Effect of Tooth Loss on Cognitive Function among Older Adults in Singapore

Evidence suggests a longitudinal association between tooth loss and cognitive function. However, the temporality of this association is not well understood. We investigated the effect of several emulated tooth loss prevention scenarios on cognitive function. We used data from 3 waves (baseline: 2009, second wave: 2011-2012, and third wave: 2015) of the Panel on Health and Ageing of Singaporean Elderly (PHASE). PHASE targeted older adults, aged ≥60 y, in Singapore. Number of teeth was used as a time-varying exposure (baseline, second wave). Cognitive function (Short Portable Mental Status Questionnaire score) in the third wave was assessed as the outcome. Multiple time-invariant (baseline) and time-varying (baseline and second wave) covariates were included. The "longitudinal modified treatment policy approach" combined with targeted minimum loss-based estimation was used to define and estimate additive effects of emulated tooth loss prevention scenarios. Emulated scenarios were the following: what if edentate people retained 1 to 4 teeth (scenario 1), what if those with <5 teeth retained 5 to 9 teeth (scenario 2), what if those with <10 teeth retained 10 to 19 teeth (scenario 3), and what if everyone retained ≥20 teeth (scenario 4)? A total of 1,516 participants, excluding those with severe cognitive impairment, were included (male: 41.6%). The mean age at baseline was 70.6 y (SD = 7.1). The mean SPMSQ score at baseline was 2.06 (SD = 0.02) for edentulous, 1.55 (SD = 0.04) for 1 to 4 teeth, 1.61 (SD = 0.03) for 5 to 9 teeth, 1.73 (SD = 0.02) for 10 to 19 teeth, and 1.71 (SD = 0.02) for ≥20 teeth. Additive effect of hypothetical intervention gradually increased with intensity of prevention from scenario 1 to scenario 4 (scenario 1: -0.02 [95% CI, -0.08 to 0.04], scenario 2: -0.05 [95% CI, -0.11 to -0.00], scenario 3: -0.07 [95% CI, -0.14 to -0.00], scenario 4: -0.15 [95% CI, -0.23 to -0.06]). Emulated tooth loss prevention interventions were associated with better cognitive function score. Therefore, preventing tooth loss could potentially benefit maintenance of cognitive function among older adults.

Change in Geographic Accessibility to Dental Clinics Affects Access to Care

Access to dental clinics is a feature of the neighborhood service environment that may influence oral health care utilization. However, residential selection poses a challenge to causal inference. By studying the involuntary relocation of survivors of the 2011 Great East Japan Earthquake and Tsunami (GEJE), we examined the association between changes in geographic distance to dental clinics and dental visits. Longitudinal data from a cohort of older residents in Iwanuma City directly impacted by the GEJE were analyzed in this study. The baseline survey was conducted in 2010, 7 mo before the occurrence of GEJE, and a follow-up was conducted in 2016. Using Poisson regression models, we estimated the incidence rate ratios (IRR) and 95% confidence intervals (CIs) for the uptake of denture use (as a proxy for dental visits) according to changes in distance from the nearest dental clinic to their house. Age at baseline, housing damage by the disaster, deteriorating economic conditions, and worsened physical activity were used as confounders. Among the 1,098 participants who had not worn dentures before the GEJE, 495 were men (45.1%), with a mean ± SD age at baseline of 74.0 ± 6.9 y. During the 6-year follow-up, 372 (33.9%) participants initiated denture use. Compared to those who experienced a large increase in distance to dental clinics (>370.0-6,299.1 m), a large decrease in distance to dental clinics (>429.0-5,382.6 m) was associated with a marginally significantly higher initiation of denture use among disaster survivors (IRR = 1.28; 95% CI, 0.99-1.66). The experience of major housing damage was independently associated with higher initiation of denture use (IRR = 1.77; 95% CI, 1.47-2.14). Improved geographic access to dental clinics may increase dental visits of disaster survivors. Further studies in non-disaster-affected areas are needed to generalize these findings.

Impact of Teeth on Social Participation: Modified Treatment Policy Approach

Social participation prevents social isolation and loneliness among older adults while having numerous positive effects on their health and well-being in rapidly aging societies. We aimed to estimate the effect of retaining more natural teeth on social participation among older adults in Japan. The analysis used longitudinal data from 24,872 participants in the Japan Gerontological Evaluation Study (2010, 2013, and 2016). We employed a longitudinal modified treatment policy approach to determine the effect of several hypothetical scenarios (preventive scenarios and tooth loss scenarios) on frequent social participation (1 = at least once a week/0 = less than once a week) after a 6-y follow-up. The corresponding statistical parameters were estimated using targeted minimum loss-based estimation (TMLE) method. Number of teeth category (edentate/1-9/10-19/≥20) was treated as a time-varying exposure, and the outcome estimates were adjusted for time-varying (income, self-rated health, marital status, instrumental activities of daily living, vision loss, hearing loss, major comorbidities, and number of household members) and time-invariant covariates (age, sex, education, baseline social participation). Less frequent social participation was associated with older age, male sex, lower income, low educational attainment, and poor self-rated health at the baseline. Social participation improved when tooth loss prevention scenarios were emulated. The best preventive scenario (i.e., maintaining ≥20 teeth among each participant) improved social participation by 8% (risk ratio [RR] = 1.08; 95% confidence interval [CI], 1.05-1.11). Emulated tooth loss scenarios gradually decreased social participation. A hypothetical scenario in which all the participants were edentate throughout the follow-up period resulted in a 11% (RR = 0.89; 95% CI, 0.84-0.94) reduction in social participation. Subsequent tooth loss scenarios showed 8% (RR = 0.92; 95% CI, 0.88-0.95), 6% (RR = 0.94; 95% CI, 0.91-0.97), and 4% (RR = 0.96; 95% CI, 0.93-0.98) reductions, respectively. Thus, among Japanese older adults, retaining a higher number of teeth positively affects their social participation, whereas being edentate or having a relatively lower number of teeth negatively affects their social participation.

