Association between dry eye and periodontal disease in community-dwelling Japanese adults: data from the Uonoma cohort study

BACKGROUND

While research has explored the risk of periodontal disease in various eye conditions, the link between dry eye and periodontal disease remains underexplored, especially in Japanese adults. This study aims to investigate the association between dry eye and periodontal disease in community-dwelling Japanese adults.

METHODS

This study is a subset of the Uonuma cohort study, which includes Japanese adults aged 40 years and older residing in the Uonuma area of Niigata Prefecture, Japan. Participants completed a self-administered, paper-based questionnaire. Statistical analyses, including the chi-square test, independent t test, ANOVA test, and logistic regressions, were employed to assess the association of periodontal disease with independent variables.

RESULTS

Among 36,488 participants (average age 63.3 years, 47.4% men), 39.3% had a history of periodontal disease, and gender differences were statistically significant (p < 0.001). Significant associations were found between periodontal disease and dry eye diagnosis or symptoms. Univariable logistic regression revealed links between periodontal disease and age, gender, living status, alcohol consumption, remaining teeth, bite molar availability, and history of dry eye disease or symptoms. Multiple-adjusted regression found that doctor-diagnosed dry eye was associated with a higher likelihood of periodontal disease (odds ratio, 1.12; 95% confidence interval, 1.03-1.22). Participants who never experienced dryness or foreign body sensation had lower ORs of periodontal disease than those who always experienced such symptoms across all models.

CONCLUSION

A significant correlation was found between dry eye and periodontal disease in Japanese adults. Regular check-ups, early detection, and effective management of both conditions are strongly recommended.

Interaction between serum vitamin C levels and smoking on the periodontal condition in older adults

BACKGROUND AND OBJECTIVES

Several epidemiological studies have reported that smokers have a higher prevalence and severity of periodontal disease than do nonsmokers, and that smoking negatively affects nutritional status and is associated with a reduced intake of antioxidants, particularly vitamin C. The present investigation aimed to examine the relationship between serum vitamin C levels and smoking and its influence on the periodontal condition in older adults.

MATERIALS AND METHODS

A total of 353 respondents met the inclusion criteria and were enrolled in the present study. The periodontal status of the study participants was determined through examinations of one or more residual teeth, which included a measurement of the probing pocket depth (PPD) and clinical attachment level (CAL) at six regions of each tooth. Blood samples were collected during the dental examinations and then sent to a laboratory to evaluate serum vitamin C and cotinine levels. A serum cotinine concentration of 100 ng/ml was considered a relevant threshold for active smoking. After dividing the participants into two groups according to serum cotinine levels, Poisson regression analysis was carried out to compare vitamin C levels with the prevalence rate ratio (PRR) for periodontal condition markers for each group based on serum cotinine levels.

RESULTS

We evaluated differences in the PRR of serum vitamin C tertiles between participants with high (≥100 ng/ml) or low (<100 ng/ml) serum cotinine levels after adjusting for sex, the use of interdental brushes or dental floss, and the number of teeth. A negative tendency between the PRR of vitamin C tertiles for the PPD or CAL was seen for both groups. Especially, a bigger difference was observed in the group with high serum cotinine levels. The PRR of the first tertiles in the high serum cotinine group was 5.03, compared with 2.69 in the low serum cotinine group (relative risk: 1.9).

CONCLUSION

The results of this study suggest a potential association between vitamin C levels and the periodontal condition, which may be influenced by smoking status.

Measurements of Strong-Interaction Effects in Kaonic-Helium Isotopes at Sub-eV Precision with X-Ray Microcalorimeters

We have measured the 3d→2p transition x rays of kaonic ^{3}He and ^{4}He atoms using superconducting transition-edge-sensor microcalorimeters with an energy resolution better than 6 eV (FWHM). We determined the energies to be 6224.5±0.4(stat)±0.2(syst)  eV and 6463.7±0.3(stat)±0.1(syst)  eV, and widths to be 2.5±1.0(stat)±0.4(syst)  eV and 1.0±0.6(stat)±0.3(stat)  eV, for kaonic ^{3}He and ^{4}He, respectively. These values are nearly 10 times more precise than in previous measurements. Our results exclude the large strong-interaction shifts and widths that are suggested by a coupled-channel approach and agree with calculations based on optical-potential models.

