Evidence of a Hardening in the Cosmic Ray Proton Spectrum at around 166 TeV Observed by the GRAPES-3 Experiment

We present the measurement of the cosmic ray proton spectrum from 50 TeV to 1.3 PeV using 7.81×10^{6} extensive air shower events recorded by the ground-based GRAPES-3 experiment between 1 January 2014 and 26 October 2015 with a live time of 460 day. Our measurements provide an overlap with direct observations by satellite and balloon-based experiments. The electromagnetic and muon components in the shower were measured by a dense array of plastic scintillator detectors and a tracking muon telescope, respectively. The relative composition of the proton primary from the air shower data containing all primary particles was extracted using the multiplicity distribution of muons which is a sensitive observable for mass composition. The observed proton spectrum suggests a spectral hardening at ∼166  TeV and disfavors a single power law description of the spectrum up to the Knee energy (∼3  PeV).

Career outcomes and satisfaction among graduates of a 4-year oral health and welfare baccalaureate program at Niigata University, Japan: A cross-sectional study

OBJECTIVE

Globally, baccalaureate programs in dental hygiene are increasingly established. In addition, in Japan, many dental hygienists (DHs) and social workers (SWs) are prematurely leaving the workforce. This study aimed to investigate the most recent employment, career outcomes, reasons for a job change, and satisfaction with the job and undergraduate curriculum among graduates of the baccalaureate program at the Department of Oral Health and Welfare (DOHW), Faculty of Dentistry, Niigata University.

METHODS

All 262 graduates (graduating classes 1-10) of the DOHW were invited to participate in this survey; an original self-administered questionnaire was distributed to those who consented. Responses were received from 114 (43.5%) graduates.

RESULTS

Almost all respondents (89.5%) had dual licensure as both DH and certified SW. They were employed immediately after graduation (99.1%) and at the time of the survey (96.5%). Over 60% of them worked as DHs, mainly in hospitals. SWs mainly worked in administration. Among the 113 respondents who were employed, 39.8% changed jobs at least once. The main reasons for job selection were 'interest in job content' and 'flexible working hours'. Nearly 90% of the respondents felt satisfied or fairly satisfied with their job and their undergraduate education.

CONCLUSIONS

A quality 4-year baccalaureate degree program in dental hygiene and social welfare positively influenced graduates' work continuity. Most graduates felt satisfied or fairly satisfied with their job and the undergraduate curriculum. Employment rates within each profession and the prevalence of hospital and administrative roles were higher than national averages. Long-term studies of graduates' career outcomes are warranted.

Semisupervised Deep State-Space Model for Plant Growth Modeling

The optimal control of sugar content and its associated technology is important for producing high-quality crops more stably and efficiently. Model-based reinforcement learning (RL) indicates a desirable action depending on the type of situation based on trial-and-error calculations conducted by an environmental model. In this paper, we address plant growth modeling as an environmental model for the optimal control of sugar content. In the growth process, fruiting plants generate sugar depending on their state and evolve via various external stimuli; however, sugar content data are sparse because appropriate remote sensing technology is yet to be developed, and thus, sugar content is measured manually. We propose a semisupervised deep state-space model (SDSSM) where semisupervised learning is introduced into a sequential deep generative model. SDSSM achieves a high generalization performance by optimizing the parameters while inferring unobserved data and using training data efficiently, even if some categories of training data are sparse. We designed an appropriate model combined with model-based RL for the optimal control of sugar content using SDSSM for plant growth modeling. We evaluated the performance of SDSSM using tomato greenhouse cultivation data and applied cross-validation to the comparative evaluation method. The SDSSM was trained using approximately 500 sugar content data of appropriately inferred plant states and reduced the mean absolute error by approximately 38% compared with other supervised learning algorithms. The results demonstrate that SDSSM has good potential to estimate time-series sugar content variation and validate uncertainty for the optimal control of high-quality fruit cultivation using model-based RL.