Weight Loss Mediated the Relationship between Tooth Loss and Mortality Risk

Tooth loss is a risk factor for increased mortality; however, the underlying mechanism remains unclear. This study aimed to evaluate the mediating effect of weight change on the relationship between tooth loss and mortality risk. This was a 10-y follow-up prospective cohort study using the data from the Japan Gerontological Evaluation Study (JAGES). The participants were independent older adults aged ≥65 y at baseline and were followed up from 2010 to 2020. The incidence of death in 2013 and 2020, incidence of >5% weight loss/gain in 2010 and 2013, and the number of remaining teeth in 2010 were used as the outcome, mediator, and explanatory variables, respectively. We conducted causal mediation analysis by fitting the Cox proportional hazard model, including possible confounders. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) of the total effect (TE), natural indirect effect (NIE), and proportion mediated (PM) were estimated. Among the 34,510 participants, the mean age was 72.6 (SD = 5.4) y, and 47.6% were men. From 2013 to 2020, 14.0% of the participants (n = 4,825) died, 60.5% (n = 20,871) had 0 to 19 remaining teeth, and 17.2% (n = 5,927) and 8.4% (n = 2,907) experienced >5% weight loss and gain, respectively. The mortality rate was 0.016 per person-year among those with ≥20 remaining teeth and 0.027 per person-year among those with 0 to 19 remaining teeth. Weight loss of >5% significantly mediated the association between tooth loss and higher mortality risk (TE: HR, 1.28 [95% CI, 1.16 to 1.40]; NIE: HR, 1.03 [95% CI, 1.02 to 1.04]; PM, 13.1%); however, we observed a slight mediating effect for >5% weight gain (NIE: HR, 1.003 [95%CI, 1.0001 to 1.01]; PM, 1.3%). The present study suggests that a clinically meaningful level of weight loss mediated the association between tooth loss and increased risk of mortality among independent older adults.

Oral Status and Dementia Onset: Mediation of Nutritional and Social Factors

Some modifiable risk factors for dementia are closely related to oral health. Although eating and speaking abilities are fundamental oral functions, limited studies have focused on the effect of malnutrition and lack of social interaction between oral health and dementia. We investigated the mediating effects of nutritional and social factors on the association between the number of teeth and the incidence of dementia. This 6-y cohort study used data from the Japan Gerontological Evaluation Study targeting older adults aged 65 y and above. The number of teeth (exposure) and covariates in 2010 (baseline survey), mediators (weight loss, vegetable and fruit intake, homeboundness, social network) in 2013, and the onset of dementia (outcome) between 2013 and 2016 were obtained. The Karlson-Holm-Breen mediation method was applied. A total of 35,744 participants were included (54.0% women). The mean age at baseline was 73.1 ± 5.5 y for men and 73.2 ± 5.5 y for women. A total of 1,776 participants (5.0%) had dementia during the follow-up period. There was a significant total effect of the number of teeth on the onset of dementia (hazard ratio, 1.14; 95% CI, 1.01-1.28). Controlling for nutritional and social mediators, the effect of the number of teeth was reduced to 1.10 (95% CI, 0.98-1.25), leaving an indirect effect of 1.03 (95% CI, 1.02-1.04). In the sex-stratified analysis, the proportion mediated by weight loss was 6.35% for men and 4.07% for women. The proportions mediated by vegetable and fruit intake and homeboundness were 4.44% and 4.83% for men and 8.45% and 0.93% for women, respectively. Furthermore, the proportion mediated by social networks was 13.79% for men and 4.00% for women. Tooth loss was associated with the onset of dementia. Nutritional and social factors partially mediated this association.

Primary solitary fibrous tumour of the prostate: A case report and literature review

INTRODUCTION

Solitary fibrous tumour (SFT) is a rare mesenchymal tumour with intermediate malignant potential. Although this tumour arises in several sites, prostatic SFT is an extremely rare neoplasm and may prove confusing owing to the lack of clinical experience because of tumour rarity. The diagnosis may be further difficult because SFTs can manifest positive immunoreactivity for CD34 and progesterone receptor, which are known markers of prostatic stromal tumours. Herein, we describe a case of prostatic SFT that was difficult to differentiate from a prostatic stromal tumour of uncertain malignant potential because of positive immunoreactivity to CD34 and progesterone receptor.

CASE REPORT

A 40-year-old Japanese man presented with lower abdominal pain. Computed tomography revealed a prostatic mass; furthermore, prostate core needle biopsy revealed proliferating bland spindle cells, without necrosis or prominent mitoses. Tumour cells were positive for CD34 and progesterone receptor on immunohistochemical analysis; thus, a prostatic stromal tumour of uncertain malignant potential was initially suspected. However, as the tumour cells showed positive immunoreactivity for STAT6, the final diagnosis was an SFT of the prostate. The patient underwent tumour resection, and at the 6-month postoperative follow-up, neither local recurrence nor distant metastasis occurred.

CONCLUSION

For an accurate diagnosis of an SFT of the prostate, STAT6 immunohistochemistry should be conducted for all mesenchymal tumours of the prostate. When STAT6 immunohistochemical analysis is unfeasible, pathologists should be aware that the morphological and immunohistochemical characteristics of SFT variable from case to case and diagnose with combined analysis of several immunohistochemical markers.

Effect of Copayment on Dental Visits: A Regression Discontinuity Analysis

Despite their prevalence and burdens, oral diseases are neglected in universal health coverage. In Japan, a 30% copayment (out of pocket) by the user and a 70% contribution by Japan’s universal health insurance (JUHI) are required for dental and medical services. From the age of 70 y, an additional 10% is offered by JUHI (copayment, 20%; JUHI, 80%). This study aimed to investigate the effect of cost on dental service use among older adults under the current JUHI system. A regression discontinuity quasi-experimental method was used to investigate the causal effect of the JUHI discount policy on dental visits based on cross-sectional data. Data were derived from the 2016 Japan Gerontological Evaluation Study. This analysis contained 7,161 participants who used JUHI, were aged 68 to 73 y, and responded to questions regarding past dental visits. Analyses were controlled for age, sex, number of teeth, and equalized household income. Mean ± SD age was 72.1 ± 0.79 y for the discount-eligible group and 68.9 ± 0.78 y for the noneligible group. During the past 12 mo, significantly more discount-eligible participants had visited dental services than noneligible participants (66.0% vs. 62.1% for treatment visits, 57.7% vs. 53.1% for checkups). After controlling for covariates, the effect of discount eligibility was significant on dental treatment visits (odds ratio [OR], 1.36; 95% CI, 1.32 to 1.40) and dental checkups (OR, 1.49; 95% CI, 1.44 to 1.54) in the regression discontinuity analysis. Similar findings were observed in triangular kernel-weighted models (OR, 1.38 [95% CI, 1.34 to 1.44]; OR, 1.52 [95% CI, 1.47 to 1.56], respectively). JUHI copayment discount policy increases oral health service utilization among older Japanese. The price elasticity for dental checkup visits appears to be higher than for dental treatment visits. Hence, reforming the universal health coverage system to improve the affordability of relatively inexpensive preventive care could increase dental service utilization in Japan.

