Hypertension, Periodontal Disease, and Potassium Intake in Nonsmoking, Nondrinker African Women on No Medication

The purpose of this cross-sectional study was to investigate the association of periodontitis and/or tooth loss with hypertension by excluding the common confounders. Eighty-one Tanzanian women who were aged 46–58 years, nonsmokers, nonalcoholic drinkers, and on no medication underwent clinical examination. Multiple-regression analysis showed that the severity of periodontitis was significantly correlated with increased systolic blood pressure and diastolic blood pressure. Simple-regression analysis indicated that the severity of periodontitis was inversely correlated with 24-hour urinary excretion of potassium (r = −0.579, P = 0.0004) and also inversely with the frequency of intakes of green vegetables (r = −0.232, P = 0.031) and fruits (r = −0.217, P = 0.0043). Low-potassium intake in the diet mostly accompanied by low dietary fiber intake increases BP as well as periodontal inflammation. Potassium intake may be an important factor linking periodontitis and hypertension in middle-aged nonsmoking and nonalcoholic women on no medication, although chronic inflammation such as periodontitis may cause hypertension through a more direct mechanism

Expressions of ezrin, ERK, STAT3, and AKT in tongue cancer and association with tumor characteristics and patient survival.

Ezrin, ERK, STAT3, and AKT are proteins that are overexpressed in various types of cancer, although their expressions in tongue cancer has received less focus. This study aimed to address associations between the expression levels of these proteins and with characteristics of the tumor and patient survival. We performed immunohistochemical staining of ezrin, ERK, STAT3, and AKT in tumors from patients with tongue carcinoma in situ (CIS, n = 17) and tongue squamous cell carcinoma (SCC, n = 46). Statistical differences between the SCC versus the CIS cohorts were estimated by calculations of bivariate odds ratios of low versus high expression of the proteins. Fisher\u27s exact tests were used to appraise interassociations between the proteins, as well as expression levels versus patient and tumor characteristics. Survival based on Kaplan-Meier statistics in combination log-rank tests were used to address potential effects of the patient and tumor characteristics versus 5-year survival rate. The relative high: low expression of all four proteins in the two cohorts differed, and particularly ERK was markedly overexpressed in the SCC versus the CIS cohort (odds ratio = 45.3, p < .01). The relative high: low expression each protein versus patient and tumor characteristics; showed associations between AKT expression and T stage (p = .002) plus node metastases (p = .12), and between ERK expression and drinking (p = .01) and smoking history (p = .01). There was no significant difference observed between ERK and the three other molecules, nor any significant difference between the degree of expression of each protein and the 5-year disease-specific survival rate. Ezrin, ERK, STAT3, and AKT appear to be involved in the progress from carcinoma in situ in the tongue into squamous cell carcinoma. ERK in particular is overexpressed, suggesting that ERK may be a novel therapeutic target for preventing tongue cancer

Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients.

Aim:Prevention of medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis requires the cooperation of physicians and dentists. We investigated the knowledge, experience, and behaviour related to medical and dental cooperation for MRONJ prevention in patients with osteoporosis between physicians and dentists practising in the Shiga prefecture.Materials and methods:We conducted a cross-sectional study to investigate the cooperation between practising physicians and dentists for preventing osteonecrosis of the jaw (ONJ) in patients with osteoporosis using 2 separate questionnaires from July 28, 2018, to February 3, 2019, in Shiga prefecture, Japan.Results:Of 461 dentists who were sent the questionnaires at their dental clinics, 307 (67%) responded via fax. Of 846 physicians who were sent the questionnaire at their clinics, 378 (45%) responded via fax. Of these, 268 (32%) were finally analysed because 110 (13%) physicians had never treated patients with osteoporosis; 50% dentists and 24% physicians were familiar with the MRONJ position paper in Japan, and 39% dentists and 9% physicians had encountered MRONJ in their clinical practice. A total of 30% physicians had requested oral health care by a dentist before administering bone-modifying agents (BMA) therapy. The knowledge and experience of MRONJ differed between doctors and dentists.Conclusion:The behaviour of doctors and dentists was insufficient to enable medical and dental cooperation for the prevention of MRONJ in patients with osteoporosis. The lack of cooperation between physicians and dentists during osteoporosis treatment in the Shiga prefecture in Japan is documented in this study