TBX1 Regulates Chondrocyte Maturation in the Spheno-occipital Synchondrosis

The synchondrosis in the cranial base is an important growth center for the craniofacial region. Abnormalities in the synchondroses affect the development of adjacent regions, including the craniofacial skeleton. Here, we report that the transcription factor TBX1, the candidate gene for DiGeorge syndrome, is expressed in mesoderm-derived chondrocytes and plays an essential and specific role in spheno-occipital synchondrosis development by inhibiting the expression of genes involved in chondrocyte hypertrophy and osteogenesis. In Tbx1-deficient mice, the spheno-occipital synchondrosis was completely mineralized at birth. TBX1 interacts with RUNX2, a master molecule of osteoblastogenesis and a regulator of chondrocyte maturation, and suppresses its transcriptional activity. Indeed, deleting Tbx1 triggers accelerated mineralization due to accelerated chondrocyte differentiation, which is associated with ectopic expression of downstream targets of RUNX2 in the spheno-occipital synchondrosis. These findings reveal that TBX1 acts as a regulator of chondrocyte maturation and osteogenesis during the spheno-occipital synchondrosis development. Thus, the tight regulation of endochondral ossification by TBX1 is crucial for the normal progression of chondrocyte differentiation in the spheno-occipital synchondrosis.

Effects of the time-of-day (morning vs. afternoon) of implementing a combined physical and cognitive exercise program on cognitive functions and mood of older adults: A randomized controlled study

This study examined the effects of the time of conducting a combined physical and cognitive exercise program on cognitive functions and the mood of older adults. We randomly assigned 17 participants (8 men, 9 women, age 73,24±3,75) to the morning group (AM Group), 18 (8 men, 10 women, age 73,11±4,84) to the afternoon group (PM Group), and they completed a 12-week, dual-task exercise program in the morning or the afternoon, respectively. Moreover, the waiting-list control group consisted of 12 participants (6 men, 6 women, age 73,25±5,93). The cognitive functions and the mood of the participants were assessed before and after the program by using the Neurobehavioral Cognitive Status Examination, and the short version of the Profile of Mood States, respectively. As a result, the exercise program conducted in the afternoon had broader effects on cognitive functions (increased Repetition and Memory) than in the morning (increased Repetition), or the waiting-list control group (increased Judgment). Moreover, the program in the afternoon tended to reduce Anger-Hostility, and Fatigue. In conclusion, conducting the exercise program in the afternoon might be more effective for improving cognitive functions and the mood of older adults than in the morning. However, there was heterogeneity between the groups despite the randomization. Therefore, we suggest conducting a more rigorously controlled study using a larger sample to validate these findings.

P1707Non-business hours and cold exposure independently worsen neurological outcome after out-of-hospital cardiac arrest

Background

It has been known that survival rates after out-of-hospital cardiac arrest (OHCA) are lower at night than during the day. It may be explained by diurnal temperature changes.

Purpose

The purpose of the present study was to test our hypothesis that diurnal variation of the prognosis after OHCA would be independent from the ambient temperature changes.

Methods

We used the All-Japan Utstein Registry (2005–2010) combined with atmospheric temperature from the Automated Meteorological Data Acquisition System, and enrolled adult OHCA patients who had suffered from a witnessed cardiac arrest and who had been resuscitated.

The primary outcome was a favorable neurological outcome one month after OHCA and the secondary outcome was the presence of return of spontaneous circulation (ROSC) before hospital admission. Effects of business vs. non-business hours and ambient temperature on the primary and secondary outcomes were assessed with adjustment for factors that are known to potentially affect OHCA outcomes. Sub-group analysis based on the initial cardiac rhythm (VT/Vf, PEA and Asystole) was also performed.

Results

Among the 263,750 witnessed OHCA patients, neurological survival and ROSC rates were significantly increased with an adjusted odds ratio (OR) of 1.13 (95% CI 1.08–1.18) and hazard ratio (HR) of 1.06 (95% CI 1.04–1.09) for non-business hours, and OR of 1.11 (95% CI 1.05–1.17) and HR of 1.05 (95% CI 1.02–1.08) for each 20°C increase in temperature. The effects were different between business vs. non-business hours and ambient temperature dependent on the initial cardiac rhythm.

Conclusions

These findings suggest that both the outdoor temperature and business hours are independent factors for predicting neurological outcomes after OHCA with different characteristics based on the initial cardiac rhythms. Diurnal variability of prognosis after OHCA is likely to be attributable to diurnal variation of medical resources.

