25 research outputs found

    The efficacy of a novel zinc-containing desensitizer CAREDYNE Shield for cervical dentin hypersensitivity: a pilot randomized controlled trial

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    Background: Recently, a novel zinc-containing desensitizer, CAREDYNE Shield, was developed. This new type of desensitizer induces chemical occlusion of dentinal tubules for desensitization and releases zinc ion for root caries prevention. Despite these features, its clinical effectiveness in the improvement of cervical dentine hypersensitivity remains to be elucidated. Thus, we aimed to evaluate the effectiveness of CAREDYNE Shield in patients with CDH.Methods: Forty CDH teeth which matched the eligibility criteria were randomly allocated to two groups in a 1:1 ratio: the CAREDYNE Shield group (intervention group) and the Nanoseal group (control group). The pain intensity in response to air stimuli, gingival condition, and oral hygiene status of CDH teeth were assessed before and at 4 weeks after treatment. The primary outcome was the reduction of pain intensity in response to air stimuli from baseline to 4 weeks after intervention.Results: From November 2019 to April 2021, 24 participants with 40 teeth were enrolled in this study and 33 teeth in 20 participants were assessed at 4 weeks after treatment. A significant reduction of pain in response to air stimuli was observed in both groups; however, no significant difference was observed between the groups.Conclusions: This study showed that CAREDYNE Shield is effective for CDH and its effectiveness is similar to Nanoseal

    Relationship between BPSD and regional cortical volume in dementia

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     認知症の症状,特に BPSD は罹患した本人のみならずその家族や周りの人の生活,QOL にも影響を与える.BPSD は中核症状と環境要因,身体要因,心理要因などの相互作用によって起こることが多く症状の軽重には個人差もあることからその発症予測は難しい.BPSD 発症に関わる神経基盤の理解とその発症リスク予測につながる客観的な指標の確立のための探索的検討として, BPSD の発症と脳の構造的変化との関連を検討する目的で,MRI データにおける大脳皮質の局所容積変化を BPSD 発症の有無で比較し,BPSD 発症に関連する脳領域の検討を行った.川崎医科大学附属病院脳神経内科ものわすれ外来を受診した患者20名(平均74.8歳,男性5名)を対象に年齢,性別,認知機能(MMSE-J,FAB),うつ(GDS-15-J),BPSD の程度(阿倍式 BPSD スコア: ABS)を用い,BPSD の有無(ABS:0vs1以上)によって患者を2群に分け患者背景,臨床指標評価を比較した.また同時期に測定した MRI 3DT1画像データを使用し,SPM12ソフトウェアを用いて患者の灰白質,白質,脳脊髄液領域を分離し,解剖学的標準化を行って灰白質容積の群間差を検討した.結果,年齢,性別,MMSE,FAB,GDS は両群間で有意差を認めなかった.灰白質容積の群間差の検討では,BPSD あり群では右中前頭回(BA6),右下前頭回三角部(BA45)の灰白質容積が有意に低下していた.BA6と BA45における ABS と灰白質容積にはそれぞれ負の相関があった.認知症患者の BPSD 発症が右前頭葉皮質の灰白質容積低下が関連している可能性が示唆された.先行研究により BA6は他者の意図を推察する心の理論課題に関与し,BA45の灰白質容積の低下は統合失調症患者における妄想や陽性症状との相関が示唆されている.今後 BPSD の発症予測や個別治療の可能性につながる重要な知見と考えられ,今後の研究の進展が期待される. Symptoms of dementia, especially Behavioral and Psychological Symptom of Dementia (BPSD), affect the quality of life of not only patients but also family members and caregivers. Underlying mechanisms of BPSD is still unknown but multiple factors including cognitive impairments as well as environmental, physical, and psychological factors may cause BPSD and the severity of symptoms varies individually. In this study, we aimed to investigate the underlying neural mechanisms for emerging BPSD by comparing the regional volume change of the cerebral cortex in patients with or without BPSD to identify the cortical region critical for emerging BPSD. We evaluated 20 patients (average age 74.8, M5) who visited our memory clinic for their age, gender, cognitive function (MMSE-J, FAB), depression (GDS-15-J), and BPSD (ABS) degree. We divided patients into two groups according to the presence of BPSD (ABS: 0 vs 1 or higher) and background characteristics and clinical indicators were compared. Using 3DT1 image data acquired by 3-Tesla MRI apparatus, we segmented the patient’s brain into gray matter, white matter, and cerebrospinal fluid. After anatomical normalization, we conducted group-wise comparison between patients with and without BPSD to investigate cortical area associated with emerging BPSD. Patients’characteristics and baseline cognitive factiors including Age, sex, MMSE-J, FAB, and GDS-15-J showed no significant difference between the two groups. The gray matter volume of the right middle frontal gyrus (BA6) and the right lower frontal gyrus triangle (BA45) were significantly reduced in the patients with BPSD. Furthermore, in BA6 and BA45, there were negative correlation between severity of BPSD and gray matter volumes suggesting possible association between gray matter volume in the right frontal cortex and BPSD. Previous studies have shown that BA6 is associated with the Theory of Mind, and that a decrease in the gray matter volume of BA45 is correlated with delusions and positive symptoms in patients with schizophrenia. This is an important finding that leads to the prediction of the onset of BPSD and the possibility of individual treatment