High-throughput powder diffraction measurement system consisting of multiple MYTHEN detectors at beamline BL02B2 of SPring-8

In this study, we developed a user-friendly automatic powder diffraction measurement system for Debye-Scherrer geometry using a capillary sample at beamline BL02B2 of SPring-8. The measurement system consists of six one-dimensional solid-state (MYTHEN) detectors, a compact auto-sampler, wide-range temperature control systems, and a gas handling system. This system enables to do the automatic measurement of temperature dependence of the diffraction patterns for multiple samples. We introduced two measurement modes in the MYTHEN system and developed new attachments for the sample environment such as a gas handling system. The measurement modes and the attachments can offer in situ and/or time-resolved measurements in an extended temperature range between 25 K and 1473 K and various gas atmospheres and pressures. The results of the commissioning and performance measurements using reference materials (NIST CeO₂ 674b and Si 640c), V₂O₃ and Ti₂O₃, and a nanoporous coordination polymer are presented.

Dental Status and Compression of Life Expectancy with Disability

This study examined whether the number of teeth contributes to the compression of morbidity, measured as a shortening of life expectancy with disability, an extension of healthy life expectancy, and overall life expectancy. A prospective cohort study was conducted. A self-reported baseline survey was given to 126,438 community-dwelling older people aged ≥65 y in Japan in 2010, and 85,161 (67.4%) responded. The onset of functional disability and all-cause mortality were followed up for 1,374 d (follow-up rate = 96.1%). A sex-stratified illness-death model was applied to estimate the adjusted hazard ratios (HRs) for 3 health transitions (healthy to dead, healthy to disabled, and disabled to dead). Absolute differences in life expectancy, healthy life expectancy, and life expectancy with disability according to the number of teeth were also estimated. Age, denture use, socioeconomic status, health status, and health behavior were adjusted. Compared with the edentulous participants, participants with ≥20 teeth had lower risks of transitioning from healthy to dead (adjusted HR, 0.58 [95% confidence interval (CI), 0.50-0.68] for men and 0.70 [95% CI, 0.57-0.85] for women) and from healthy to disabled (adjusted HR, 0.52 [95% CI, 0.44-0.61] for men and 0.58 [95% CI, 0.49-0.68] for women). They also transitioned from disabled to dead earlier (adjusted HR, 1.26 [95% CI, 0.99-1.60] for men and 2.42 [95% CI, 1.72-3.38] for women). Among the participants aged ≥85 y, those with ≥20 teeth had a longer life expectancy (men: +57 d; women: +15 d) and healthy life expectancy (men: +92 d; women: +70 d) and a shorter life expectancy with disability (men: -35 d; women: -55 d) compared with the edentulous participants. Similar associations were observed among the younger participants and those with 1 to 9 or 10 to 19 teeth. The presence of remaining teeth was associated with a significant compression of morbidity: older Japanese adults' life expectancy with disability was compressed by 35 to 55 d within the follow-up of 1,374 d.

Nutritional status and dysphagia risk among community-dwelling frail older adults

OBJECTIVES

Although the presence of dysphagia is a key determinant of nutritional status among older adults, few studies have focused on the association between malnutrition and dysphagia risk in community-dwelling frail older adults. This study estimated the prevalence of malnutrition and quantified the association between malnutrition and dysphagia risk among community-dwelling older Japanese adults requiring long-term care.

DESIGN

Cross-sectional study.

SETTING

This study was conducted with the cooperation of the Japan Dental Association and local dental associations in all 47 prefectures from January to February 2012.

PARTICIPANTS

Individuals aged ≥65 years capable of oral nutrient intake who were living at home and receiving home dental care and treatment.

MEASUREMENTS

Individual demographic characteristics and factors associated with health loss-related functional decline were obtained through interviews by home-visit dentists and self-administered questionnaires. Nutritional status and dysphagia risk were evaluated using the Mini Nutritional Assessment Short Form and the Dysphagia Risk Assessment for the Community-dwelling Elderly.

RESULTS

Among 874 respondents (345 men and 529 women), 24.6% were malnourished, 67.4% were at risk of malnutrition, and 8.0% were well nourished. Dysphagia risk was related to an increased likelihood of malnutrition at an old age, even after adjusting for covariates (PR = 1.30, 95% CI = 1.01-1.67).

CONCLUSION

Malnutrition is highly prevalent among community-dwelling frail older adults, and dysphagia risk is independently associated with malnutrition. Dysphagia may be an important predictor of malnutrition progression in aged populations.

Structural, magnetic and electronic state characterization of L1 0-type ordered FeNi alloy extracted from a natural meteorite

To understand the hard magnetism of L10-type ordered FeNi alloy, we extracted the L10-FeNi phase from a natural meteorite, and evaluated its fundamental solid-state properties: sample composition, magnetic hysteresis, crystal structure and electronic structure. We executed multidirectional analyses using scanning electron microscopy with an electron probe micro-analyzer (SEM-EPMA), a superconducting quantum interference device (SQUID), x-ray diffraction (XRD) and magnetic circular dichroism (MCD). As a result, we found that the composition was Fe: 50.47 ± 1.98 at.%, Ni: 49.60 ± 1.49 at.%, and an obvious superlattice peak is confirmed. The estimated degree of order was 0.608, with lattice constants a = b = 3.582 Å and c = 3.607 Å. The obtained coercivity was more than 500 Oe. MCD analysis using the K absorption edge suggests that the magnetic anisotropy could originate from the orbital magnetic moment of 3d electrons in Fe; this result is consistent with that in a previous report obtained with synthetic L10-FeNi.