A population-based cross-sectional study of the association between periodontitis and arterial stiffness among the older Japanese population

OBJECTIVE

To investigate the potential association between periodontitis and arterial stiffness among the older Japanese population.

BACKGROUND

The prevalence of periodontitis is increasing in Japanese older adults. Arterial stiffness increases the risks of cardiovascular events and death, morbidity, and dementia.

METHODS

This secondary analysis of data from a cross-sectional study evaluated the periodontal inflamed surface area (PISA), reflecting the amount of inflamed periodontal tissue that was estimated by a full-mouth periodontal examination. Severe periodontitis was defined per the parameters provided by the Centers for Disease Control/American Academy of Periodontology. The Cardio-Ankle Vascular Index (CAVI) was used for measuring the overall stiffness of the artery, and higher CAVI indicated increased arterial stiffness. An ordinal logistic regression model was used to evaluate the association between periodontitis and arterial stiffness.

RESULTS

The analysis included 185 Japanese adults [35% men; age, mean (standard deviation) 80.2 (4.4) years]. The average PISA and the prevalence of severe periodontitis were 64.4 mm² and 27.6%, respectively; 54 (29.2%), 56 (30.3%), and 75 (40.5%) participants were stratified to the CAVI < 9, 9 ≤ CAVI <10, and CAVI ≥ 10 groups, respectively. After adjusting for potential confounders, the odds ratio of the prevalence and severity of arterial stiffness evaluated using CAVI was 1.06 [95% confidence interval (CI) 1.01 to 1.10] for PISA per 10 mm² and 2.12 (95% CI 1.09 to 4.11) for severe periodontitis.

CONCLUSION

Periodontitis was associated with arterial stiffness among Japanese older adults. Further studies are needed to investigate whether arterial stiffness is an intermediate factor in the pathway between periodontitis and systemic diseases, including cardiovascular disease and dementia.

Influence of occlusal deterioration considering prosthetics on subsequent all-cause mortality in a Japanese elderly independent population

PURPOSE

The influence of occlusal deterioration on mortality may be incorrectly estimated due to improvements in the occlusal condition with prosthetics or deterioration without prosthetics. The purpose of this study was to evaluate the influence of occlusion cross-sectional status and longitudinal changes considering prosthetics for subsequent all-cause mortality in an elderly population.

METHODS

Two dental examinations, in 1999 and 2003, were conducted in 378 subjects aged 71 years old in 1999. Annual follow-ups to check survival information were performed until 2011. The Eichner index (EI), based on tooth contacts between the maxilla and mandible in the bilateral molar regions, was used as a measurement of occlusal condition. Three modified EIs, EI-o (ie, original EI), EI-f adding contacts by fixed prosthetic appliances, and EI-r adding contacts by all prosthetics, were used. For survival analysis, the survival period was calculated from the last dental examination (in 2003) to death or censoring.

RESULTS

In Cox proportional hazards regression analysis, a deterioration in EI-f was a significant risk factor for stability (HR = 2.56, P = 0.018) after adjusting for potential confounders. However, occlusal conditions in 2003 did not have an influence on subsequent mortality and the occlusal losses of almost all subjects were at least partially recovered by removable prosthetics.

CONCLUSION

This study clarified that prosthetic dental care may reduce the influence of occlusal loss on mortality and that an event such as a large occlusal loss unrecoverable with fixed prosthesis alone at an older age may increase risk of death in Japanese elderly subjects.