    Current status and problems of elderly drivers in our outpatient clinic

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     当院では平成29年3月12日の道路交通法改正を踏まえて平成29年4月より,もの忘れ外来とは別に「運転免許外来」を新設し,時間をかけた丁寧な診療と告知,指導,運転免許返納後の生活確保・支援ができるよう,多職種で受診者に対応している.平成31年4月までの運転免許外来受診者は31人で,平均年齢80.07±3.91歳.第一分類該当者19人,交通違反での紹介3人で,その他は自発的な受診であった.10例は既に事故を起こし,6例は既に抗認知症薬を内服していた . 受診者のほとんどが,通院,買い物,農作業など運転中止後の生活が困るとの理由から,運転継続を希望した.神経心理検査では,MMSE-J 22.32/30±3.87, Kohs IQ 66.42±11.87, DASC-21 29.53±7.07, CDR 0.58±0.19と比較的認知機能低下が軽度な者が多かった.頭部 MRI では20例に陳旧性脳梗塞や脳挫傷,12例に脳萎縮を認め,123I-IMP 脳血流 SPECT では14例にアルツハイマー病を示唆する脳血流低下を認めた.診断後,全例に運転免許返納を推奨したが,自発的に運転中止に至った例は9例のみであった.かかりつけ医による診断書作成が普及し自主返納事例も増加したためか,当院の受診者数ならびに運転免許取り消し処分となる事例は外来開設当初の予想より少なかった.認知機能低下は認めるものの明らかな認知症に至っていない MCI 症例については,診断書提出後も運転継続している事例が多かった.運転継続希望者に丁寧に現制度の意義を説明し,移動手段の確保や生活支援について地域で相談できる体制作りが必要である. Following the revision of the Road Traffic Act, which obligates elderly drivers to undergo cognitive screening tests at license renewal, we established a new outpatient memory clinic specializing in issues surrounding elderly drivers’ driver licenses. In this new outpatient clinic, we provide guidance and information about supporting resources for life after returning their driver’s licenses and the usual medical care and education. In the past two years, 31 patients, with an average age of 80.1±3.9 years, visited this clinic. Among these, 19 were referred to our clinic because of impaired cognition by screening test (the first classification), three were referred us for traffic violations and the others visited voluntarily. Among these 31 patients, ten had already experienced car accidents and six had already been prescribed cholinesterase inhibitors. Neuropsychological examination revealed mildly impaired cognitive function including MMSE-J 22.3±3.9, Kohs IQ 66.4±11.9, DASC-21 29.5±7.1 and CDR 0.58 ±0.19. Brain MRI revealed significant brain atrophy in 20 patients and brain contusions in 12. 123I-IMP SPECT showed decreased cerebral blood flow in 14 patients. Although driving is necessary for most patients to maintain activities of daily living and quality of life, we recommended all to stop driving based on the revised Road Traffic Act, which restricts driving by people with dementia. However, only nine patients suspended their driving and returned their licenses voluntarily; most MCI patients continued driving even after diagnosis. More effort is necessary to persuade patients of the significance of the current system, as is a social system that offers alternative means of transportation and supports patients in their lives in their local community