当科が報告したインシデントレポートの分析

当院では 2010年7月からコンピューターを用いたインシデント報告システムを導入し,職員が匿名でインシデントを報告できる体制となっている.本体制運用開始後10年間に当科で報告されたインシデントレポート55件を患者影響レベルに従って8段階に分類した.レベル0は6件(10.9%),レベル1は14件 (25.5%),レベル2は13件(23.6%),レベル 3a は10件(18.2%),レベル3bは8件(14.5%),レベル4aは0件(0%),レベ4bは3件(5.4%),レベ5は1 件(1.8%)であった.当科におけるレベル別報告件数の比率は，重大なアクシデントと中等度のエラーと300のヒヤリ・ハットの比率が1：29：300であるというハインリッヒの法則に則っていなかった.しかし当科では2010年から2020年にかけてヒヤリ・ハット報告数は増加しているため,インシデントを報告する習慣が身につきつつあると考えられた.今後,より積極的に報告を行うように，職員へのさらなる啓蒙活動が医療事故の防止のために重要であると考えられた.In July 2010,we introduced a computerized incident reporting system, which allows staff to report incidents anonymously. The 55 incidents reported in our department during the first 10 years of operation of this system were classified into 8 levels according to the patient impact level. Level 0 was 6 incidents (10.9%),level 1 was 14 incidents (25.5%),level 2 was 13 incidents (23.6%),level 3a was 10 incidents (18.2%),level 3b was 8 incidents (14.5%),level 4a was 0 incidents (0%),level 4b was 3 incidents (5.4%),and level 5 was 1 incident (1.8%).The ratio of the number of reports by level in our department did not follow Heinrich\u27s law, which states that the ratio of serious incidents to moderate errors and 300 near-misses is 1:29:300.However,the number of Hiyari-Hatto reports increased from 2010 to 2020 in our department, suggesting that the habit of reporting incidents is becoming more common. In the future, it will be important to educate the staff to report more actively in order to prevent medical accidents

シガ イカ ダイガク イガクブ フゾクビョウイン ノ シュウジュツキ コウクウ キノウ カンリ ノ リンショウテキ トウケイ 2002ネン

滋賀医科大学医学部附属病院歯科口腔外科では2014年より, 周術期患者の口腔機能管理を目的とした「オーラルマネジメントシステム」を稼働した. 2015年には, 患者に快適, 安心, 安全な周術期医療を提供することを目的として, 多職種からなる「周術期チーム」が発足し, 当科はチームの一員として口腔機能管理を担っている. 今回われわれは, 2015年4月１日から2022年3月31日までの７年間の年度毎の全身麻酔手術件数, 周術期口腔機能管理依頼件数の推移と周術期口腔機能管理依頼率(1年間の全身麻酔手術件数に対する周術期口腔機能管理依頼件数の割合), 依頼件数の多かった診療科について臨床的検討を行った. 当院の2021年度の全身麻酔手術件数は4158件, 依頼件数は1931件, 依頼率は46.3%であり, オーラルマネジメントシステムを導入した2015年度より年々増加を認めていた. 診療科毎の依頼件数は消化器外科, 耳鼻咽喉科が多かった. 当科の院内啓蒙活動や周術期口腔機能管理により術後合併症のリスクが低下する報告が増えたことにより, 医科の周術期口腔機能管理の認知が高まり, 依頼件数, 依頼率の増加につながったと考える. 診療科毎の依頼件数に関しては, 歯科口腔領域と関係の深い診療科の依頼が多いと考えられた. 周術期チームが発足してから, 他職種連携は密となり, 依頼件数, 依頼率の増加を認めたが, 周術期口腔機能管理が, 術後合併症の予防を示すエビデンスはまだないため今後の課題と考えている.The Department of Oral Surgery of Shiga University Hospital launched the "Oral Management System" for the purpose of managing oral functions of perioperative patients, in 2014. "Perioperative team" consisting of members from various professions was established in 2015, with the aim of providing comfortable, safe, and secure perioperative care to patients. Our department is responsible for the management of oral functions. In this study, we conducted a clinical review of the number of general anesthesia cases per year, the number of requests for perioperative oral function management, the rate of requests for perioperative oral function management (the ratio of the number of requests for perioperative oral function management to the number of general anesthesia cases per year), and the departments with high number of requests for perioperative oral function management during the seven years from April 1, 2015, to March 31, 2022. The number of general anesthesia surgeries in our hospital in 2021 was 4158, and the number of requests was 1931, for a request rate of 46.3%. The number of requests had been increasing every year since 2015, when the oral management system was introduced. The number of requests per department was higher in the departments of gastroenterological surgery and otorhinolaryngology. The number of requests and the request rate increased. Because we consider that the awareness of perioperative oral functional management in the medical department has increased due to our hospital\u27s educational activities and an increase in the number of reports showing that perioperative oral function management reduced postoperative complications. After the perioperative team was established, the collaboration among other departments became closer, and the number of requests and the request rate increased. However, there is still no evidence that perioperative oral function management prevents postoperative complications, and this is an issue for the future

