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.

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.

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.

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.

Effect of low-level laser irradiation on osteoglycin gene expression in osteoblasts.

Many studies have attempted to elucidate the mechanism of the biostimulatory effects of low-level laser irradiation (LLLI), but the molecular basis of these effects remains obscure. We investigated the stimulatory effect of LLLI on bone formation during the early proliferation stage of cultured osteoblastic cells. A mouse calvaria-derived osteoblastic cell line, MC3T3-E1, was utilised to perform a cDNA microarray hybridisation to identify genes that induced expression by LLLI at the early stage. Among those genes that showed at least a twofold increased expression, the osteoglycin/mimecan gene was upregulated 2.3-fold at 2 h after LLLI. Osteoglycin is a small leucine-rich proteoglycan (SLRP) of the extracellular matrix which was previously called the osteoinductive factor. SLRP are abundantly contained in the bone matrix, cartilage cells and connective tissues, and are thought to regulate cell proliferation, differentiation and adhesion in close association with collagen and many other growth factors. We investigated the time-related expression of this gene by LLLI using a reverse transcription polymerase chain reaction (RT-PCR) method, and more precisely with a real-time PCR method, and found increases of 1.5-2-fold at 2-4 h after LLLI compared with the non-irradiated controls. These results suggest that the increased expression of the osteoglycin gene by LLLI in the early proliferation stage of cultured osteoblastic cells may play an important role in the stimulation of bone formation in concert with matrix proteins and growth factors.

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.

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.

Phylogenetic investigation for the risk of hepatitis C virus transmission to surgical and dental patients.

Blood loss during treatment carries a potential risk for the transmission of blood-borne pathogens in hospital patients. To determine whether nosocomial transmission of hepatitis C virus (HCV) occurs in surgical wards and dental hospitals, we tested anti-HCV antibodies and HCV RNA in sera from these patients and analysed the hypervariable region 1 (HVR1) sequence of HCV phylogenetically in the HCV RNA-positive patients. Five of 83 patients from a surgical ward were positive for HCV RNA, and six patients from one dental hospital and nine patients from a second were found to be positive for HCV RNA during the examination period. The HVR1 sequences were amplified from these patients' serum, and after subcloning, multiple clones of the HVR1 sequence from each patient were determined. The phylogenetic analysis of these sequences showed that HVR1 species from each patient could be classified into one to three genetic clusters of HVR1 quasi-species and that these clusters were independent of each other among patients. Thus, there was no evidence of HCV transmission in our study, and unrecognized transmission of HCV may be a rare event in surgical and dental patients at university hospitals.

[New trends in neoadjuvant chemoradiotherapy for locally-advanced esophageal cancer: esophagectomy--is it necessary?].

In responders to neoadjuvant chemoradiotherapy for locally-advanced esophageal cancer, there was no significant difference in the long-term outcome between patients who underwent esophagectomy and those who did not. Esophagectomy might be unnecessary for patients who achieve a complete response with chemoradiotherapy for an esophageal cancer, in cases when salvage surgery is considered in order to treat any future recurrence.

Synthesis and antitumor activity of benzimidazolyl-1,3,5-triazine and benzimidazolylpyrimidine derivatives.

Triamino-substituted 1,3,5-triazine and pyrimidine derivatives were synthesized and tested for antitumor activities using some human cancer cell lines and murine leukemia cell lines. All the compounds having benzimidazolyl and morpholino groups as substituents on the 1,3,5-triazine ring showed antitumor activity. Pyrimidine derivatives having the same groups as substituents also showed antitumor activity. Among them, the compounds having 1-benzimidazolyl, morpholino and cis-2,3-dimethylmorpholino groups as substituents on the 1,3,5-triazine ring or pyrimidine ring exhibited the most potent antitumor activity, and these compounds exhibited no or very weak aromatase inhibitory activity. In contrast, the compounds having imidazolyl group instead of benzimidazolyl group as a substituent on the 1,3,5-triazine ring showed a potent aromatase inhibitory activity.

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).

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.

Specific preinduction of 60-kDa heat shock protein (chaperonin homolog) by TRH does not protect colonic mucosa against acetic acid-induced lesion in rats.

