/C® device to deliver electrical stimulation. A single operator obtained PT measurements from around the left greater palatine foramen and from the tip of the left first finger and of the left great toe. Individuals with DM had significantly lower PT values than those without DM. The PT values for the oral cavity, hands, and feet differed significantly from each other (foot > hand, foot > oral cavity, hand > oral cavity). Moreover, there was a significant difference in the PT values for 5 Hz and 2000 Hz, as well as for 250 Hz and 2000 Hz. This study concluded that PT values derived from DM participants are lower than those from NDM participants, although PT measurements varied across regions and with current frequency.

Perfusion MR Imaging Using a 3D Pulsed Continuous Arterial Spin-Labeling Method for Acute Cerebral Infarction Classified as Branch Atheromatous Disease Involving the Lenticulostriate Artery Territory.

BACKGROUND AND PURPOSE: Branch atheromatous disease is a stroke subtype considered a risk factor for early neurologic deterioration. Meanwhile, crossed cerebellar diaschisis is thought to be influenced by the degree and location of supratentorial perfusion abnormalities and is associated with the clinical outcome in the case of an ischemic stroke. In this article, our aim was to clarify the utility of using a whole-brain 3D pulsed continuous arterial spin-labeling method as an imaging biomarker for predicting neurologic severity in branch atheromatous disease. MATERIALS AND METHODS: Twenty-three patients with branch atheromatous disease in the lenticulostriate artery territory were enrolled. All patients underwent MR imaging, including DWI, 3D-TOF-MRA, and 3D-arterial spin-labeling. We measured the asymmetry index of CBF in the affected area (branch atheromatous disease), the asymmetry index of the contralateral cerebellar hemisphere (crossed cerebellar diaschisis), and the DWI infarct volume in the lenticulostriate artery territory. We also compared each parameter with the initial NIHSS score with the Pearson correlation coefficient. RESULTS: Among the 23 patients, we found no correlation between NIHSS score and the asymmetry index of CBF in the affected area (branch atheromatous disease) (r = -0.027, P = .724), whereas the asymmetry index of the contralateral cerebellar hemisphere (crossed cerebellar diaschisis) and DWI infarct volumes were significantly correlated with NIHSS score (r = 0.515, P = .012; r = 0.664, P = .001, respectively). CONCLUSIONS: In patients with branch atheromatous disease, 3D-arterial spin-labeling can detect crossed cerebellar diaschisis, which is correlated with the degree of neurologic severity.

Sialadenoma papilliferum in the buccal mucosa detected on 18F-fluorodeoxyglucose-positron emission tomography.

An incidental discovery of an accumulation of 18F-fluorodeoxyglucose (FDG) in the oral cavity of patients with malignant tumours on FDG positron emission tomography (PET) can pose a problem regarding the differential diagnosis of metastatic lesions. Large accumulations can often be found even when tumours in the salivary or thyroid gland are benign, so FDG-PET is limited in its ability to differentiate between benign and malignant disease. This report describes a rare case of sialadenoma papilliferum in the buccal mucosa that was discovered incidentally on FDG-PET in a patient with multiple metastases to bone after an operation for rectal cancer.

Efficacy and safety of rebamipide liquid for chemoradiotherapy-induced oral mucositis in patients with head and neck cancer: a multicenter, randomized, double-blind, placebo-controlled, parallel-group phase II study.

BACKGROUND: Recent preclinical and phase I studies have reported that rebamipide decreased the severity of chemoradiotherapy-induced oral mucositis in patients with oral cancer. This placebo-controlled randomized phase II study assessed the clinical benefit of rebamipide in reducing the incidence of severe chemoradiotherapy-induced oral mucositis in patients with head and neck cancer (HNC). METHODS: Patients aged 20-75 years with HNC who were scheduled to receive chemoradiotherapy were enrolled. Patients were randomized to receive rebamipide 2% liquid, rebamipide 4% liquid, or placebo. The primary endpoint was the incidence of grade ≥ 3 oral mucositis determined by clinical examination and assessed by central review according to the Common Terminology Criteria of Adverse Events version 3.0. Secondary endpoints were the time to onset of grade ≥ 3 oral mucositis and the incidence of functional impairment (grade ≥ 3) based on the evaluation by the Oral Mucositis Evaluation Committee. RESULTS: From April 2014 to August 2015, 97 patients with HNC were enrolled, of whom 94 received treatment. The incidence of grade ≥ 3 oral mucositis was 29% and 25% in the rebamipide 2% and 4% groups, respectively, compared with 39% in the placebo group. The proportion of patients who did not develop grade ≥ 3 oral mucositis by day 50 of treatment was 57.9% in the placebo group, whereas the proportion was 68.0% in the rebamipide 2% group and 71.3% in the rebamipide 4% group. The incidences of adverse events potentially related to the study drug were 16%, 26%, and 13% in the placebo, rebamipide 2%, and rebamipide 4% groups, respectively. There was no significant difference in treatment compliance among the groups. CONCLUSIONS: The present phase II study suggests that mouth washing with rebamipide may be effective and safe for patients with HNC receiving chemoradiotherapy, and 4% liquid is the optimal dose of rebamipide. TRIAL REGISTRATION: ClinicalTrials.gov under the identifier NCT02085460 (the date of trial registration: March 11, 2014).

Taste-related sensations in old age.