Measurement of the Electrical Properties of a Thundercloud Through Muon Imaging by the GRAPES-3 Experiment

The GRAPES-3 muon telescope located in Ooty, India records rapid (∼10  min) variations in the muon intensity during major thunderstorms. Out of a total of 184 thunderstorms recorded during the interval of April 2011-December 2014, the one on December 1, 2014 produced a massive potential of 1.3 GV. The electric field measured by four well-separated (up to 6 km) monitors on the ground was used to help estimate some of the properties of this thundercloud, including its altitude and area that were found to be 11.4 km above mean sea level and ≥380  km^{2}, respectively. A charging time of 6 min to reach 1.3 GV implied the delivery of a power of ≥2  GW by this thundercloud that was moving at a speed of ∼60  km h^{-1}. This work possibly provides the first direct evidence for the generation of gigavolt potentials in thunderclouds that could also possibly explain the production of highest-energy (100 MeV) gamma rays in the terrestrial gamma-ray flashes.

Angular and Abundance Distribution of High-energy Gamma Rays and Neutrons Simulated by GEANT4 Code for Solar Flares

In the solar flare observed on June 3, 2012, high energy gamma-rays and neutrons were observed. The event includes a remarkable feature of a high neutron/gamma-ratio in the secondary particles. We have examined whether this high n/γ-ratio can be explained by simulation. As a result of simulations using the GEANT4 program, the high n/γ-ratio may be reproduced for the case that helium and other heavy ions were dominantly accelerated in the flare.

Income from nutrition and oral health management among long-term care insurance facilities in Niigata Prefecture, Japan

OBJECTIVE

To determine recent insurance claim rates for, facility income from, and the roles of professionals associated with management of nutrition, oral ingestion and oral health maintenance in long-term care insurance facilities (LTCIFs) in Niigata Prefecture.

METHODS

A questionnaire on current staffing, oral health professional (OHP) utilisation, and claims for insured benefits for the investigated services was mailed to all LTCIFs in Niigata Prefecture, Japan (n = 304). Claim rates for and average facility income from these benefits were calculated. Facility income was compared between facilities with and without employed OHPs. Statistically significant factors associated with claims for investigated benefits were identified by logistic regression.

RESULTS

Responses from 111 facilities indicated that they made insurance claims for nutrition management (95%), transition from tube feeding to oral ingestion (9%), basic maintenance of oral ingestion (39%), additional services for maintenance of oral ingestion (23%), oral health management system (68%), and oral health management (17%). Most facilities established collaborations with private dental clinics, but only 16% of facilities employed OHPs. Facility income was significantly higher (P = 0.005) for facilities that employed OHPs. OHP employment by facilities was associated with claims for four of the six benefits (P < 0.05).

CONCLUSIONS

Most facilities consulted with private dental clinics, and 16% of the facilities employed dentists or dental hygienists to help residents manage oral ingestion problems and oral health maintenance. The facility income associated with management of these problems was significantly higher in facilities employing dental professionals.

Eighteen-month Clinical Study of Universal Adhesives in Noncarious Cervical Lesions

OBJECTIVE

To evaluate the clinical performance of Scotchbond Universal (3M Oral Care) and Prime & Bond Elect (Dentsply Sirona) in the restoration of noncarious cervical lesions (NCCLs).

METHODS AND MATERIALS

This was a randomized controlled clinical trial involving 63 subjects. Two hundred and three NCCLs were restored using Scotchbond Universal and Prime & Bond Elect using both an etch-and-rinse and a self-etch technique. Lesions were notch-shaped NCCLs, and the restorations were placed without any mechanical retention. Restorations were finished immediately after placement and scored with regard to retention, marginal discoloration, marginal adaptation, and secondary caries. Similar assessment of the restorations was performed 18 months after placement. Logistic regression was performed for each outcome separately with a compound symmetric variance-covariance structure assumed to consider a correlation of restorations within subjects. All analyses were conducted using SAS version 9.4 (SAS Inc).

RESULTS

One hundred and fifty-eight teeth (77.8% of the restorations placed) in 46 subjects (73% of subjects enrolled) were available for the 18-month follow-up. A statistically significant difference was reached only for the comparison Scotchbond Universal/self-etch (SU_SE) and Prime & Bond Elect/etch-and-rinse (PBE_E&R) groups ( p=0.01), where a restoration with SU_SE was 66% less likely to maintain a score of Alpha for marginal discoloration than a restoration performed with PBE_E&R.