In order to study the cytoprotective function of colonic heat shock proteins (HSPs) in vivo, the effect of specific preinduction of HSP60 by thyrotropin-releasing hormone (TRH) administration on the development of acetic acid-induced colonic mucosal lesion was investigated. Expression of 60-kDa, 72-kDa, and 90-kDa heat shock proteins (HSP60, HSP72, and HSP90, respectively) in rat colonic mucosa was investigated by western blot and immunohistochemical analyses before and after TRH administration. Following pretreatment with or without TRH administration, the rats received intrarectal infusion of 5% acetic acid. The colonic mucosal damage was macroscopically evaluated 24 hr after the intrarectal infusion of acetic acid. Expression of HSP60 was significantly increased by TRH administration in the colonic mucosa, whereas HSP72 and HSP90 did not increase. Immunohistochemical study also showed a significant increase in HSP60 in colonic mucosal cells, especially at the surface of the colonic mucosa after TRH administration. No histopathologic alteration was observed in the colonic mucosa after TRH administration. The colonic mucosal damage caused by intrarectal infusion of 5% acetic acid was not prevented by preinduction of HSP60. We demonstrated that specific preinduction of HSP60 by TRH administration did not show cytoprotective function in the colonic mucosa, although this protein plays a crucial role for cytoprotection in the pancreatic acinar cells. Our results indicate that the role of HSP60 may be different in each organ with respect to cytoprotection.

The validity and reproducibility of an oral rating index as a measurement of gingival health care and oral hygiene level in adults.

The purpose of this study was to investigate the validity and reproducibility of an oral rating index (ORI) as a conceptual measurement of "gingival health care" level in adults. The study was conducted on 163 patients who received medical examinations and attended for dental checkups at a hospital. The score of the ORI was recorded as excellent (+2), good (+ 1), questionable (0), poor (-1) or very poor (-2). The validity of the ORI was investigated by comparing it with: Jackson's gingivitis index (GI); Greene & Vermillion's debris index (DI) and calculus index (CI); probing pocket depth (PPD); and percentage of bleeding on probing (%BOP). The intra- and inter-examiner reproducibility of the ORI was assessed on a flat screen using patients' color transparencies of the mouth. The ORI had significantly negative correlations with the GI, DI, CI, and PPD (p<0.001). The K values were 0.604-0.672 for intra-examiner reproducibility, and 0.441-0.449 for inter-examiner reproducibility. The present study suggests that the ORI has moderate to good intra-examiner and inter-examiner reproducibility. Mouth examination using the ORI appears to provide useful information that will enable a dental professional or health educator to make sensible decisions on the type and level of oral health instruction according to adults' gingival health care level.

Radical esophagectomy and secondary anastomosis for high-risk patients with intrathoracic esophageal carcinoma.

OBJECTIVE: We have often conducted esophageal reconstruction via a thoracic subcutaneous route in high-risk patients to avoid major complications following anastomotic leakage. This type of reconstruction is nonphysiological, however, and presents a poor cosmetic appearance. In better risk patients, therefore, we usually conduct gastric-tube replacement via a posterior mediastinal route. We have recently begun gastric-tube replacement via the posterior mediastinal route with secondary anastomosis for high-risk patients to avoid anastomotic leakage. RESULTS: From 1996 to 1999, secondary anastomosis was conducted in 25 patients with different degrees of risk--10 with diabetes mellitus, 7 with liver dysfunction, 3 with simultaneous laryngeal and/or pharyngeal cancer, 2 each with induction chemoradiotherapy, cardiac failure, renal dysfunction, respiratory failure, and cardiorespiratory dysfunction, and 1 with cerebral infarction. 6 patients had with multiple combined diseases. Secondary anastomosis was conducted 3-12 weeks (mean: 5.5 weeks) after esophagectomy. Stomach-tube necrosis was not seen in any of the 25 patients undergoing this 2-step procedure. Anastomosis leakage was seen in 5 of the 25 patients (20%), but was slight, in all but 1. CONCLUSION: Our 2-step procedure has the following advantages: low risk of anastomotic leakage, radical surgery for esophageal cancer, the potential for early adjuvant therapy after esophagectomy, easy and early training in swallowing, and no cosmetic problem. Its disadvantages are prolonged hospitalization, multiple surgery, and esophageal stoma formation. Secondary anastomosis thus appears helpful in treating high-risk patients with advanced esophageal cancer.

