Requirement for Improved Undergraduate Education in Oral Traumatic Injuries

口腔外傷に関する教育の基準や指導内容が日常臨床を反映したものか否かを評価することを目的として、歯科医師国家試験(第95～ 104回) 3,510問題のうち口腔外傷に関する77問題について調査、検討を行った。 結果を以下に示す。 1.口腔外傷関連問題は各年約1～3%であった。 2.関連領域別では、口腔外科学(歯科放射線学を含む)、小児歯科学の順に多かった。 3.内容別では、一般問題においては「特徴」が多く、臨床実地問題においては「破折歯」の「治療」が最も多かった。 4.外傷の「予防」についての出題は無く、「児童虐待」に関する問題数は極めて少なかった。 5.臨床実地問題の約90%に視覚素材が使用されており、「口腔内写真」、「デンタルエックス線写真」の順に多かった。 本調査より、近年の歯科医師国家試験問題は概ね口腔外傷の診断や処置をする上で重要な項目について出題されていた。反面、近年注目されている「口腔外傷」と「児童虐待」との関係や「口腔外傷の予防」などの臨床上重要であるにも関わらず出題が無い、もしくは少ない項目もみられた。今後、これらの項目について、その重要性を裏付けするエビデンスの集積や、日本外傷歯学会ガイドラインへの追加などを行うことの必要性が示唆された。With remarkable developments in dentistry, the diagnosis and treatment of oral traumatic injuries have become relatively sophisticated. Dental students should be taught to respond to these developments through special dental education. This training should be taught in dental schools in accordance with fixed standards within dentistry teaching outlines, core curricula, CBT, and the standards of national dentistry examinations. However, there is a lack of data with regard to whether these standards of education in oral trauma are being met, making it difficult to evaluate whether a suitable education in oral trauma is being provided to students. We report here the results of an investigation of exam questions relating to dental trauma from ten consecutive national dentistry examinations (2002-2011). Questions regarding oral traumatic injuries represented only 1.3% of the total. We examined these questions for their subject, content and form. Most of the questions were asked in the section about "Oral Surgery (including Dental Radiology)" and the second highest number asked in "Pedodontics". For general dentistry, the contents of the questions were mostly related to "features" of the trauma and second about their "treatment" . For clinical practice, most of the questions were related to "treatment" and the next highest related to their "diagnosis" . No questions addressed the "prevention" of dental trauma, and very few questions concerned "child abuse." These are important aspects of a rounded education in oral trauma and it is suggested that the Association of Dental Traumatology plays a major role in collating new evidence and creating new guidelines for better dental education

Individualized Support Based on Characteristics of Patients with Autistic Spectrum Disorder in Pediatric Practice

自閉症スペクトラム障害(Autism Spectrum Disorder以下ASD)の小児には,知的障害の有無に関わらず整理統合が困難で視覚優位である者が多い。また,ASD児の能力には個人差があるため,支援者は障害特性に配慮した個別対応が要求される。ところが,歯科診療時におけるASD児の対応法に関する情報はいまだ不十分である。 そこで,当科にて歯科診療時に行ったASD児への個別対応のうち効果的であったものを報告する。 症例1 初診時2歳11か月,男児,高機能自閉症・AD/HD(注意欠如・多動性障害) この患児は,3歳時既に全ての干仮名と数字が読めた。そこで,診療に対する混乱の除去のため,文字情報で予定を可視化した(Word Schedule)。予定の最後を「ごほうび」と記し、強化子として患児の好きなキャラクターの塗り絵を使用した。 症例2 初診時6歳11か月,男児,白閉症(知的障害を伴う) 絵カードを予定の順に並べ(予定の構造化),入室前に患児へ見せた。治療のステップが1つ終わる度に,褒め言葉と同時に○のサインボードを見せた。これは,言葉だけでなく視覚的にもできたことや褒められたことを認識できるようにするための援助である。 以上の対応により,スムーズに診療が行えた。このように,ASD児の歯科診療の際には,個々の発達レベルや行動を十分に観察した上で個別化された支援方法により対応することが有効と考えられた。Many children with autistic spectrum disorder (ASD) and with or without intellectual disability have weak central coherence and a tendency to learn in a visual manner. Because of individual differences in the developmental status of ASD children, personalized support is optimal. However, there is scant published information about methods for providing individualized support in dental practice for children with ASD. Here, we describe effective strategies for providing individualized support in dental practice for children with ASD treated at our clinic. Case 1 : Boy, aged 2 years 11 months, with high-functioning autism and AD/HD This child was able to read hiragana letters and numerals at the age of 3. Therefore, we showed him information about the clinical procedures (Word schedule) to remove emotional confusion about dental practice. We noted "reward" in red to give him a clear concept of the finish. The reward was included as a "reinforcer" and we used a drawing of his favorite cartoon character. Case 2 : Boy, aged 6 years 11 months, with autism and intellectual disability Picture cards portraying the events of the dental procedures in sequential order were shown to the child prior to and during therapy, with the picture card for each event removed when that step had been completed and a signboard with a red circle containing words of praise shown to the child. Thus, he received praise visually as well as through verbal encouragement. We also showed the child a timer that counted down the seconds until the procedure would be completed. Using these approaches, we were able to successfully facilitate dental treatments for children with ASD. It is clear that an individualized method, generated by assessing the development and behavior of each child, is advantageous for providing support of children with ASD

Loop energy : A useful indicator of the hardness of minerals from depth-sensing indentation tests

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Heparin Cofactor II and Hyperglycemia

Aim: Accelerated thrombin action is associated with insulin resistance. It is known that upon activation by binding to dermatan sulfate proteoglycans, heparin cofactor Ⅱ(HCⅡ) inactivates thrombin in tissues. Because HCⅡ may be involved in glucose metabolism, we investigated the relationship between plasma HCⅡ activity and insulin resistance. Methods and Results: In a clinical study, statistical analysis was performed to examine the relationships between plasma HCⅡ activity, glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and homeostasis model assessment-insulin resistance (HOMA-IR) in elderly Japanese individuals with lifestyle-related diseases. Multiple regression analysis showed significant inverse relationships between plasma HCⅡ activity and HbA1c (p=0.014), FPG (p=0.007), and HOMA-IR (p= 0.041) in elderly Japanese subjects. In an animal study, HCⅡ＋/＋ mice and HCⅡ＋/− mice were fed with a normal diet or high-fat diet (HFD) until 25 weeks of age. HFD-fed HCⅡ＋/− mice exhibited larger adipocyte size, higher FPG level, hyperinsulinemia, compared to HFD-fed HCⅡ＋/＋ mice. In addition, HFD-fed HCⅡ＋/− mice exhibited augmented expression of monocyte chemoattractant protein-1 and tumor necrosis factor, and impaired phosphorylation of the serine/threonine kinase Akt and AMP-activated protein kinase in adipose tissue compared to HFD-fed HCⅡ＋/＋ mice. The expression of phosphoenolpyruvate carboxykinase and glucose-6-phosphatase was also enhanced in the hepatic tissues of HFD-fed HCⅡ＋/− mice. Conclusions: The present studies provide evidence to support the idea that HCⅡ plays an important role in the maintenance of glucose homeostasis by regulating insulin sensitivity in both humans and mice. Stimulators of HCⅡ production may serve as novel therapeutic tools for the treatment of type 2 diabetes