Assessment of Diagnosis Timing of Attention-Deficit/Hyperactivity Disorder in Working-Age Workers with Psychiatric Diseases Using Large Claims Data.

Attention deficit/hyperactivity disorder (ADHD) is a common developmental disorder. This study aims to clarify the timing of diagnosis of ADHD in working-age workers with psychiatric comorbidities using large claims data in Japan. Based on a literature survey, we identified 10 typical comorbidities of ADHD. Among 3064162 participants with social insurance, 215060 working-age workers who were diagnosed with the 10 typical comorbidities of ADHD were included. Cohort 1 consisted of 96994 patients with the index date set as the earliest date of diagnosis of a comorbidity within the 12-month screening and 12-month observation periods. In cohort 2, 107436 patients were included, and the first date of diagnosis of each comorbidity was used as the index month. In cohort 1, 0.19% of the patients were diagnosed with ADHD after being diagnosed with a typical comorbidity. In cohort 2, 4 out of 4 patients with ADHD and obsessive-compulsive disorders were diagnosis ADHD after obsessive-compulsive disorders. Pervasive developmental disorders were the highest comorbidity of ADHD for 62 out of 566 (11.0%) patients. This is the first study to determine the proportion of ADHD with typical comorbidities in working-age workers in Japan. Our findings highlight the need for timely diagnosis of ADHD to improve patients' QOL.

Effect of interprofessional education on cadaver dissection seminar.

In 2010, WHO published a "Framework for action on interprofessional education and collaborative practice." Interprofessional education (IPE) is now being conducted in various ways. We have been holding cadaver dissection seminars to provide opportunities for medical students, nursing students, and nurse practitioner (NP) students to learn together. In this study, we investigated the effect of learning about IPE in cadaver dissection seminars. The seminars were held for 5 days each in 2021 and 2022 (the number of days of participation was arbitrary). In the seminars, teams of 3-5 participants with the same theme collaborated to dissect a single donated cadaver. Teams were made up of participants with different departments: 29 medical students, 12 NP students, and 20 nursing students participated in the seminar, and participants were surveyed before and after the seminars. The Readiness for Interprofessional Learning Scale (RIPLS) scores before and after the dissection seminar increased significantly overall. The scores of medical and nursing students increased significantly, but those of NP students did not significantly change. In terms of the number of days of participation, a significant increase in scores was found for participants who participated for ≥ 2 days. Overall, a significant positive correlation was found between intrinsic motivation to learn and RIPLS scores. For medical students, a significant negative correlation was noted between extrinsic motivation and RIPLS scores. Cadaver dissection seminars conducted by medical, nursing, and NP students demonstrated IPE learning effect on medical students and undergraduate nursing students.

Effect of intensive care provided by nurse practitioners for postoperative patients: A retrospective observational before-and-after study.

Nurse practitioners are increasingly now members of intensive care teams in Japan, but no data exist about their effect on the outcomes for critically ill patients. This study aimed to compare the outcomes of postoperative patients on mechanical ventilators before and after the participation of nurse practitioners in intensive care teams. We retrospectively identified 387 patients who underwent postoperative mechanical ventilation at a University Hospital in Japan, using data from medical records from 1 April 2015 to 31 March 2017. We extracted data and compared patients' length of stay in the intensive care unit and the hospital, mechanical ventilation days, postoperative rehabilitation start date, rehabilitation prescription, intensive care unit and hospital mortality, and intensive care unit readmission. Multiple regression analysis was used to analyze the factors affecting length of stay in the intensive care unit. Patients who received care from nurse practitioners and physicians had significantly shorter stays in intensive care (4.8 ± 4.8 days versus 6.7 ± 10.3 days, p < 0.021). Mechanical ventilation days, total length of hospital stay, rehabilitation prescription, mortality in intensive care and hospital, and readmission to intensive care were all similar to those who received care only from physicians. The multiple regression analysis suggests that participation of nurse practitioners in intensive care reduced the length of stay in the unit by 2.6 days (p = 0.003). These findings could help to increase use of non-physician healthcare providers in intensive care. Our results demonstrated that it is both effective and safe for nurse practitioners to participate in intensive care teams that provide care for postoperative patients receiving mechanical ventilation.

Human Rickettsia heilongjiangensis infection, Japan.

A case of Rickettsia heilongjiangensis infection in Japan was identified in a 35-year-old man who had rash, fever, and eschars. Serum contained R. heilongjiangensis antibodies, and eschars contained R. heilongjiangensis DNA. R. heilongjiangensis was also isolated from ticks in the suspected geographic area of infection.