Oral health and cancer, cardiovascular, and respiratory mortality of Japanese

Cardiovascular diseases, cancer, and respiratory disease are major causes of death in developed countries. No study has simultaneously compared the contribution of oral health with these major causes of death. This study examined the association between oral health and cardiovascular diseases, cancer, and respiratory mortality among older Japanese. Self-administered questionnaires were mailed to participants in the Aichi Gerontological Evaluation Study (AGES) Project in 2003. Mortality data were analyzed for 4425 respondents. Three categories of oral health were used: 20 or more teeth, 19 or fewer teeth and eat everything, 19 or fewer teeth and eating difficulty. Sex, age, body mass index (BMI), self-rated health, present illness, exercise, smoking, alcohol, education, and income were used as covariates. During 4.28 years' follow-up, 410 people died, 159 from cancer, 108 of cardiovascular diseases, and 58 of respiratory disease. Multivariate adjusted Cox proportional hazard models showed that, compared with the respondents with 20 or more teeth, respondents with 19 or fewer teeth and with eating difficulty had a 1.83 and 1.85 times higher hazard ratio for cardiovascular disease mortality and respiratory disease mortality, respectively. There was no significant association with cancer mortality. Oral health predicted cardiovascular and respiratory disease mortality but not cancer mortality in older Japanese.

Association between caregiver behaviours to prevent vertical transmission and dental caries in their 3-year-old children

BACKGROUND

It has been suggested that oral organisms in children are mainly those transmitted from their mothers. That may account for the relationship between caries levels in children and their parents. However, few studies have investigated the effect of trying to prevent vertical transmission of oral organisms on dental caries levels in children, and the findings in the studies are controversial. The aim of this study was to investigate the association between measures to prevent vertical transmission of oral organisms and the caries experience in 3-year-old children.

METHODS

Data were collected from dental examinations for 3-year-old children and a self-administered questionnaire for their caregivers. Absence of maternal sharing of utensils and mouth-to-mouth feeding between caregivers and children was used as the variable about behaviour to prevent vertical transmission of oral organisms. Sex, age in months, dietary behaviour, oral health behaviour and sociodemographic factors were used as covariates.

RESULTS AND CONCLUSION

Data for 3,035 children (73.5% of the subjects) were analysed. Caregivers who practised vertical transmission prevention tended to have better oral health behaviours. Multivariate logistic regression analysis did not show any significant association between behaviour to prevent vertical transmission and caries experience (OR = 1.10, 95% CI = 0.86-1.41). This study suggests that caregiver behaviour to prevent vertical transmission was not effective in reducing levels of childhood caries.

Evaluation of nutrient loads from a mountain forest including storm runoff loads

Water quality and flow rates at a weir installed on the end of Aburahi-S Experimental Watershed (3.34 ha) were measured once a week from 2001 to 2003 and in appropriate intervals from 30 min to 6 h during five storm runoff events caused by each rainfall from 8 mm to 417 mm. The average annual loads of total nitrogen (TN) and total phosphorus (TP) were calculated to be 19.0 and 0.339 kg ha(-1) y(-1) from the periodical data by using the integration interval-loads method (ILM), which did not properly account for storm runoff loads. Three types of L(Q) equations (L = aQ(b)) were derived from correlations between loading rates L and flow rates Q obtained from the periodic observation and from storm runoff observation. L(Q) equation method (LQM), which was derived from the storm runoff observation and allowed for the hysteresis of discharge of materials, gave 9.68 and 0.159 kg ha(-1) y(-1), respectively, by substitution of the sequential hourly data of flow rates. L(R) equation (L = c(R - r)d) was derived from the correlations between the loads and the effective rainfall depth (R - r) measured during the storm runoff events, and L(R) equation method (LRM) calculated 9.83 +/- 1.68 and 0.175 +/- 0.0761 kg ha(-1) y(-1), respectively, by using the rainfall data for the past 16 years. The atmospheric input-fluxes of TN and TP were 16.5 and 0.791 kg ha(-1) y(-1).

Magnetic-field switching of crystal structure in an orbital-spin-coupled system: MnV2O4

We studied the magnetic and structural properties of spinel MnV2O4, which has S=5/2 spin with no orbital degrees of freedom on the Mn2+ site and S=1 spin and three orbital degrees of freedom on the V3+ site. We found that the ferrimagnetic ordering at TN=56.5K and the structural phase transition at Ts=53.5K are closely correlated in this compound and found a switching of crystal structure between cubic and tetragonal phases by the magnetic field. This phenomenon can be explained by the coupling between orbital and spin degrees of freedom in the t2g states of the V site.

Vibrio vulnificus septicaemia in Japan: an estimated number of infections and physicians' knowledge of the syndrome

Questionnaire surveys were implemented to study the incidence and physicians' knowledge of Vibrio vulnificus infections in Japan. Registered emergency physicians were selected by stratified random sampling for a questionnaire survey. A total of 235 out of 386 physicians (61%) responded to the questionnaire and 12 V. vulnificus septicaemia cases were reported from 10 respondents. The annual estimated number of V. vulnificus septicaemia was calculated as 425 (95 % CI 238-752). The study also revealed that only 15.7 % (95 % CI 11.3-21.0) of responding physicians had a basic knowledge of V. vulnificus infection. Education for both physicians and people in the high-risk group for developing the infection (e.g. immunocompromised, chronic liver disease) will be necessary for the prevention, early diagnosis and appropriate treatment of the disease.

Testing a symptom-based surveillance system at high-profile gatherings as a preparatory measure for bioterrorism

We tested symptom-based surveillance during the G8 conference in 2000 as a means of detecting outbreaks, including bio-terrorism attacks, promptly. Five categories of symptoms (skin and haemorrhagic, respiratory, gastrointestinal, neurological and unexplained) were adopted for the case definition of the surveillance. The surveillance began I week before the conference, and continued until 1 week after the conference ended. We could not detect any outbreaks during this surveillance. Compared to the existing diagnosis-based surveillance system, symptom-based surveillance has the advantages of timeliness and simplicity. However, poor specificity and difficulties in determining epidemic threshold were important limitations of this system. To increase the specificity of surveillance, it is essential to incorporate rapid laboratory diagnoses into the system.