イ ネンマク シンジュン Th1 サイボウ ワ コウゲン シゲキ ニ ヨリ ジョウヒ サイボウ ノ サイボウ カイテン オヨビ アポトーシス ノ チョウセツ イジョウ オ ヒキオコシ コレ オ ゾウキョウスル

京都大学0048新制・課程博士博士(医学)甲第11063号医博第2776号新制||医||876(附属図書館)22595UT51-2004-J735京都大学大学院医学研究科外科系専攻(主査)教授 千葉 勉, 教授 湊 長博, 教授 鈴木 茂彦学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA

カンセツ エンバン ノ カドウ セイゲン ト エンバン コウホウ ヒコウブ ノ ヒダイ オ トモナイ ヘイコウ ショウガイ オ ショウジタ カンセツ エンバン ゼンポウ テンイ ノ 1レイ

習慣性の閉口障害についての報告は散見され、顎関節脱臼や関節円板後方転位よるものが多い。今回われわれは非復位性円板前方転位症例において関節円板の可動制限と円板後方肥厚部の肥大に伴い、関節円板が復位することにより習慣性に閉口末期の閉口障害を生じた一例を経験したので、その概要を報告する。患者は40歳代の女性で，主訴は咬合不全．既往歴・家族歴に特記事項はなし．現病歴は数年前より最大開口時からの閉口末期に閉口困難を時々自覚していたが，自己整復が可能であったため放置していた．200X年9月下旬，大開口した後に閉口末期の閉口障害が出現した．臨床所見および画像所見において右側顎関節に関節円板前方転位を認め,下顎頭が関節円板に復位した際，関節円板の可動制限と円板後方肥厚部の肥大に伴って下顎頭の運動障害を生じていた．保存療法にて一旦，閉口障害は改善したが，再発のリスクを最小限にするため10月初旬，全身麻酔下に右側顎関節円板切除術を行った．その後15年以上経過するが，閉口障害の再発は認めていない．We report a case of recurrent mouth- closing disturbance caused by limited disk mobility and hypertrophic posterior band in a patient with anterior disk displacement. A middle-aged woman was complained of her mouth closing disturbance and pain in the right temporomandibular joint. She had experienced intermittent painless clicking in the right temporomandibular joint and difficulty in closing her mouth. At the end of September 200X, after opening her mouth widely, she was not able to completely close her mouth. Based on clinical findings and magnetic resonance imaging, she was diagnosed as mouth closing disturbance caused by limited disk mobility and hypertrophic posterior band. Surgical removal of articular disc was performed to minimize the risk of the recurrence. Over 15years after surgery, there has been no recurrence of symptom

A case of oral metastasis of rectal adenocarcinoma with KRAS mutation in patient with synchronous lung adenocarcinoma.

Detecting the origin of the primary cancer that metastasizes in the oral cavity in patients with multiple primary cancers is challenging because of its rarity and complexity. We present an unusual case of an 86‐year‐old women with a maxillary gingival tumor that was histologically proven to be adenocarcinoma; she had been diagnosed with rectal and lung adenocarcinoma. A multidisciplinary approach involving complementary molecular analysis of KRAS gene mutation helped in the diagnosis of metastatic gingival tumor from rectal cancer

A pragmatic method for electronic medical record-based observational studies: developing an electronic medical records retrieval system for clinical research.

[Objective]The use of electronic medical record (EMR) data is necessary to improve clinical research efficiency. However, it is not easy to identify patients who meet research eligibility criteria and collect the necessary information from EMRs because the data collection process must integrate various techniques, including the development of a data warehouse and translation of eligibility criteria into computable criteria. This research aimed to demonstrate an electronic medical records retrieval system (ERS) and an example of a hospital-based cohort study that identified both patients and exposure with an ERS. We also evaluated the feasibility and usefulness of the method. [Design] The system was developed and evaluated. [Participants] In total, 800 000 cases of clinical information stored in EMRs at our hospital were used. [Primary and secondary outcome measures]The feasibility and usefulness of the ERS, the method to convert text from eligible criteria to computable criteria, and a confirmation method to increase research data accuracy. [Results] To comprehensively and efficiently collect information from patients participating in clinical research, we developed an ERS. To create the ERS database, we designed a multidimensional data model optimised for patient identification. We also devised practical methods to translate narrative eligibility criteria into computable parameters. We applied the system to an actual hospital-based cohort study performed at our hospital and converted the test results into computable criteria. Based on this information, we identified eligible patients and extracted data necessary for confirmation by our investigators and for statistical analyses with our ERS. [Conclusions ]We propose a pragmatic methodology to identify patients from EMRs who meet clinical research eligibility criteria. Our ERS allowed for the efficient collection of information on the eligibility of a given patient, reduced the labour required from the investigators and improved the reliability of the results