Class II Division 1 malocclusion with a high mandibular plane angle corrected with 2-phase treatment.

A 10-year-old girl with maxillary protrusion and crowding of the maxillary and mandibular anterior teeth was treated in 2 phases. In the first phase of treatment, maxillary anterior growth was restrained and mandibular anterior growth promoted for skeletal improvement. In the second phase, at age 13, 4 first premolars were extracted, and an edgewise appliance was used for alveolar improvement. Because the patient had a high mandibular plane angle with a large Frankfort-mandibular plane angle, special care was taken from the beginning to prevent mandibular clockwise rotation. The Frankfort-mandibular plane angle decreased 3.1 degrees at posttreatment. In addition to the skeletal changes, we obtained a favorable lateral profile. This was achieved by the alveolar changes from the lingual movement of the maxillary and mandibular anterior teeth, and the anterior growth of the nasal apex region. The occlusion was stable at the 38-month postretention follow-up.

Bite force measurement system using pressure-sensitive sheet and silicone impression material.

This study was conducted to reduce the bias in measured values caused by the thickness of materials used in occlusal examinations. To this end, a silicone impression material for bite force measurement and an experimental model of a simplified stomatognathic system were employed in this study. By means of this experimental model, results showed that the effect of bias toward the posterior arch could be reduced in the anterior-posterior distribution of bite forces and in the occlusal contact areas due to the thickness of the materials used in occlusal examinations.

A study on measuring occlusal contact area using silicone impression materials: an application of this method to the bite force measurement system using the pressure-sensitive sheet.

The aim of this study was to establish an objective and quantitative method of measuring occlusal contact areas. To this end, bite records were taken with a silicone impression material and a light transmission device was used to read the silicone impression material. To examine the effectiveness of this novel method, the occlusal contact area of the silicone impression material and its thickness limit of readable range were measured. Results of this study suggested that easy and highly accurate measurements of occlusal contact area could be obtained by selecting an optimal applied voltage of the light transmission device and an appropriate color of the silicone impression material.

Regulation of ERK-mediated signal transduction by p38 MAP kinase in human monocytic THP-1 cells.

SB 203580 has been widely used to specifically shut down the p38 MAP kinase-dependent pathway, although it is capable of inducing c-Raf kinase activity in cells. The present study demonstrates that SB 203580 activates members of the ERK cascade, c-Raf, MEK, and ERK, in human monocytic THP-1 cells. The activation of these kinases was sustained for at least 24 h after SB 203580 treatment and was also observed in U937 cells, suggesting that c-Raf efficiently transduces the signal even in the presence of the inhibitor in these cells. However, the expression of ERK cascade-dependent genes, such as c-fos and IL-1beta, was extremely limited. Analysis of the cellular distribution of ERK in SB 203580-treated cells indicated that nuclear translocation of phosphorylated ERK was impaired. Also, nuclear translocation of ERK induced by 12-O-tetradecanoyl-phorbol-13-acetate (TPA) was inhibited by SB 239063, which does not associate with c-Raf and is highly selective for p38 MAP kinase. In addition, the forced expression of the dominant negative mutant of p38 MAP kinase suppressed serum responsive element-dependent transactivation induced by TPA. These results suggest that the steady-state level of p38 MAP kinase activity modulates ERK signaling.

Effect of heat treatment conditions on the mechanical properties of Ti-6Mo-4Sn alloy for orthodontic wires.

ß-titanium alloy is frequently used in nickel-free orthodontic wires for patients with a metal allergy. However, the Young's modulus of ß-titanium alloy wires is lower than that of Co-Cr-Ni alloys, causing loss of anchorage and failure to prevent unwanted tooth movements. To improve its mechanical properties for use in anchorage appliances such as transpalatal arches, Ti-6Mo-4Sn alloy wire was heat-treated at 300, 400, 500 and 600 °C for 5 min, 30 min, and 4 h in this study. Tensile testing revealed that the wire heated at 500 °C/30 min had a Young's modulus of 75 GPa and a tensile strength of 1,650 MPa - the highest among all the heat treatment groups. Therefore, Ti-6Mo-4Sn alloy wire heat-treated at 500 °C/30 min yielded mechanical properties approximating those of wires currently used for retainers and transpalatal arches.

A comparison of the efficacy, relapse rate and side effects among three modalities of systemic corticosteroid therapy for alopecia areata.