Association of plasma adrenomedullin with carotid atherosclerosis in chronic ischemic stroke

Adrenomedullin is a potent vasodilator peptide exerting anti-atherosclerotic actions in vitro. We investigated the impact of the severity of atherosclerosis on plasma mature-adrenomedullin (m-AM) levels in 38 patients with chronic ischemic stroke. The variables of carotid artery atherosclerosis assessed using ultrasound measurement, blood pressure, and risk factors were related to m-AM levels. Severe atherosclerosis was associated with a further elevation of the increased m-AM level in patients with high systolic blood pressure. Even in patients with fewer risk factors, the presence of severe atherosclerosis was associated with an increased m-AM level. Thus, atherosclerosis elevates m-AM independent of the blood pressure level or presence of risk factors.

Expansion of the zinc metallo-hydrolase family of the beta-lactamase fold

Recently, the zinc metallo-hydrolase family of the beta-lactamase fold has grown quite rapidly, accompanied by the accumulation of sequence and structure data. The variety of the biological functions of the family is higher than expected. In addition, the members often have mosaic structures with additional domains. The family includes class B beta-lactamase, glyoxalase II, arylsulfatase, flavoprotein, cyclase/dehydrase, an mRNA 3'-processing protein, a DNA cross-link repair enzyme, a DNA uptake-related protein, an alkylphosphonate uptake-related protein, CMP-N-acetylneuraminate hydroxylase, the romA gene product, alkylsulfatase, and insecticide hydrolases. In this minireview, the functional and structural varieties of the growing protein family are described.

Molecular cloning of the complement (C1r/C1s/MASP2-like serine proteases from the common carp (Cyprinus carpio)

The classical pathway of complement composed of C1, C4, and C2 is an antibody-dependent activation cascade that is present in jawed vertebrates. C1 is a Ca2+-dependent complex of C1q, C1r, and C1s, and analogous to an initiation complex of the lectin pathway of complement, which consists of the mannose-binding lectin (MBL) homologous to C1q and the MBL-associated serine proteases (MASPs) homologous to C1r and C1s. Thus divergence of Clq and MBL and that of C1r, C1s and the MASPs are considered to be crucial events in the establishment and evolution of the classical complement pathway. However, molecular information on the C1 subcomponents is very limited in lower vertebrates. Here we describe two distinct C1r/C1s/MASP2-like cDNA clones (C1r/s-A, C1r/s-B) isolated from the common carp (Cyprinus carpio). They share 83% identity at the amino acid level and have a domain structure similar to that of C1r/C1s/MASPs from other species. The serine protease domain of the carp homologues lacks the histidine loop and is encoded by a single exon containing an AGY codon for the active serine residue, as in mammalian C1r, C1s, and MASP2. Southern blot and PCR analyses indicated that the carp has at least three copies of the C1r/s-A gene and a single C1r/s-B gene. Although phylogenetic tree analysis does not definitively assign carp C1r/s-A and C1r/s-B, they might represent ancestral molecules which later diverged into C1r, C1s, and MASP2 of higher vertebrates.

Analysis of Japanese encephalitis epidemic in Western Nepal in 1997

We conducted an epidemiological study of a Japanese encephalitis (JE) outbreak in the southwestern part of Nepal in 1997. A high density of JE infections was found and it was estimated that 27.9% the total population were infected with JE virus in the study area. The fatality rate was 13.2% and there was no difference in the fatality rate between males and females over 5 years old. However, the case fatality rate was 2.1 times higher in females than in males (14.6% vs. 6.9%) among children under 5 years of age. Fifty-three blood samples were collected from suspected JE cases during the epidemic period in 1998. Findings for JE specific IgM revealed that clinical diagnoses of JE were serologically confirmed in an average 78% (70-93%) of patients in three collaborating hospitals. These studies demonstrated that JE was highly prevalent in the area and clinical diagnoses were reliable. Effective preventive measures should be taken against this vaccine-preventable disease.

Electronic network for monitoring travellers' diarrhoea and detection of an outbreak caused by Salmonella enteritidis among overseas travellers

The Traveller's Diarrhoea Network, by which the Infectious Disease Surveillance Center is electronically connected with two major airport quarantine stations and three infectious disease hospitals, was launched in February 1988 in Japan. The data on travellers' diarrhoea detected is reported weekly by e-mail. Two clusters of infection among travellers returning from Italy were reported by two airport quarantine stations at the end of September 1998. A total of 12 salmonella isolates from 2 clusters were examined. All were identified as Salmonella enteritidis, phage type 4 and showed identical banding patterns on pulsed-field gel electrophoresis. A case-control study showed that the scrambled eggs served at the hotel restaurant in Rome were the likely source of this outbreak. This outbreak could not have been detected promptly and investigated easily without the e-mail network. International exchange of data on travellers' diarrhoea is important for preventing and controlling food-borne illnesses infected abroad.

Control of dengue fever with active surveillance and the use of insecticidal aerosol cans

An interventional study was conducted in southern Vietnam to evaluate the feasibility and effectiveness of a new approach to control dengue fever. The approach consisted of active surveillance of dengue patients and the use of insecticidal aerosol cans. Febrile patients were tested serologically at local health centers and insecticidal aerosol cans were given to the family and employed in the neighborhood of dengue patients instead of ultra low volume (ULV) fogging with insecticide. The number of dengue IgM antibody positive cases among febrile patients, the number of reported dengue hemorrhagic fever patients and the total cost were compared in the 2 approaches (prompt focal ULV fogging and the use of insecticidal aerosol cans) in 1997. The aerosol cans were employed 5 times (in June, July, August, September and October) in the study area. ULV fogging in the control area was performed 5 times (in March, May, July, August and September). Twenty-two serologically positive cases were found in the study area which was about half that found in the control area (43 cases). A total of 16 dengue hemorrhagic fever patients was reported in the study area and 43 in the control area. Compared with the reported numbers of the previous year, the reduction rate in the number of dengue hemorrhagic fever cases was 71.4% in the study area and 51.7% in the control area. There were statistically significant differences in the morbidity of dengue fever and the reduction rate of dengue hemorrhagic fever. The cost of the insecticidal aerosol cans was US$393 which was lower than the cost of US$553 for ULV fogging. The findings suggest that insecticidal aerosol cans were effective and feasible for dengue fever control.