CONCLUSIONS

Scotchbond Universal and Prime & Bond Elect presented acceptable clinical performance after 18 months of clinical service. However, Scotchbond Universal, when applied with a self-etch approach, did demonstrate a relatively high level of marginal discoloration when compared to the other groups.

Relationship of Serum Carnitine Level with Falls and Gait Disturbance in the Elderly

BACKGROUND

Gait disturbance and falls are serious events that can impair activities of daily living (ADL) in the elderly. On the other hand, carnitine plays essential roles in energy production, and carnitine deficiency leads to low activity levels.

OBJECTIVES

We examined whether a lower serum carnitine concentration was correlated with falls and gait disturbances in the elderly.

DESIGN, SETTING, AND PARTICIPANTS

We performed a cross-sectional study. One hundred and ninety-eight elderly patients (male, 83; female, 115; 81 ± 6 years old) were enrolled in this study.

MEASUREMENTS

Physical performance (hand grip strength, leg strength, walking speed, one-leg standing time, and tandem gait steps) and frailty status (The Edmonton Frail Scale: EFS) were evaluated. The serum total, free, and acylated carnitine levels were measured using an enzyme cycling method. We then investigated the associations between the serum carnitine level, history of falls, and the results of these physical examinations.

RESULTS

Of the 198 subjects, 56 (28%) had a history of falls within the past one year. The patients with a history of falls had lower serum total carnitine and free carnitine levels than those without a history of falls. Regarding the physical performance results, the patients with a history of falls had higher EFS scores, a weaker hand grip strength, a slower walking speed, a shorter one-leg standing time, and a smaller number of tandem gait steps than those without a history of falls. A logistic regression analysis showed that the low serum total carnitine concentration was identified as an independent factor associated with a history of falls, a slow walking speed after adjustments for age, sex and modified EFS.

CONCLUSIONS

A low serum carnitine level is associated with a history of falls and gait disturbances in elderly people.

Relationship between alcohol consumption and periodontal tissue condition in community-dwelling elderly Japanese

OBJECTIVES

To examine the associations among alcohol consumption level, dietary intake and other lifestyle factors, and periodontal condition, in community-dwelling elderly Japanese of a specific age.

BACKGROUND

The relationship between alcohol consumption level and periodontitis is a controversial issue.

METHODS

Participants were 438 dentate elders aged 73 years from a larger cohort survey of elders in Niigata City, Japan. Data collected from oral examination of each participant, including number of the existing teeth, mean probing pocket depth and mean clinical attachment level (CAL) were used for the analyses. A semiquantitative food frequency questionnaire and a lifestyle habit questionnaire were used to assess food and alcohol consumption, smoking experience, frequency of tooth brushing, interdental brush use, and visits to a dental clinic during the previous year. Blood glucose control was assessed by the glycated haemoglobin (HbA1c) level. Body mass index was calculated from height and weight measurements. The relationships between each variable and the individual mean CAL were analysed by univariate and multivariate analyses.

RESULTS

According to logistic regression analysis, the mean CAL was significantly associated with the number of existing teeth (odds ratio [OR] = 0.90; P < .001), being a heavy drinker (OR = 2.44; P < .05), and smoking experience (OR = 2.37; P < .01).

CONCLUSION

This study showed that increased mean CAL was significantly associated with heavy drinking in community-dwelling elderly Japanese (aged 73 years) compared with non-drinking. Our results provide new evidence that high alcohol consumption is associated with an increased risk of periodontal disease and its progression.