BACKGROUND: Systemic corticosteroids are one of the most commonly used therapeutic modalities for patients with extensive alopecia areata (AA), although they entail several drawbacks. OBJECTIVE: To determine the best modality for systemic corticosteroid use in terms of their efficacy, relapse rate, and side effects. METHODS: Fifty-one patients with single or multiple AA (AA/multiplex) and 38 patients with alopecia totalis or AA universalis (AA totalis/universalis) were enrolled in this open study. They were randomly divided into three groups depending on the time of their initial visit. They were administered (1) oral dexamethasone (Dex) 0.5 mg/day for 6 months (Dex group), (2) intramuscular triamcinolone acetonide (imTA) 40 mg once a month for 6 months followed by 40 mg once every 1.5 months for 1 year (imTA group), and (3) pulse therapy (PT) using oral predonine 80 mg for 3 consecutive days once every 3 months (PT group). After the treatment, each treatment modality was evaluated by the response rate, relapse rate, and side effect profile. RESULTS: The response rate of AA/multiplex was significantly better in the imTA group than in the Dex group. The overall relapse rate and that of AA totalis/universalis were significantly better in the PT group than in the Dex group. Dysmenorrhea was the most common and problematic side effect. Impairment of the adrenocortical reserve was seen in 7% of the PT group and 23% of the imTA group, which was recovered without any further medical treatment. CONCLUSION: imTA or pulse therapy is effective for AA and has an acceptable level of side effects. The development of a new strategy to reduce the relapse rate is needed.

Cellular basis of the role of diesel exhaust particles in inducing Th2-dominant response.

There is growing evidence that diesel exhaust particles (DEP) can induce allergic diseases with increased IgE production and preferential activation of Th2 cells. To clarify the cellular basis of the role of DEP in the induction of Th2-dominant responses, we examined the effects of DEP on the cytokine production by T cells stimulated with anti-CD3/CD28 Ab and on that by monocyte-derived dendritic cells (MoDCs) stimulated with CD40L and/or IFN-gamma. We examined IFN-gamma, IL-4, IL-5, IL-8, and IL-10 produced by T cells and TNF-alpha, IL-1beta, IL-10, and IL-12 produced by MoDCs using real-time PCR analysis or by ELISA. To highlight the effects of DEP, we compared the effects of DEP with those of dexamethasone (DEX) and cyclosporin A (CyA). DEP significantly suppressed IFN-gamma mRNA expression and protein production, while it did not affect IL-4 or IL-5 mRNA expression or protein production. The suppressive effect on IFN-gamma mRNA expression was more potent than that of DEX and comparable at 30 mug/ml with 10(-7) M CyA. The suppressive effect on IFN-gamma production was also more potent than that of either DEX or CyA. DEP suppressed IL-12p40 and IL-12p35 mRNA expression and IL-12p40 and IL-12p70 production by MoDCs, while it augmented IL-1beta mRNA expression. Finally, by using a thiol antioxidant, N-acetyl cysteine, we found that the suppression of IFN-gamma production by DEP-treated T cells was mediated by oxidative stress. These data revealed a unique characteristic of DEP, namely that they induce a Th2 cytokine milieu in both T cells and dendritic cells.

Ber-EP4 antigen is a marker for a cell population related to the secondary hair germ.

Ber-EP4 is an antibody to a cell membrane glycoprotein of unknown function. In the skin, Ber-EP4 immunoreactivity has been reported to be localized in structures composed of basaloid epithelial cells, i.e. fetal epithelial germ cells, basal cell carcinoma, and trichoepithelioma as well as eccrine or apocrine ducts. In this study, we further characterized the follicular expression of Ber-EP4 immunoreactivity at different stages of the hair cycle of human terminal hair follicles. In addition, to clarify the location of Ber-EP4(+) cells, we compared the Ber-EP4 immunoreactivity with the expression of keratin 15 and keratin 19. Positive staining by Ber-EP4 was found in the lower part of the epithelial strand of late catagen hair follicles, in the secondary hair germ of telogen hair follicles, and in the matrix of early anagen hair follicles but not in any parts of mature anagen hair follicles. In contrast, the follicular expression of keratin 15 detected by using LHK15 antibody was restricted to two distinct parts of anagen hair follicles, i.e. the outer root sheath above the hair bulb and that of the isthmus including the bulge area, and to the outer root sheath of late catagen and telogen hair follicles. The follicular expressions of keratin 19 and that of keratin 15 were apparently superimposed, whereas keratin 15 expression was more extended. The immunoreactivity of LHK15 antibody and antikeratin 19 antibody against the secondary hair germ of telogen follicles was negative or dim. Our results suggest that Ber-EP4 reacts with the secondary hair germ and possibly a cell population related to the secondary hair germ but not with the presumptive stem cell population as revealed immunohistochemically either by the keratin 15 or keratin 19 expression.