    Temporal dispersion in vasculitic neuropathy: its microscopic ultrastructural findings

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     症例は35歳男性.32歳のときに右腓腹神経・足底神経支配領域の異常感覚で発症し,その後,左腓腹神経・足底神経領域,両側尺骨神経領域に感覚障害が拡大した.神経伝導検査では,左脛骨神経複合筋活電位において,時間的分散の所見が認められた.腓腹神経生検では,神経上膜にフィブリノイド壊死を伴う壊死性血管炎を認めた.エポン包埋トルイジン青染色では、有髄神経線維の脱落が著明であり,髄鞘の薄い再生軸索が認められた.電子顕微鏡による観察では,脱髄は認められず,軸索の再生が認められたが,髄鞘再生に乏しい thin myelin が特徴的であった.神経伝導検査で,伝導ブロックや時間的分散といった脱髄を疑う所見を呈する血管炎性ニューロパチーについて24例の報告があるが,これまで電子顕微鏡による観察はされていない.血管炎性ニューロパチーによって惹起される時間的分散の出現機序について,微細構造所見を基に考察する. A previously healthy 35-year-old man developed abnormal sensation in the right sural and medial plantar nerve territory 2 years ago. The sensory impairment gradually spread to the left sural and medial plantar nerve regions, then bilateral ulnar nerve regions. Nerve conduction study showed temporal dispersion in the left tibial nerve. Sural nerve biopsy revealed necrotizing vasculitis with fibrinoid necrosis in the epineurium. Toluidine blue staining of Epon-embedded tissue showed significant loss of myelinated nerve fibers without demyelination, even in the teased nerve fiber preparations. Electron microscopy showed immature regenerated nerve fibers with thin myelin sheaths. Even including 24 reported cases of vasculitic neuropathy with either conduction block, pseudo-conduction block, or temporal dispersion, this is the first case examined by electron microscopy. Herein, we discuss the ultrastructural background of“temporal dispersion”in vasculitic neuropathy

    Nationwide surveillance of bacterial respiratory pathogens conducted by the surveillance committee of Japanese Society of Chemotherapy, the Japanese Association for Infectious Diseases, and the Japanese Society for Clinical Microbiology in 2010: General view of the pathogens\u27 antibacterial susceptibility

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    The nationwide surveillance on antimicrobial susceptibility of bacterial respiratory pathogens from patients in Japan, was conducted by Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases and Japanese Society for Clinical Microbiology in 2010.The isolates were collected from clinical specimens obtained from well-diagnosed adult patients with respiratory tract infections during the period from January and April 2010 by three societies. Antimicrobial susceptibility testing was conducted at the central reference laboratory according to the method recommended by Clinical and Laboratory Standard Institutes using maximum 45 antibacterial agents.Susceptibility testing was evaluable with 954 strains (206 Staphylococcus aureus, 189 Streptococcus pneumoniae, 4 Streptococcus pyogenes, 182 Haemophilus influenzae, 74 Moraxella catarrhalis, 139 Klebsiella pneumoniae and 160 Pseudomonas aeruginosa). Ratio of methicillin-resistant S.aureus was as high as 50.5%, and those of penicillin-intermediate and -resistant S.pneumoniae were 1.1% and 0.0%, respectively. Among H.influenzae, 17.6% of them were found to be β-lactamase-non-producing ampicillin (ABPC)-intermediately resistant, 33.5% to be β-lactamase-non-producing ABPC-resistant and 11.0% to be β-lactamase-producing ABPC-resistant strains. Extended spectrum β-lactamase-producing K.pneumoniae and multi-drug resistant P.aeruginosa with metallo β-lactamase were 2.9% and 0.6%, respectively.Continuous national surveillance of antimicrobial susceptibility of respiratory pathogens is crucial in order to monitor changing patterns of susceptibility and to be able to update treatment recommendations on a regular basis

    Effect of dual-task interaction combining postural and visual perturbations on cortical activity and postural control ability