[Epidemiological studies on drug-resistance patterns, coagulase types, and MRSA-phage types of MRSA isolates during 1990-1994]

We examined drug-resistance patterns, coagulase types, and MRSA-phage types of 125 MRSA strains isolated from clinical specimens during the period of January 1990 and December 1994. No vancomycin-resistant strain was isolated. Twenty one antibiotics were divided into three classes, low-intermediate- and high-isolation-frequency class, based on isolation frequencies of resistant strains. Minocycline, chloramphenicol, streptomycin, and imipenem were found to be included in low-isolation-frequency class (16.8-40%). In intermediate-isolation-frequency class (45.6-62.9%), cefmetazole, amikacin, gentamicin, and tetracycline were included. Oxacillin, ampicillin, piperacillin, ceftizoxime, cefoperazone, cefazolin, erythromycin, oleandomycin, kitasamycin, clindamycin, kanamycin, tobramycin, and ofloxacin belonged to high-isolation-frequency class (97.6-100%). MIC90s of vancomycin and minocycline (1.56 and 25 micrograms/ml) were lower than that of other 13 drugs. Comparing medical ward with dental ward, imipenem-, gentamicin-, and minocycline-resistant strains at medical ward, chloramphenicol- and streptomycin-resistant strains at dental ward were isolated dominantly on each ward, MRSA isolates were classified to 39 types by drug-resistance patterns. The isolation frequencies of coagulase type II and type IV strains were 65.6% and 29.6%, respectively. At dental ward, the isolation frequency of coagulase type IV strains was higher than that of coagulase type II strains during 1990-1992. However, coagulase type II strains were isolated considerably more than type IV strains during 1993-1994. By MRSA-phage typing, MRSA isolates were grouped into 18 MRSA-phage types. One hundred and twenty five MRSA isolates were divided into 56 types by using drug-resistance patterns, coagulase typing, and MRSA-phage typing. It was considered that such classification in combination of three methods is useful to make decision of epidemic by the same MRSA strain.

[Drug susceptibility of clinically isolated Helicobacter pylori]

Between January 1995 and March 1997, 78 Helicobacter pylori strains were isolated from patients with gastritis and gastric ulcer and their drug-susceptibilities to 8 antimicrobial agents and 3 anti-ulcer drugs were determined. Imipenem was the most active agent and its MICs to all the strains tested were lower than 0.013 microgram/ml. Amoxicillin, cefaclor and minocycline were active against H. pylori with MIC90s of 0.05 microgram/ml, 0.78 microgram/ml and 0.39 microgram/ml, respectively, and no resistant strains against these drugs were isolated. However, resistant strains to clarithromycin (isolation frequency: 9%), erythromycin (13%), ofloxacin (8%) and metronidazole (13%) were isolated. Triple, double and single resistant strains to above 4 antimicrobial agents were noted. No quadruple resistant strain was isolated. Frequencies of those resistance patterns were 14.3% (triple), 28.6% (double), and 57.1% (single), respectively. Seven erythromycin-resistant strains were shown to be cross-resistant to clarithromycin but 3 erythromycin-resistant strains were susceptible to clarithromycin. It seems likely that this phenomenon is caused by the fact that clarithromycin is more active to H. pylori than erythromycin. The MIC90 value of lansoprazole was lower than those of omeprazole and famotidine.

Amphotericin B as an intracellular antioxidant: protection against 2,2'-azobis(2,4-dimethylvaleronitrile)-induced peroxidation of membrane phospholipids in rat aortic smooth muscle cells

The antifungal activity of amphotericin B (AmB) and its side-effects (e.g. nephrotoxicity and hemolytic action) are suggested to be associated with its prooxidant effects in target cells. To test this hypothesis, we have undertaken studies to examine the role of AmB in oxidative stress in cultured rat aortic smooth muscle cells (SMC) incubated in the absence or in the presence of a lipid-soluble azo-initiator of peroxyl radicals, 2,2'-azobis(2,4-dimethylvaleronitrile) (AMVN). No changes in the pattern of membrane phospholipids could be detected by two-dimensional high performance thin-layer chromatography (HPTLC) after oxidative stress induced by AMVN in which the cells remained viable, as judged by trypan blue exclusion. To improve the sensitivity of detection of oxidative stress in the cells, cis-parinaric acid (PnA) was incorporated biosynthetically into the membrane phospholipids [using PnA-human serum albumin (hSA) complex]. Incubation of the cells under aerobic conditions in the presence of up to 10 microM AmB showed no significant change in the pattern of PnA-labeled phospholipids, suggesting that AmB was not affecting the oxidative state of the cells. In contrast, treatment with AMVN (0.5 mM, incubation in the dark for 2 hr at 37 degrees--conditions in which the viability of the cells was maintained) caused a significant reduction of all fluorescently labeled phospholipid fractions separated by HPLC. When PnA-labeled cells were subjected to oxidative stress by incubation with 0.5 mM AMVN in the presence of AmB, the loss of fluorescent phospholipids was reduced in a concentration-dependent manner over a concentration range of 0.25 to 10 microM. Thus, AmB does not produce any prooxidant effect but rather acts as an intracellular antioxidant.

Amphotericin B protects cis-parinaric acid against peroxyl radical-induced oxidation: amphotericin B as an antioxidant

The antifungal effects of amphotericin B are believed to be due to two possibly interrelated mechanisms: an increase in permeation by binding to sterols in cellular membranes and a prooxidant effect causing oxidative damage in target cells. However, the seven conjugated double bonds in amphotericin B raise the possibility that it could be highly susceptible to autoxidation, causing an antioxidant effect. In the present study, we investigated the prooxidant and antioxidant properties of amphotericin B in a model system in which oxidation of a reporter molecule, cis-parinaric acid, was induced by azo initiators of peroxyl radicals. Since interactions of amphotericin B with sterols are essential for its pharmacological and toxic actions, we also studied the effects of cholesterol on the prooxidant and antioxidant properties of amphotericin B. Amphotericin B caused a noncollisional quenching of a characteristic fluorescence of cholesteryl cis-parinarate integrated in liposomes, suggesting the formation of amphotericin B-cholesteryl cis-parinarate complex. This effect of amphotericin B was ablated by increasing concentrations of cholesterol. We found that amphotericin B inhibited oxidation of cis-parinaric acid complexed with human serum albumin [using a water-soluble azo initiator, 2,2'-azobis(2aminopropane)dihydrochloride] and in liposomes [using a lipid-soluble azo initiator, 2,2'-azobis(2,4-dimethylvaleronitrile)]. The inhibitory effect of amphotericin B on 2,2'-azobis(2,4-dimethylvaleronitrile)-induced peroxidation of cis-parinaric acid in liposomes was also diminished by cholesterol. The antioxidant effect of amphotericin B in this model system suggests that amphotericin B does not exert its pharmacological and toxicological responses through a prooxidant effect to cause damage in target cells.

