Formative Factors of Membranous Substances on Dorsum of Tongue, Teeth, Buccal Mucosa in Elderly Persons Requiring Nursing Care

要介護者の口腔粘膜にみられる付着物は，痰，痂皮，剥離上皮と呼ばれているが，上皮成分を主体とした付着物を剥離上皮膜と定義づけ，本研究にて，要介護高齢者の口腔内に形成された剥離上皮膜を部位別に形成要因を検討した。調査対象者は，入院中の患者のうち65 歳以上の要介護高齢者70 名であった（81.1±7.7 歳）。入院記録より年齢，疾患，常用薬，寝たきり度を調査し，意識レベル，発語の可否，介助磨きの頻度は担当看護師から聴取した。歯科医師が口腔内診査を行い，膜状物質の形成の有無，Gingival Index などを評価した。形成された膜状物質は，歯科医師がピンセットで採取した。粘膜保湿度（舌背部，舌下粘膜）は，粘膜湿潤度試験紙（キソウエット®）により10秒法で評価した。採取された膜状物質は，通法に従ってパラフィン切片を作製し，HE 染色とサイトケラチン1 による免疫染色で重層扁平上皮か否かについて確認し，重層扁平上皮由来の角質変性物が認められたものを剥離上皮膜と判断した。剥離上皮膜形成の有無を従属変数として，患者背景・口腔内の14 項目，疾患の15 項目，常用薬の32項目，合計61項目を独立変数として部位ごとで決定木分析を行った。すべての部位で剥離上皮膜の形成に最優先される要因は「摂食状況」であり，経口摂取者には，剥離上皮膜がみられなかった。第2 位は舌背部で舌背湿潤度，頰部で開口，歯面の第3 位が開口であり，口腔粘膜の乾燥を示唆する結果であった。以上，剥離上皮膜の形成要因には口腔乾燥があり，保湿の維持が剥離上皮膜の予防につながると考えられた

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Phenotypic alteration of basal cells in oral lichen planus; switching keratin 19 and desmoglein 1 expression

In oral lichen planus, extracellular matrix and basal cells are damaged by T-lymphocytes. As a consequence, changes in expression of collagen fibers within the connective tissue and cytoskeletons of the epithelial tissue can be observed. With the goal of examining the characteristic changes undergone by basal cells as a consequence of T-lymphocytes damage in oral lichen planus, we investigated protein expression in the epithelial-connective junction. We selected 20 cases of oral lichen planus and 5 control samples of buccal mucosa. Subsequently, we divided the oral lichen planus cases into thin and thick parts based on the mean values of epithelial thickness from the control samples, and counted the positive rate of collagen IV, keratin 19, desmoglein 1, and Ki-67. Collagen IV immune-reactivity partially disappeared or thickened in oral lichen planus. The keratin 19 positive rate in oral lichen planus cases was significantly lower than in the controls. Desmoglein 1 positive rate of the thick part was significantly higher compared to the thin part of oral lichen planus. Thus, modifications in basal cells with both reduced keratin 19 expression and alterations of desmoglein 1 expression suggest that in oral lichen planus, as a consequence of cell injury or regeneration in the interface area, there is a disappearance of the “true basal cell nature”

Bypassing the EPR effect with a nanomedicine harboring a sustained-release function allows better tumor control

The current enhanced permeability and retention (EPR)-based approved nanomedicines have had little impact in terms of prolongation of overall survival in patients with cancer. For example, the two Phase III trials comparing Doxil®, the first nanomedicine approved by the US Food and Drug Administration, with free doxorubicin did not find an actual translation of the EPR effect into a statistically significant increase in overall survival but did show less cardiotoxicity. In the current work, we used a two-factor factorial experimental design with intraperitoneal versus intravenous delivery and nanomedicine versus free drug as factors to test our hypothesis that regional (intraperitoneal) delivery of nanomedicine may better increase survival when compared with systemic delivery. In this study, we demonstrate that bypassing, rather than exploiting, the EPR effect via intraperitoneal delivery of nanomedicine harboring a sustained-release function demonstrates dual pharmacokinetic advantages, producing more efficient tumor control and suppressing the expression of stemness markers, epithelial-mesenchymal transition, angiogenesis signals, and multidrug resistance in the tumor microenvironment. Metastases to vital organs (eg, lung, liver, and lymphatic system) are also better controlled by intraperitoneal delivery of nanomedicine than by standard systemic delivery of the corresponding free drug. Moreover, the intraperitoneal delivery of nanomedicine has the potential to replace hyperthermic intraperitoneal chemotherapy because it shows equal efficacy and lower toxicity. In terms of efficacy, exploiting the EPR effect may not be the best approach for developing a nanomedicine. Because intraperitoneal chemotherapy is a type of regional chemotherapy, the pharmaceutical industry might consider the regional delivery of nanomedicine as a valid alternative pathway to develop their nanomedicine(s) with the goal of better tumor control in the future.Published versio

Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value

Malnutrition is associated with adverse outcomes in patients with liver cirrhosis. Relevant data about nutrition risk in critically ill cirrhotic patients are lacking. The modified Nutrition Risk in Critically Ill (mNUTRIC) score is a novel nutrition risk assessment tool specific for intensive care unit (ICU) patients. This retrospective study was conducted to evaluate the prevalence and prognostic significance of nutrition risk in cirrhotic patients with acute gastroesophageal variceal bleeding (GEVB) using mNUTRIC scores computed on admission to the intensive care unit. The major outcome was 6-week mortality. One-hundred-and-thirty-one admissions in 120 patients were analyzed. Thirty-eight percent of cirrhotic patients with acute GEVB were categorized as being at high nutrition risk (a mNUTRIC score of ≥5). There was a significantly progressive increase in mortality associated with the mNUTRIC score (χ2 for trend, p < 0.001). By using the area under a receiver operating characteristic (ROC) curve, the mNUTRIC demonstrated good discriminative power to predict 6-week mortality (AUROC 0.859). In multivariate analysis, the mNUTRIC score was an independent factor associated with 6-week mortality. In conclusion, the mNUTRIC score can serve as a tool to assess nutrition risk in cirrhotic patients with acute GEVB

Silymarin Accelerates Liver Regeneration after Partial Hepatectomy

Partial hepatectomy (PHx) is a liver regeneration physiological response induced to maintain homeostasis. Liver regeneration evolved presumably to protect wild animals from catastrophic liver loss caused by toxins or tissue injury. Silymarin (Sm) ability to stimulate liver regeneration has been an object of curiosity for many years. Silymarin has been investigated for use as an antioxidant and anticarcinogen. However, its use as a supportive treatment for liver damage is elusive. In this study, we fed silymarin (Sm, 25 mg/kg) to male Sprague-Dawley rats for 7 weeks. Surgical 2/3 PHx was then conducted on the rats at 6 hrs, 24 hrs, and 72 hrs. Western blot and RT-PCR were conducted to detect the cell cycle activities and silymarin effects on hepatic regeneration. The results showed that silymarin enhanced liver regeneration by accelerating the cell cycle in PHx liver. Silymarin led to increased G1 phase (cyclin D1/pRb), S phase (cyclin E/E2F), G2 phase (cyclin B), and M phase (cyclin A) protein and mRNA at 6 hrs, 24 hrs, and 72 hrs PHx. HGF, TGFα, and TGFβ1 growth factor expressions were also enhanced. We suggest that silymarin plays a crucial role in accelerated liver regeneration after PHx

Potential phytoestrogen alternatives exert cardio-protective mechanisms

The 17 beta-estradiol (E2) is a sex hormone that is most abundant and most active estrogen in premenopausal women. The importance of E2 in providing cardioprotection and reducing the occurrence of heart disease in women of reproductive age has been well recognized. There are three subtype of estrogen receptors (ERs), including ERα, ERβ and GPR30 have been identified and accumulating evidence reveal their roles on E2-mediated genomic and nongenomic pathway in cardiomyocytes against various cardiac insults. In this review, we focus on the estrogen and ERs mediated signaling pathways in cardiomyocytes that determines cardio-protection against various stresses and further discuss the clinical implication of ERs and phytoestrogens. Further we provide some insights on phytoeostrogens which may play as alternatives in estrogen replacement therapies

Synchronous double primary lung cancers via p53 pathway induced by heavy smoking

Differences in the histological manifestation of synchronous lung cancers are rare. Synchronous multiple primary lung cancers (SMPLC) are associated with long-term tobacco use, which could independently lead to mutations in the p53 and K-ras genes. We present the case of an 82-year-old man who smoked 30 cigarettes daily for the past 60 years. CT of the chest showed a right upper lobe mass. Bronchoscopy revealed an intra-lumen nodular lesion in the right lower lobe bronchus. The diagnoses of small cell lung carcinoma (SCLC) of the right upper lobe and non-small cell lung carcinoma (NSCLC) of the right lower lobe were confirmed by the morphologic features and the detected immunoreactivity. Immunohistochemical analyses showed a strong positive reaction for p53 in samples of the SCLC and NSCLC. The cancers had a different phenotype, but similar genetic abnormalities may have developed due to the carcinogens in the cigarettes