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    Previous studies have suggested cortical involvement in postural control in humans by measuring cortical activities and conducting dual-task paradigms. In dual-task paradigms, task performance deteriorates and can be facilitated in specific dual-task settings. Theoretical frameworks explaining these dual-task interactions have been proposed and debated for decades. Therefore, we investigated postural control performance under different visual conditions using a virtual reality system, simultaneously measuring cortical activities with a functional near-infrared spectroscopy system. Twenty-four healthy participants were included in this study. Postural stability and cortical activities after perturbations were measured under several conditions consisting of postural and visual perturbations. The results showed that concurrent visual and postural perturbations could facilitate cortical activities in the supplementary motor area and superior parietal lobe. Additionally, visual distractors deteriorated postural control ability and cortical activation of the supplementary motor area. These findings supported the theoretical framework of the “Cross talk model”, in which concurrent tasks using similar neural domains can facilitate these task performances. Furthermore, it indicated that the cortical resource capacity and domains activated for information processing should be considered in experiments involving dual-task paradigms and training

    Effects of Melatonin on the Transcriptome of Human Granulosa Cells, Fertilization and Blastocyst Formation

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    Melatonin is a promising reagent that can improve assisted reproductive technology (ART) outcomes in infertility patients. However, melatonin is not effective for all infertile patients, and it remains unclear for which patients melatonin would be effective. This study examined the effects of melatonin on ART outcomes and examined its mechanisms. Melatonin increased the fertilization rate in patients whose fertilization rates in the previous cycle were less than 50%, but not in patients whose fertilization rates were more than 50% in the previous cycle. Melatonin increased the blastocyst formation rate in patients whose embryo development rates in the previous cycle were less than 50%, but not in patients whose embryo development rates were more than 50% in the previous cycle. To clarify its mechanisms, transcriptome changes by melatonin treatment in granulosa cells (GCs) of the patients were examined by RNA-sequence. Melatonin treatment altered the transcriptomes of GCs of patients with poor ART outcomes so that they were similar to the transcriptomes of patients with good ART outcomes. The altered genes were associated with the inhibition of cell death and T-cell activity, and the activation of steroidogenesis and angiogenesis. Melatonin treatment was effective for patients with poor fertilization rates and poor embryo development rates in the previous ART cycle. Melatonin alters the GCs transcriptome and, thus, their functions, and this could improve the oocyte quality, leading to good ART outcomes

    ダイカンミンコク コウトウ ガッコウ シンキョウイクカテイ ト モギ ジュギョウ ノ ココロミ

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    日本語国際センターでは、「大韓民国高等学校日本語教師研修」が1994年度に引き続き実施された。本稿の目的は、同研修において力点を置いた教授法科目の一つである「総合教授演習」の模擬授業を、どう構想し実施し、結果 は如何であったかを報告することにある。同研修においては、初年度から一つの目標としたことがあった。韓国では、日本の文部省にあたる教育部が1996年度から高等学校教育課程(指導要領)を改定することを決定している。その中の日本語1の「方法」の部分に、「聴解発話に重点を置く」「教師と生徒及び生徒と生徒の間の活動を展開する」「生徒に能動的に表現しうる機会を与える」という内容が盛り込まれている。目標は、その実現の可能性を模索させることである。そのため、研修生に自己の授業を振り返り、他者の授業を参考にし、諸々の技法に関する情報を収集する機会を提供する科目を設定した。それが模擬授業である。模擬授業は、少人数で実施した。その際昨年度の反省に鑑み注意した点は、模擬授業を全員に課すこと、グループの構成を少人数にすること、マイクロティーチングを強調すること、全員にフィードバックの時間を設けることであった。この方針の下に模擬授業を実施した。今後の課題は、相互啓発を目的としたグループ活動を徹底させること、教授法関連用語の確認作業を組み込むことがある。また問題点は、模擬授業で日本語として不適切な表現が散見されたことがある。研修の結果、事後アンケート調査を見ると、具体的な教授活動についての言及が増えていた。これは、模擬授業を全員に課したことと、フィードバックを徹底したことの現れであると推測される。また研修修了後授業見学を行ったところ、できる限り日本語で授業を進行させようとしていること、生徒を視野に入れていることが看取された
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