[Serotypes and drug susceptibility of Pseudomonas aeruginosa isolated from clinical specimens]

Between January, 1982 and December, 1994, 236 Pseudomonas aeruginosa strains were isolated from clinical specimens at our division, and were tested for serotypes and drug-susceptibilities to 15 antibiotics. Serotype G strains were isolated at the highest frequency (32.6%), and followed by strains of serotype B (15.7%), A (11.9%), E (9.3%), I (7.2%), F and M (5.5%), non-typable (5.1%), D (3.4%), H (2.1%), C and K (0.8%). We examined the changes of isolation frequencies of different serotypes annually. Isolation frequencies of serotypes E and F showed tendency to decrease, whereas serotype I has been isolated increasingly year by year. MIC90's of the 15 antibiotics were as follows, tosufloxacin: 0.78 microgram/ml, biapenem (BIPM) and ofloxacin (OFLX): 3.13 micrograms/ml, imipenem (IPM), ceftazidime, cefozopran, cefsulodin and gentamicin: 6.25 micrograms/ml, aztreonam and amikacin: 12.5 micrograms/ml, piperacillin, cefoperazone and minocycline (MINO): 25 micrograms/ml, fosfomycin: > 100 micrograms/ml and chloramphenicol: > 200 micrograms/ml. MIC90'S of IPM, BIPM, MINO and OFLX increased 4-fold from stage I (1982-1987) through stage III (1992-1994) and the isolation frequency of drug-resistant strains increased year by year. In other words, antibiotic resistant strains appeared increasing with time. No relationship between serotypes and drug-resistance were observed.

Transvenous embolization of high flow carotid cavernous fistula: a case report

We treated a patient with a high flow traumatic carotid-cavernous fistula (CCF) by embolization using detachable balloons and metallic coils, by transarterial and transvenous approaches. The patient was a 20-year-old woman who had fractures in the skull base from a traffic accident. She was admitted to our hospital one month after the accident due to exophthalmos, chemosis, and periorbital bruit. Cerebral angiograms demonstrated left traumatic CCF and steal phenomenon of blood flow. Balloon embolization by transarterial approach performed three times was unsuccessful, probably because of balloon puncture due to bone fragments. Embolization using metalic coils via the superior ophthalmic vein route was then attempted. As a result of this approach, complete obliteration of CCF was obtained, and clinical symptoms subsided within a few days. Treatment of CCF by transvenous approach is one alternative when transarterial occlusion is difficult.

Adenosine inhibits growth of rat aortic smooth muscle cells. Possible role of A2b receptor

Abnormal growth of vascular smooth muscle cells (SMC) is frequently associated with hypertension and atherosclerosis, and homeostasis within a normal vessel is maintained by the balanced generation of both vasoconstrictors and vasodilators. Moreover, several endogenous vasoconstricting factors induce SMC growth, whereas several vasodilators inhibit SMC growth. Inasmuch as adenosine is a potent vasodilator, it is possible that it too could inhibit SMC growth. Hence, the effects of adenosine (10(-8) to 10(-3) mol/L), 2-chloroadenosine (a stable analogue of adenosine; 10(-8) to 10(-3) mol/L), and 8-bromo-cAMP (10(-8) to 10(-3) mol/L) on fetal calf serum (FCS; 2.5%)-induced growth of rat aortic SMC were evaluated. Growth was analyzed by assaying DNA synthesis (thymidine incorporation in SMC pulsed for 4 hours with 1 microCi/mL [3H]thymidine) and cell proliferation (change in cell number). Growth-arrested SMC were treated with 2.5% FCS in the presence and absence of adenosine, 2-chloroadenosine, or 8-bromo-cAMP for 24 hours for DNA synthesis or 4 days for cell proliferation. All three substances inhibited DNA synthesis and cell proliferation in a concentration-dependent manner. Compared with adenosine, 2-chloroadenosine was more potent in inhibiting growth. The inhibitory effects of 2-chloroadenosine were reversed by KF17837 (a specific A2 receptor antagonist) but not by DPCPX (a specific A1 receptor antagonist). Furthermore, the inhibitory effects of 2-chloroadenosine were not mimicked by CGS21680 (an A2a receptor agonist), and the effects of N6-cyclopentyladenosine (CPA; an A1 receptor agonist) were not markedly more potent than those of 2-chloroadenosine, suggesting that the inhibitory effects of adenosine are possibly mediated via A2b receptors. These studies provide evidence that adenosine inhibits SMC growth and suggest that a decrease in local levels of adenosine may initiate SMC growth and contribute to the vascular remodeling process observed in hypertension and atherosclerosis.

[Dislodgement of the ringed-graft--a case report]

A 70-year-old man underwent replacement of the distal aortic arch which contained a huge aneurysm using a ringed graft. He died suddenly of hemoptysis 54 months following the operation. An autopsy revealed dislodgement of the spool on the posterior aspect of the aorta. Histologic examination of the dislodged portion of the ring showed complete disruption of the intima and elastic fibers of the media. There were minimal histologic changes in the anterior portion of the anastomotic site. It is postulated that the long, kinked graft might have caused the late ring dislodgement.

[Aortitis syndrome with left coronary ostial occlusion and aortic regurgitation: a case report]

A 22-year-old woman with left coronary ostial occlusion and aortic regurgitation due to aortitis syndrome was reported. The coronary artery bypass grafting, using saphenous vein and aortic valve replacement were performed. The distal anastomosis of saphenous vein was performed to left anterior descending artery (Seg. 6), just distal to the origin of circumflex artery. The postoperative course was uneventful. There was no peri-prosthetic valvular leakage and bypass graft was patent.

[Surgical management of infective endocarditis in childhood]

From 1971 to 1993, four patients, 7 to 13 years of age, underwent intracardiac operation for infective endocarditis. Two patients underwent mitral valve replacements, one was tricuspid replacement and one received tricuspid valvulectomy. There was no operative death but one late death occurred (correction of occurred) due to cerebral bleeding. Surgical treatment of infective endocarditis in childhood could be performed safely by adequate selection of operative methods.