Oral health status in relation to cognitive function among older Japanese

Epidemiologic data examining the relationship between oral health status and cognitive status are sparse, especially in Asian populations. This study aimed to assess whether periodontal disease and tooth loss were related to cognitive impairment among older Japanese. Study participants were 291 Japanese (101 men and 190 women, average age: 80.9 years), classified into three groups based on a clinical examination of oral health status: no periodontal disease, periodontal disease, and edentulous. Periodontal disease was defined using criteria recommended in the consensus report of the European Workshop in Periodontology with a modification. Cognitive impairment was defined using the results of the Mini-mental State Examination (MMSE) and Hasegawa Dementia Scale-Revised (HDS-R) scores. Multivariable logistic regression analyses assessed the relationship of the three-category oral health status variable (reference category = no periodontal disease) with low MMSE score (≤23) and low HDS-R score (≤20). Age, gender, years of education, body mass index, smoking status, drinking behavior, and history of cardiovascular disease were tested as potential confounders in the multivariable models. Periodontal disease and edentulous were significantly associated with greater odds of low cognitive performance after controlling for potential confounders. The multivariable adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for low MMSE score associated with periodontal disease and edentulous were 2.21 (1.01-4.84) and 2.28 (1.06-4.90), respectively. The multivariable adjusted ORs (95% CIs) for low HDS-R score associated with periodontal disease and edentulous were 4.85 (1.29-18.15) and 3.86 (1.05-14.20), respectively. Poor oral health status was significantly associated with cognitive impairment among community-dwelling older Japanese. Additional well-controlled longitudinal studies are needed to elucidate whether there may be a possible cause-and-effect relationship between oral health status and cognitive function.

Association between dental status and food diversity among older Japanese

OBJECTIVE

To investigate the relationship of dental status to food diversity among older Japanese.

DESIGN AND SETTING

A community-based cross-sectional study conducted in the town of Tosa, Kochi Prefecture, Japan.

METHODS

The study participants were 252 Japanese (84 men and 168 women, average age 81.2 years) and dentate participants were classified into three groups: 1-9 teeth, 10-19 teeth and 20 or more teeth. Food diversity was assessed as a validated measure of dietary quality using the 11-item Food Diversity Score Kyoto (FDSK-11), which evaluates frequency of consumption of 11 main food groups. Multivariable analysis of the differences in FDSK-11 score ranging from 0 to 11, with a higher score indicating greater food diversity, among the three dental status groups was conducted using general linear models. All the performed analyses were stratified by gender.

RESULTS

There was no association between dental status and food diversity score in models for men. In contrast, women with ≤ 9 teeth and with 10-19 teeth had significantly lower FDSK-11 scores than women with ≥ 20 teeth after adjusting for confounders (p < 0.001 and p = 0.009, respectively). Additionally, there was a trend toward lower scores for FDSK-11 with fewer teeth (p = 0.001).

CONCLUSION

A less varied diet, as indicated by low FDSK-11 score, was observed in female participants with fewer teeth. Tooth loss was associated with poor diet quality among older Japanese women.

Evaluation of chewing ability and its relationship with activities of daily living, depression, cognitive status and food intake in the community-dwelling elderly

AIM

The aim of this study was to assess chewing ability using color-changeable chewing gum and to show the association between chewing ability and geriatric functions, as well as dietary status in the community-dwelling elderly.

METHODS

The study population consisted of 269 community-dwelling elderly aged ≥ 75 living in Tosa, Japan. Assessment of chewing ability was carried out by a dentist using color-changeable chewing gum. Activities of daily living (ADL), depression and subjective quality of life (QOL) were assessed by questionnaire. Cognitive status was assessed by; Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale-Revised (HDS-R) and Frontal Assessment Battery (FAB) during the check-up. Food diversity was assessed using the 11-item Food Diversity Score Kyoto (FDSK-11).

RESULTS

Number of teeth was significantly related to chewing ability (P<0.001). The participants with low chewing ability had significantly lower ADL scores in the items of self-maintenance (P=0.029) and intellectual activity (P=0.021). There was a significant association between low chewing ability and depression (P<0.001). Lower cognitive functions were significantly related to low chewing ability; MMSE (P=0.022), HDSR (P=0.017) and FAB (P=0.002). The participants with low chewing ability had lower food variety (P<0.001), and less frequent intake of beans, vegetables, seaweed and nuts, than the participants with high chewing ability.