An assessment of oral self-care level among Japanese dental hygiene students and general nursing students using the Hiroshima University--Dental Behavioural Inventory (HU-DBI): surveys in 1990/1999.

PURPOSE: The purpose of this study was to determine the differences in oral self-care levels between Japanese dental hygiene students and general nursing students in 1999, and compare them with a similar study in 1990. METHODS: The examination was mainly based upon responses to a questionnaire titled "Hiroshima University--Dental Behavioural Inventory (HU-DBI)". Higher scores of the HU-DBI indicate better oral health attitudes/behaviour. RESULTS: The mean HU-DBI score of the 2nd-year dental hygiene students was significantly greater than that of the 2nd-year nursing students (9.56 and 6.65, respectively; p<0.001), and much higher than those of the 1st-year students at each course (dental hygiene course; 6.30, nursing course; 5.88). Except for the 2nd-year dental hygiene class, there were no significant differences in the HU-DBI score between the 1990 and 1999 subgroups of each class. About 1/3 of the 2nd-year nursing students reported a belief that they may eventually require false teeth, while 6% of the 2nd-year dental hygiene students held this belief. More than 60% of this study sample stated that they put off going to the dentist until they had toothache. The 2nd-year dental hygiene students were more likely to have this attitude than their 1990 peers. Flossing was not popular among the nursing students in either 1990 or 1999. CONCLUSION: Although the difference in the HU-DBI score across time was not major, the variation in HU-DBI and the favourable attitudes/behaviour toward oral health appeared to reflect the differences in schooling between student hygienists and student nurses.

Corticosteroid pretreatment prevents small intestinal mucosal lesion induced by acetic acid-perfusion model in rats.

One of the important problems in experimentally induced small intestinal lesions is that there is no reproducible model of diffuse and stable mucosal lesion. In this paper, we studied in detail the effects of continuous perfusion of various concentrations of acetic acid on the rat small intestinal mucosa. In order to evaluate its applicability for screening of the preventive effect of drugs on gut damage, we also evaluated the efficacy of corticosteroid pretreatment in preventing acetic acid-induced mucosal lesion. Male Sprague-Dawley rats were fasted for 12 hr, and the small intestinal lumen was perfused with 1%, 1.5%, 2.5%, 3%, 3.75% (pH 2.4-2.6) acetic acid or saline (control) at 1 ml/min for 15 min. In separate experiments, the effect of preadministration of budesonide (0.5 or 0.75 mg/kg/day) and prednisone (0.75 mg/kg/day) on 1.5% acetic acid-induced mucosal damage was investigated. Macroscopic and microscopic lesions occurred diffusely in a concentration-dependent fashion. Histological findings revealed signs of transmural inflammation characterized by mucosal-submucosal edema, ulceration, and neutrophil infiltration. Mucosal-submucosal height had an inverse relation with the acetic acid concentrations perfused. Myeloperoxidase activity levels increased several-fold in the acetic acid-perfused groups. Corticosteroid pretreatment prevented microscopic damage and was associated with reduction of MPO activity levels in 1.5% acetic acid-perfused rats. We conclude that this simple and reproducible model could be applied for the screening of new drugs in the gastrointestinal tract in which large numbers of animals are taken into account.

Histopathological analysis of non-malignant and malignant epithelium in achalasia of the esophagus.

We studied the premalignant nature of achalasia using anti-Ki-67 and anti-p53 monoclonal antibodies immunohistochemically. In this study, four patients with esophageal carcinoma and achalasia were investigated. Three tumors were pT4 (UICC pTNM) and one tumor was pT1. The majority of non-malignant esophageal epithelium showed esophagitis and/or dysplasia histologically. Esophageal epithelial cells in the lesions of esophagitis and/or dysplasia had a higher number of Ki-67-positive cells than normal epithelial cells. p53 protein was expressed in two tumors and it was not expressed in non-malignant epithelium. From these results, we found that esophageal epithelium in achalasia lesions is changed to varying degrees of esophagitis and/or dysplasia by stagnation of intake foods, and these abnormal epithelial cells showed a high proliferative state compared with the normal cells without the p53 gene mutation. We suggest that the distinct proliferative status is a cause of carcinogenesis.