[Systemic-pulmonary artery shunt using Golaski graft: trial for measurement of the shunt flow]

For the systemic-pulmonary artery shunt operation, the modified Blalock-Taussig shunt was the first choice for procedure in our institution. Since 1990, Golaski knitted Dacron graft (4 or 5 mm in diameter) was used for the prosthesis. Ex-vivo flow calibration of the electromagnetic flow meter (Nihon Koden, MFV-3100) to Golaski graft showed good correlation between the real flow and value measured by the electromagnetic flow meter. Shunt flow was measured in the consecutive clinical fifteen cases. The shunt flow per body surface area of the patient who required additional shunt operation was 721 ml/min/m2 and one patient in whom the congestive heart failure developed after the shunt operation, had the shunt flow of 3,022 ml/min/m2. The adequate shunt flow in these cases was ranged from 745 to 2,820 ml/min/m2 (mean +/- 1 SD, 1,490 +/- 587.8). Therefore we performed the systemic-pulmonary artery shunt operation using Golaski graft to get the shunt flow of 1,000 ml/min/m2 (approximately a third of cardiac index) for the guide of good results.

[A case of hemothorax occurred two months after graft replacement of descending thoracic aorta with Hemashield arterial prosthesis]

A 70-year-old man performed graft replacement of descending thoracic aorta for chronic aortic dissection (DeBakey IIIb) with Hemashield arterial prosthesis. He also had coronary artery disease (LAD seg. 7.99% stenosis) and he had received PTCA prior to operation. He was administered anticoagulants such as Aspirin and Warfarin postoperatively. Two months after operation, he complained dyspnea and came back to our hospital. Chest X-ray showed left hemothorax. CT scan and aortogram could not revealed bleeding points such as pseudoanerysm at anastomosis site nor new dissection. He recovered after discontinued anticoagulants and drainage. If you need to use the anticoagulants after graft replacement with Hemashield, you should administer the anticoagulants about 14 days after operation. This is the first clinical report that hemothorax occurred two months after graft replacement with Hemashield.

[Staged operation for aneurysm of the entire aorta: report of four cases]

Between September 1989 and May 1994, 3 patients with aortic dissection and one with atherosclerotic total aortic aneurysm associated with annuloaortic ectasia underwent successful staged operation for aneurysm of the entire aorta and aortic regurgitation. A composite graft was used for total aortic root replacement. Carbrol and Piehler techniques, Carrel patch and saphenous vein grafting were employed for coronary artery reconstruction. En bloc arch reconstruction was performed in one patient and three vessels graft replacement in 3 patients under hypothermic separate cerebral perfusion. Combined antegrade with retrograde oxygenated crystalloid cardioplegia and terminal warm blood cardioplegia were used for myocardial protection during prolonged aortic cross clamping in a simultaneous total aortic root and arch replacement. Elephant trunk was used at the distal arch anastomosis in 3 patients and useful for following thoracoabdominal surgery. In 3 patients, separate perfusion of upper and lower body technique with moderate hypothermia was employed and seemed to be useful in the patients who require extensive thoracoabdominal replacement to prevent spinal cord injury. All patients had no major complications and have been well.

Renal and hormonal responses to repeated treatment with enalapril in non-azotemic cirrhosis with ascites

Since a single dose of the angiotensin-converting enzyme inhibitor enalapril was shown to cause natriuresis in cirrhosis in a previous study, we investigated whether repeated doses of this substance would sustain a favorable renal effect in cirrhosis. Ten milligrams of enalapril maleate were administered once a day for 8 days to ten patients with non-azotemic cirrhosis and ascites. Enalapril reduced blood pressure significantly at 4 to 12 h (systolic blood pressure) and 2, 6, and 8 h (diastolic blood pressure) on day 2, compared to pretreatment (day 0) values, but this depressor effect decreased on day 8. No change in heart rate could be detected. Enalapril significantly suppressed serum angiotensin-converting enzyme activity and plasma aldosterone concentration (p < 0.001 to 0.01), which were elevated prior to treatment, with pretreatment values of 25.8 +/- 1.8 IU/l for serum angiotensin-converting enzyme activity and 241 +/- 67 pg/ml for plasma aldosterone concentration. This drug caused a 12 to 24% increase (p < 0.05 to 0.01) in mean daily urinary volume and a 40 to 54% increase (p < 0.001 to 0.01) in mean daily urinary sodium excretion from the respective pretreatment baselines during the 8-day period. Creatinine clearance was improved (p < 0.05) by the treatment, with mean improvement values from 24 to 34% above the pretreatment value of 47.4 +/- 4.3 ml/min.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac dilatation after cardiopulmonary bypass: ceramic plate technique for sternal splinting

Intraoperative sternal closure after cardiopulmonary bypass in patients with cardiac dilatation and dysfunction may cause fatal deterioration of their hemodynamics. To avoid this complication, a ceramic plate made from methyl methacrylate was used for sternal splinting. This simple splint can avoid chest wall compression to the overdilated heart, maintaining stable hemodynamics after cardiopulmonary bypass without postoperative respiratory complications or mediastinal infection.

[Growth of tracheal anastomoses in growing animals]

Growth of the trachea after complete transection and anastomoses was studied in four equal groups (N = 7) of young New Zealand white rabbits (mean weight 1.19 +/- 0.19 kg). The trachea was transected below the 5th cartilagenous ring and immediately anastomosed. Suture materials and sewing techniques used for comparison were continuous 6-0 polypropylene, interrupted 6-0 polypropylene, continuous 6-0 polydioxanone (PDS) or interrupted 6-0 PDS. The animals were electively sacrificed between 95 and 98 days after surgery. Mean body weight increased to 2.7 +/- 0.18 kg. Mean cross sectional area (CSA) of the trachea at sacrifice at the anastomosis (A) and an average of CSA 5 mm above and below the anastomosis (B) were compared. The ratios (A/B) of each groups were 0.52 (continuous polypropylene), 0.62 (interrupted polypropylene), 0.58 (continuous PDS) and 0.80 (interrupted PDS), respectively. One way of analysis of variance revealed that growth of the tracheal anastomoses in interrupted PDS was significantly better (p less than 0.005) than other combinations. It was concluded that growth of the trachea following complete transection and anastomosis in a growing animal was significantly better with absorbable suture material and interrupted suturing technique.