Recurrent Spindle Cell Carcinoma Shows Features of Mesenchymal Stem Cells

This study investigated a case of spindle cell carcinoma (SpCC) in tongue pathological lesions. The patient experienced a local recurrence and distant metastasis after surgical intervention. Although standard chemotherapy was administered, a granulomatous mass continued to develop. This aggressive growth led to survival of the tumor. Secondary debulking surgery was performed to improve the patient's quality of life at the request of the patient. Using a tissue sample derived from the secondary debulking surgery, we performed an analysis of the tumor's cell surface antigens, differentiation potential, metastatic ability, and inhibition potential by anticancer reagents. In vitro analysis revealed that the cell population grown under adherent culture conditions expressed the mesenchymal stem cell (MSC) markers CD73, CD90, and CD105. The cell line established from this SpCC contained colony-forming unit fibroblasts (CFU-Fs) and exhibited multipotent differentiation into several mesenchymal lineages, including bone, cartilage, and fat. The SpCC cells also displayed vigorous mobilization. These characteristics suggested that they had the differentiation potential of mesenchymal cells, especially MSCs, rather than that of epithelial cells. The surgical specimen analyzed in this study resisted the molecular target reagent cetuximab, which is an epidermal growth factor receptor inhibitor. This clinical insight revealed that chemotherapy-resistant SpCC cells have different characteristics compared to most other cancer cells, which are sensitive to cetuximab. Our cell death assay revealed that SpCC cell death was induced by the anticancer drug imatinib, which is known to inhibit protein tyrosine kinase activity of ABL, platelet-derived growth factor receptor α (PDGFRα), and KIT. Here, we report recurrent SpCC with characteristics of MSCs and potential for treatment with imatinib.

Theoretical Considerations on the Health Checkup Accuracy of Combination Testing

Objectives: To find basic theoretical evidence for an optimum combination of multi-phasic health checkup testing obtained by considering how the health checkup accuracy changes with the number of tests (n) and kinds of combination methods (A, B, C, D and E).

Methods: To find how the health checkup accuracy changes with the number of tests and type of combination method, generalized formulas as functions of the number of tests, are obtained to calculate the over-all health checkup accuracy which is defined by sensitivity ( ), specificity ( ) and odds-ratio ( ), based on the two-by-two table. Five kinds of combination methods were considered: A) Sequential tests. B) Sequential tests after changing the order in A. C) Simultaneous tests using the Believe-the-Negative Rule. D) Simultaneous tests using the Believe-the-Positive Rule. E) Simultaneous tests using the Believe-all-Positive-all-Negative Rule.

Results: It was provend that combination methods A, B and C are “equivalent” for health checkup accuracy. Therefore, the five methods could be summarized into three patterns. For A, B and C:andincreased but a decreased with increasing n. For D:increased butanddecreased with n. For E:,andincreased with n.

Conclusion: Health checkup accuracy of combination testing is the best in case of E, although problems exist concerning how to judge the borderline subjects.

Subjective Symptoms Acquisition System in a Health Promotion System for the Elderly

A previous report was concerned with the evaluation of quality of life using a Health Promotion System for the Elderly. In the present report, we describe one part of that system: a subjective symptoms acquisition and reporting system.

The main purpose of this system is to permit any physician or nurse to uniformly employ questionnaires to acquire accurate subjective symptoms. This system is applied in three steps. First, the subjective answers to 21 questions displayed on a personal computer are obtained. These answers correspond to the basic subjective symptoms. Second, if a basic subjective symptom is “positive”, more detailed questions are automatically generated. Finally, clear sentences regarding subjective symptoms are generated and output as a “finding report”.

This information is helpful to physicians and nurses in their health-counseling work. An artificial intelligence (AI) program based on “XpertRule” produces detailed questions which are generated by an interactive questionnaire using branching logical rules.

The effect of bolus volume on laryngeal closure and UES opening in swallowing: Kinematic analysis using 320-row area detector CT study

This study investigated the effects of three different volumes of honey-thick liquid on the temporal characteristics of swallowing. Twenty-six healthy subjects (15 males, 11 females) underwent 320-row area detector CT scan while swallowing 3, 10 and 20 mL of honey-thick liquid barium. Three-dimensional images were created at 10 images/s. Kinematic events involving six structures (velopharynx, hyoid bone, epiglottis, laryngeal vestibule (LV), true vocal cords (TVC), upper esophageal sphincter (UES)) and timing of bolus movement were timed using frame by frame analysis. The overall sequence of events did not differ across three volumes; however, increasing bolus volume significantly changed the onset and termination of events. The bolus head reached to pharynx and esophagus earlier and the duration of bolus passing through UES was significantly longer in 10 and 20 mL compared to 3 mL (P < .05). Consequently, the onset of UES opening was significantly earlier with increased volume (P < .05). LV and TVC closure occurred later in 20 mL compared to 3 mL (P < .05). These changes in motion of pharynx and larynx appeared to promote swallow safety by preventing aspiration, suggesting that anatomical structure movements adapt in response to bolus volume. Our findings also suggest that the pharyngeal swallow behaviours may be modified by afferents in the oral cavity. The three-dimensional visualization and quantitative measurements provided by 320-ADCT provide essential benchmarks for understanding swallowing, both normal and abnormal.