The sense of taste is important as it allows for assessment of nutritional value, safety and quality of foods as well as for food enjoyment and quality of life. Several factors are suggested to be associated with taste sensitivity, and higher prevalence of taste disorder has been reported among older adults. This review focused on the reported causes and correlates of taste decline in older adults, with the aim to consolidating existing evidence and identifying gaps and limitations. Using a scoping review methodology, we sought relevant literature from the last 20 years. Search terms included taste, gustatory sense, older adults and geriatric. Considered research was limited to reports that involved research participants over 60 years old, papers written in English, and manuscripts published after 1995. We have consolidated available evidences on the influences on taste-related sensations among international cohorts of older adults. Influences can be reflected under the topics of physiological changes in the sensory organs, physiological and behavioural variables related to taste sensation. This review identified three areas of historic and current research endeavour related to studies of taste sensation in older subjects: physiological changes in the sensory organs, factors related to the ageing of the individual and behavioural variables affecting taste-related sensation. Key limitations and gaps in the current literature include notable lack of consideration of potential confounding, mediating and moderating effects, while future research is indicated in the areas of measuring the quality of health and life. As global population ageing accelerates in the coming decades, maintaining taste sensations and sensitivity in older adults will be a key measure to ensuring quality of health and life.

Intravenous immunoglobulin contributes to the control of antimelanoma differentiation-associated protein 5 antibody-associated dermatomyositis with palmar violaceous macules/papules.

Autoantibodies to melanoma differentiation-associated protein 5 (MDA5) are associated with a subset of patients with dermatomyositis (DM) who have rapidly progressive interstitial lung disease (RP-ILD) with poor prognosis. Intensive immunosuppressive therapy is initiated before irreversible lung damage can occur; however, there are few lines of evidence for the treatment of RP-ILD. Here, we report three cases of anti-MDA5 antibody-associated DM with RP-ILD in which the patients were treated with combined-modality therapy, including high-dose prednisolone, tacrolimus, intravenous cyclophosphamide and intravenous immunoglobulin (IVIG). In all three cases, serum ferritin levels, which are known to represent the disease activity of RP-ILD, were decreased after IVIG administration. IVIG might contribute to the control of the disease activity of anti-MDA5 antibody-positive DM. Moreover, palmar violaceous macules/papules around the interphalangeal joints, which was observed in all three cases in the incipient stage, might be a useful sign in suggesting a diagnosis of anti-MDA5 antibody-associated DM.

CXCL4 is a novel nickel-binding protein and augments nickel allergy.

BACKGROUND: Nickel (Ni) is the most frequent metal allergen and induces a TH1 -dependent type-IV allergy. Although Ni2+ is considered to bind to endogenous proteins, it currently remains unclear whether these Ni-binding proteins are involved in Ni allergy in vivo. We previously reported the adjuvant effects of lipopolysaccharide (LPS) in a Ni allergy mouse model. As LPS induces a number of inflammatory mediators, we hypothesized that Ni-binding protein(s) are also induced by LPS. OBJECTIVE: The objective of this study was to purify and identify Ni-binding protein(s) from serum taken from LPS-injected mice (referred as LPS serum) and examined the augmenting effects of these Ni-binding protein(s) on Ni allergy in an in vivo model. METHODS: BALB/cA mice were sensitized with an i.p. injection of NiCl2 and LPS. Ten days after sensitization, mice were challenged with NiCl2 by an i.d. injection into ear pinnae. Ni-binding protein(s) were purified by Ni-affinity column chromatography and gel filtration. RESULTS: Lipopolysaccharide serum, but not serum taken from saline-injected mice, augmented ear swelling induced by Ni-allergic inflammation. Ni-binding, but not non-binding fraction, purified from LPS serum augmented Ni-allergic inflammation. Mass spectrometry and Western blotting detected CXCL4 in the active fraction. A batch analysis with Ni-sepharose and a surface plasmon resonance analysis revealed direct binding between CXCL4 and Ni2+ . Recombinant CXCL4 augmented Ni-allergic inflammation and exerted adjuvant effects at the sensitization phase. CONCLUSIONS: These results indicate that CXCL4 is a novel Ni-binding protein that augments Ni allergy at the elicitation and sensitization phases. This is the first study to demonstrate that the Ni-binding protein augments Ni allergy in vivo.

Study of factors related to the reflection abilities of dental trainees.

INTRODUCTION: This study analysed the internal and external factors related to the reflection abilities of dental trainees. PARTICIPANTS AND METHODS: We created transcripts from oral presentations by the dental trainees of Hiroshima University Hospital (n = 35, 2012-2013) at a significant event analysis conference. The reflection depths were compared between the trainees of the university hospital and external clinical combination groups. We determined and statistically analysed the reflection depths. RESULTS: At the end of training, a Mann-Whitney U-test revealed a significant difference in the median reflection depths of the groups (U = 66, W = 342 and P = 0.007). The results of multiple regression analysis indicated a significant relation between the reflection depth and external training completion (P = 0.024). There were no relations with other factors, including gender and academic background. CONCLUSION: Experiences in external clinics create a close connection between the staff and trainees because communities of practice can cause deeper reflections. We need to create small groups in large-scale organisations such as university hospitals. This construct can be adapted not only for Japanese dental trainees but also for global dental and other medical trainees.