CONCLUSION

Low chewing ability evaluated by color-changeable gum was associated with lower ADL, lower cognitive functioning, depression and food insufficiency in the community-dwelling elderly. More attention should be paid to assessing chewing ability of elderly persons in community settings.

Tablets containing a cysteine protease, actinidine, reduce oral malodor: a crossover study

Tongue coating (TC) mainly consists of protein mostly from exfoliated epithelial cells. Until now, to reduce TC accumulation, only mechanical measures have been available, and the procedure involves unpleasant side effects, such as gagging reflex or carcinogenesis related to mechanical stimulation. We expected that protease might be effective in reducing the accumulation of TC causing oral malodor. The purpose of this study was to determine the effect of long-term use of candy tablets containing protease, actinidine, on both TC accumulation and concentration of volatile sulfur compounds (VSCs) in mouth air. We employed 14 subjects aged 24 to 54 years old for this study, and conducted a double-blind randomized crossover trial. The subjects sucked the tablets containing actinidine three times a day until the sixth day after starting the study. The tablets without actinidine were utilized as a placebo. Measurements of VSC concentration and TC accumulation were carried out before and after chewing tablets on the first day, and also on the seventh day. The levels of VSC and TC significantly (p < 0.05) decreased after tablets were taken on the first day in both the test and placebo groups. There was a statistically significant decrease (p < 0.05) in VSC after seven days of use only in the test group. The results of the study suggest that the tablets containing actinidine had an accumulative effect in reducing VSC in mouth air with long-term use.

Association between volatile sulfur compounds and periodontal disease progression in elderly non-smokers

BACKGROUND

Periodontal pathogenic microorganisms produce volatile sulfur compounds (VSCs), such as hydrogen sulfide, methyl mercaptan, and dimethyl sulfide. VSCs are toxic to periodontal tissue. Therefore, there is a relationship between periodontitis and the VSC level of mouth air. However, the association between VSC and periodontal disease progression has not been investigated in a longitudinal study. The purpose of this study is to evaluate the association between VSCs in mouth air and periodontal disease progression among elderly dentulous non-smokers.

METHODS

Two hundred forty-one dentulous non-smokers (103 males and 138 females; all 70 years old) had their VSC levels examined with a portable sulfide monitor, and their periodontal status was assessed. Periodontal examinations were performed at baseline and once a year for 3 years to investigate the clinical attachment levels of all teeth. Participants were classified by membership in tertile groups (lowest, middle, and highest) according to the value of baseline VSC measurements.

RESULTS

In negative binomial regression analysis, the number of teeth with periodontal disease progression for participants in the highest tertile of VSC measurement was greater (incidence rate ratio of 1.33, P = 0.011) than for the reference group (lowest tertile of VSC measurement) after simultaneously adjusting for sex, number of remaining teeth, and maximum clinical attachment level.

CONCLUSIONS

VSC measurements were significantly associated with periodontal disease progression in a non-smoking dentulous elderly population. This suggests that VSC measurements are useful for the diagnosis of periodontal disease progression.

Physical function is weakly associated with angiotensin-converting enzyme gene I/D polymorphism in elderly Japanese subjects

BACKGROUND

The turning point in the deterioration of physical function seems to occur between the ages of 70 and 80 years. In particular, muscle strength may decline even more in subjects older than 75. A recent study found that the angiotensin-converting enzyme (ACE) genotype also affects physiological left ventricular hypertrophy. A very limited number of papers have examined genetic differences in resistance and endurance forms of a single sporting discipline.

OBJECTIVE

The purpose of this study was to evaluate the relationship between ACE genotype and physical function by controlling the known confounding factors including dental status.