An oral health and function screening tool for nursing personnel of long-term care facilities to identify the need for dentist referral without preliminary training

OBJECTIVE

To develop and evaluate, with a dentist as gold standard, an oral health screening tool, the Oral Health Screening Tool for Nursing Personnel (OHSTNP), that assists long-term care facility nursing staff without preliminary training in identifying resident need for dentist referral.

METHODS

Using an OHSTNP adapted from previous screening tools (Chalmers, J Gerontol Nurs, 2004, 30, 5; Tsukada, J Jpn Soc Dent Hyg, 2012, 7, 43), one of four nurses, one of eight caregivers and a dentist with 15 years' experience screened the oral health/function of 57 long-term care facility residents. The OHSTNP included a question on the need and reasons for dentist referral. Tool reliability and validity were evaluated by determining inter-rater agreement (Cohen's kappa), sensitivity, specificity and accuracy.

RESULTS

For dentist-nurse and dentist-caregiver pairs, kappa was statistically significant and sensitivity was high (≥0.67, nurses; ≥0.71, caregivers) for natural teeth, dentures and oral function-related categories. Specificity for all categories was ≥0.69. Screening by nurses and caregivers for need for referral had low sensitivity (0.05, 0.23), accuracy (0.25, 0.39) and kappa (-0.01, 0.08). However, if nursing staff had been instructed to request a dentist referral in case of alterations in natural teeth/dentures or severe alterations in any other category, the estimated values increased to a sensitivity of 0.86 and 0.91, an accuracy of 0.75 and 0.82 and a kappa of 0.26 and 0.47.

CONCLUSIONS

OHSTNP was reliable and valid for screening natural teeth, denture conditions and oral functions. Supplementary guidelines improved estimates of OHSTNP sensitivity, accuracy and reliability for nurse/caregiver assessment of resident need for dentist referral.

A Conservative Technique for Repairing Class IV Composite Restorations

Composite resin may make a restoration noticeable as time passes, on account of its color instability. The repair technique is a minimally invasive treatment for class IV composite resin restorations that show unsatisfactory coloration. Thus, the objective of the present article was to report a clinical case involving a conservative technique used for repairing a class IV composite resin restoration in the left maxillary central incisor and the replacement of a class IV restoration in the right maxillary central incisor.

Transient Weakening of Earth's Magnetic Shield Probed by a Cosmic Ray Burst

The GRAPES-3 tracking muon telescope in Ooty, India measures muon intensity at high cutoff rigidities (15-24 GV) along nine independent directions covering 2.3 sr. The arrival of a coronal mass ejection on 22 June 2015 18:40 UT had triggered a severe G4-class geomagnetic storm (storm). Starting 19:00 UT, the GRAPES-3 muon telescope recorded a 2 h high-energy (∼20  GeV) burst of galactic cosmic rays (GCRs) that was strongly correlated with a 40 nT surge in the interplanetary magnetic field (IMF). Simulations have shown that a large (17×) compression of the IMF to 680 nT, followed by reconnection with the geomagnetic field (GMF) leading to lower cutoff rigidities could generate this burst. Here, 680 nT represents a short-term change in GMF around Earth, averaged over 7 times its volume. The GCRs, due to lowering of cutoff rigidities, were deflected from Earth's day side by ∼210° in longitude, offering a natural explanation of its night-time detection by the GRAPES-3. The simultaneous occurrence of the burst in all nine directions suggests its origin close to Earth. It also indicates a transient weakening of Earth's magnetic shield, and may hold clues for a better understanding of future superstorms that could cripple modern technological infrastructure on Earth, and endanger the lives of the astronauts in space.

A new insight into the fabella at knee: the foetal development and evolution

Using longitudinal semiserial sections of 12 lower extremities from 8 human foetuses at 15-18 weeks, we compared foetal morphologies of the knee in specimens with and without fabellae. We also compared the fabella, if present, with the hallucal sesamoid in the same foetus. Cartilaginous fabella, positive for versican and tenascin by immunohistochemistry, was found in 5 of the 8 foetuses. This structure was embedded in a thick and tight lateral fibrous band, providing a common origin of the plantaris muscle and the lateral head of the gastrocnemius muscle. The plantaris was covered by the lateral head of the gastrocnemius, but these 2 muscles were separated by a distinct fascia or space. Notably, the foetal fabella did not attach to the joint capsule. In the 3 specimens without fabellae, the lateral fibrous band was thin, containing a fibrous mass, negative for versican and tenascin, in place of the fabella. The "medial" head of the gastrocnemius faced or covered the plantaris, while the lateral head was continuous with the plantaris. A hallucal cartilaginous sesamoid, positive for versican and tenascin, was present in all 8 specimens. It carried a flat surface facing the joint cavity and was covered by tendons of the short muscles of the foot. Because of the difference in topographical relation of muscles between specimens with or without fabella, rather than mechanical stress to the tendon, fabella development may require a distinct plantaris muscle independent of the gastrocnemius. We discussed about an evolutionary aspect of the fabella and plantaris muscle.

Ceramic Veneers and Direct-Composite Cases of Amelogenesis Imperfecta Rehabilitation

The aim of this article is to present two case reports for the treatment of patients affected with amelogenesis imperfecta. One case was treated with composite resin and the other case with ceramic veneers. Esthetic and functional results were achieved using both treatments, and a review of advantages and disadvantages is presented.

Changes in the Oral Moisture and the Amount of Microorganisms in Saliva and Tongue Coating after Oral Ingestion Resumption: A Pilot Study

BACKGROUND AND OBJECTIVE

Tube feeding has been significantly associated with a higher rate of aspiration pneumonia that is mainly related to oral microorganisms and a reduced salivary flow. Thus, the difference in the mode of nutritional intake is expected to affect the oral environment, but this has not yet been fully clarified. The purpose of this study was to investigate, in tube-fed patients, changes in the oral moisture and the counts of microorganisms in saliva and tongue coating, which occur after oral ingestion resumption.

METHODS

Study participants were 7 tube-fed inpatients of the Niigata University Medical and Dental Hospital (72.7±8.5 years old) who received dysphagia rehabilitation at the Unit of Dysphagia Rehabilitation until oral ingestion resumption. Their oral health, swallowing, and nutrition status, oral mucosal moisture, amount of unstimulated saliva and the counts of microorganisms (total microorganisms, streptococci, Candida) in saliva and tongue coating were investigated and compared before and after the recommencement of oral intake.

RESULTS

Tongue coating, choking, oral mucosal moisture and amount of unstimulated saliva were improved significantly after resumption of oral ingestion. The other investigated parameters did not significantly change, except for the streptococci in tongue coating, which significantly increased 1 week after oral ingestion recommencement, but decreased thereafter.

CONCLUSION

After oral intake resumption, oral mucosal moisture and amount of unstimulated saliva were improved. However, because of a transitory increase in the counts of streptococci with oral ingestion recommencement, it is important to appropriately manage oral hygiene in these patients, according to the changes in their intraoral microbiota.

Comprehension of Japanese oral care-related terms among caregivers and nurses, as assessed using a newly developed instrument

OBJECTIVES

(i) To assess comprehension of oral care-related terms among caregivers and nurses working at long-term care facilities, using a newly developed test; (ii) to analyse the effect of participant characteristics on their comprehension.

BACKGROUND

Effective mutual communication between dental professionals and caregivers/nurses is essential for providing information on daily oral care for institutionalised elders.

METHODS

A 36-item word-knowledge test in Japanese was developed to assess comprehension of oral care-related terms. The test was administered to a convenience sample of 236 nursing staff (198 caregivers and 38 nurses) at six long-term care facilities in Niigata City, Japan, and its reliability and validity were verified. Associations of participant characteristics with their responses were investigated by multiple regression analysis.