METHODS

We selected 431 subjects who were aged 76 years and did not require special care for their daily activities. We conducted a medical examination, followed by 5 physical function tests, as follows: (1) maximum hand grip strength, (2) maximal isometric knee extensor strength, (3) maximal stepping rate for 10 s, (4) one-leg standing time with eyes open and (5) 10-meter maximum walking speed. Subjects were genotyped for the ACE intron 16 Alu insertion. In addition, serum concentrations of total cholesterol, total protein, IgA and IgG were measured at a commercial laboratory. The Eichner index was used as an indicator of occlusal condition. Multiple linear regression analysis was performed to evaluate the relationship between the ACE gene insertion/deletion (I/D) polymorphism and physical function considering confounding factors.

RESULTS

The ACE gene I/D polymorphism was positively associated with hand grip strength and 10-meter maximum walking speed. Betas of hand grip strength were 0.09 for I/D (p = 0.022) and 0.12 for insertion/insertion (I/I; p = 0.004). Betas of 10-meter walking speed were -0.11 for I/D (p = 0.093) and -0.14 for I/I (p = 0.039). Dental status such as Eichner index class C was significantly associated with one-leg standing time with eyes open (beta -0.11; p = 0.028).

CONCLUSION

This study suggests that there is a significant relationship between ACE genotype and physical function. In particular, subjects with the ACE deletion/deletion genotype were associated with upper extremities.

Development of a Compact and Simple Gas Chromatography for Oral Malodor Measurement

BACKGROUND

Volatile sulfur compounds (VSCs) in oral air are the only type of gases correlated with the strength of oral malodor. We developed a compact and simple gas chromatograph (GC) equipped with a newly invented indium oxide semiconductor gas sensor (SCS) for measuring the concentrations of VSCs in mouth air. We have assessed the correlation between measurements with a GC-SCS and those with a regular GC.

METHODS

Oral air samples from randomly selected volunteers were analyzed with both a GC-SCS and a GC with a flame photometric detector (FPD), which is specific to VSCs, and GC-SCS measurements were compared to those obtained by GC-FPD. Subsequently, oral air samples before and after mouthrinsing with 5% ethanol mouthwash were analyzed to determine the effect of ethanol on VSC measurements by GC-SCS.

RESULTS

There were strong correlations between VSC concentrations determined using these two gas chromatography methods (hydrogen sulfide, R=0.821, P<0.0001; methyl mercaptan, R=0.870, P<0.0001; and dimethyl sulfide, R=0.770, P<0.0001). Although GC-SCS can differentiate ethanol and VSCs in oral air samples after mouthrinsing, GC-SCS measurements demonstrated higher values than those obtained by GC-FPD; however, this discrepancy improved over time due to the reduced effect of ethanol.

CONCLUSION

The results suggest that GC-SCS may be useful for the diagnosis of halitosis.

Relationship between volatile sulphide compounds concentration and oral bacteria species detection in the elderly

AIM

To evaluate the relationship between oral bacteria species detection and volatile sulphide compounds (VSC) concentration in the elderly.

DESIGN

Cross-sectional microbiological and clinical VSC examination of elderly.

PARTICIPANTS

Sixty-seven elderly people aged 75, who were functionally independent and dentate.

METHODS

VSC (H2S and CH3SH) concentrations in the mouth air of subjects were measured using portable gas chromatography. Oral bacteria samples were taken from dental plaque and identification of bacteria species was accomplished using standard methods.

RESULTS

Fewer than 20% of subjects showed more than 10 ng/10 ml of H2S (severe odour level). The detection rate of P. melaninogenica was significantly higher in elderly people with more than 10 ng/10 ml (p=0.043) levels. Fusobacterium had a tendency to be found in those with more than 10 ng/10 ml, but a significant relation was not found.

CONCLUSIONS

The results suggest that Fusobacterium and P. melaninogenica may be involved in the production of H2S in the oral cavity of elderly people.

Breath malodor in an asthmatic patient caused by side-effects of medication: a case report and review of the literature

OBJECTIVE

The purpose of this report is to document the presence of dimethyl sulfide in mouth air as the predominant volatile sulfur compound (VSC) in an asthmatic patient who was regularly taking suplatast tosilate.