RESULTS

Mean percentage of correct responses (accuracy rate) for nursing staff was approximately 62% (highest for oral care products and lowest for prosthodontic terms). Test internal reliability was high (Cronbach's alpha >0.8). Concurrent validity (test ability to distinguish between characteristically different groups) was confirmed. Mean accuracy rate was significantly higher among nurses (78.5 ± 19.3%) than among caregivers (58.7 ± 22.8%), and among respondents with interest in oral care (64.2 ± 21.1%) than among those with no such interest (51.5 ± 28.9%).

CONCLUSION

The word-knowledge test was valid and reliable for nursing staff of six long-term care facilities in Niigata City. Their comprehension was low for perioral and intraoral structures, related symptom and disease names, and prosthodontics terms related to oral care. Understanding of oral care-related terms among the nursing staff was related to their occupation and interest in oral care.

An in situ hybridization study of perlecan, DMP1, and MEPE in developing condylar cartilage of the fetal mouse mandible and limb bud cartilage

The main purpose of this in situ hybridization study was to investigate mRNA expression of three bone/cartilage matrix components (perlecan, DMP1, and MEPE) in developing primary (tibial) and secondary (condylar) cartilage. Perlecan mRNA expression was first detected in newly formed chondrocytes in tibial cartilage at E13.0, but this expression decreased in hypertrophic chondrocytes at E14.0. In contrast, at E15.0, perlecan mRNA was first detected in the newly formed chondrocytes of condylar cartilage; these chondrocytes had characteristics of hypertrophic chondrocytes, which confirmed the previous observation that progenitor cells of developing secondary cartilage rapidly differentiate into hypertrophic chondrocytes. DMP1 mRNA was detected in many chondrocytes within the lower hypertrophic cell zone in tibial cartilage at E14.0. In contrast, DMP1 mRNA expression was only transiently detected in a few chondrocytes of condylar cartilage at E15.0. Thus, DMP1 may be less important in the developing condylar cartilage than in the tibial cartilage. Another purpose of this study was to test the hypothesis that MEPE may be a useful marker molecule for cartilage. MEPE mRNA was not detected in any chondrocytes in either tibial or condylar cartilage; however, MEPE immunoreactivity was detected throughout the cartilage matrix. Western immunoblot analysis demonstrated that MEPE antibody recognized two bands, one of 67 kDa and another of 59 kDa, in cartilage-derived samples. Thus MEPE protein may gradually accumulate in the cartilage, even though mRNA expression levels were below the limits of detection of in situ hybridization. Ultimately, we could not designate MEPE as a marker molecule for cartilage, and would modify our original hypothesis.

Serum IL-33 levels are increased in patients with psoriasis

BACKGROUND

Interleukin (IL)-33 is a recently identified cytokine, which is a member of the IL-1 family and binds to a heterodimeric receptor comprising ST2 (suppression of tumorigenicity 2) and IL-1 receptor accessory protein. Serum levels of IL-33 have been reported to be upregulated in various T helper (Th)1/Th17-mediated diseases, such as rheumatoid arthritis and inflammatory bowel disease. IL-33 expression is increased in lesional skin in patients with psoriasis, but serum levels in patients with psoriasis have not yet been studied.

AIM

To study serum IL-33 levels in patients with psoriasis, a Th1/Th17-mediated skin disease, before and after anti-tumour necrosis factor (TNF)-α therapy.

METHODS

Serum IL-33 levels were measured in patients with psoriasis vulgaris (PV), psoriatic arthritis (PsA) or pustular psoriasis (PP), and compared with those of healthy controls. Associations between serum IL-33 levels and serum TNF-α, IL-6, vascular endothelial growth factor and C-reactive protein levels were also studied. In addition, the effect of IL-33 stimulation on IL-6, IL-8, TNF-α and VEGF secretion by human keratinocyte was analysed.

RESULTS

Serum IL-33 levels in patients with PV, PsA and PP were significantly higher than those in healthy controls. Serum IL-33 levels correlated with serum TNF-α levels in patients with psoriasis, and decreased after anti-TNF-α therapy. IL-33 stimulated IL-6 and IL-8 secretion by human keratinocytes.

CONCLUSIONS

These results suggest that serum IL-33 levels generally reflect increased inflammation in patients with psoriasis.