STUDY DESIGN

The patient was a 33-year-old woman who complained of bad breath. She had been diagnosed as having asthma and was receiving periodical medical examinations once a month. VSC in her mouth air were measured with a gas chromatograph. Oral physiotherapy was also carried out to remove any oral malodor of which the source was intraoral.

RESULTS

With the improvement in oral hygiene and periodontal conditions, the level of VSC was reduced but dimethyl sulfide still remained as the predominant VSC.

CONCLUSIONS

Dimethyl sulfide metabolized from suplatast tosilate may be a potential cause of halitosis.

Relationship between dental occlusion and physical fitness in an elderly population

BACKGROUND

The relationship between physical fitness and dental health status in elderly adults is still unknown. The purpose of the present study is to examine the relationship between physical fitness and occlusal condition of natural teeth in the elderly population. The sample consisted of 591 individuals aged 70 years and 158 aged 80 years selected from the registry of residents in Niigata city.

METHODS

Hand grip strength (kg), leg extensor strength (kg), leg extensor power (watts), stepping rate (time per 10 seconds), and one-leg standing time with eyes open (seconds) were measured. The Eichner index was used as a measurement of occlusal condition. It was based on existing natural tooth contacts between maxilla and mandible in the bilateral premolar and molar regions and determined the three groups of classification used. In comparing physical fitness with Eichner index, multiple regression models were developed to adjust for variables such as age, gender, height, body weight, past medical history, blood pressure, serum albumin concentration, presence of lower back pain, smoking habit, marital status, and education.

RESULTS

Multiple regression analyses revealed that leg extensor power (R(2) =.627, p <.05), stepping rate (R(2) =.159, p <.05), and one-leg standing time with eyes open (R(2) =.179, p <.05) showed significant correlations with the Eichner index.

CONCLUSIONS

Leg extensor power, stepping rate, and one-leg standing time with eyes open are useful indicators in evaluating lower extremity dynamic strength, agility, and balance function, respectively. These findings suggest that dental occlusal condition is associated with lower extremity dynamic strength, agility, and balance function in elderly adults.

[Long time use of percutaneous cardiopulmonary support after cardiovascular operation; clinical problems from our experience]

Result and problems were studied in 12 patients who received percutaneous cardiopulmonary support (PCPS) after cardiac or aortic surgery. Causative diseases included acute myocardial infarction in 7 cases, rupture of the left ventricular septum after infarction, acute mitral valve regurgitation after infarction, rupture of the left ventricular free wall, a stuck valve, and an aortic aneurysm in the thoracicoabdominal region in each 1 case. The time of postoperative PCPS ranged from 2 to 361 hours, and the mean supply flow volume was 1.78 +/- 0.45 l/min/m2. Seven patients could be taken off the treatment or discharged from the hospital (58.3%). The comparison between surviving and non-surviving cases showed a significantly longer assisted circulation time in the latter. An increase of bleeding after surgery was found in all 8 patients who received PCPS for a long period postoperatively. This was assumed to be due to the thrombocytic activation by heparin.

Classification and examination of halitosis

In this paper, the classification of halitosis and the examination procedures used in diagnosing halitosis are outlined. Halitosis is classified into categories of genuine halitosis, pseudo-halitosis and halitophobia. Genuine halitosis is subclassified into physiologic halitosis and pathologic halitosis. Pathologic halitosis itself is subdivided into oral and extraoral halitosis. Patients diagnosed with pseudo-halitosis and halitophobia usually complain about having oral malodour that does not really exist. Pseudohalitosis can be treated by dental practitioners, but halitophobic patients must be referred to psychological specialists. Oral malodour can be measured using an organoleptic measurement or a gas chromatography analysis. The organoleptic measurement is the most practical procedure with which one can evaluate oral malodour. Gas chromatography (GC) analysis using a flame photometric detector has been shown to be the gold standard for measuring oral malodour, owing its reputation to its objectivity and reproducibility. Moreover, GC is specific for volatile sulphur compounds (VSC), which are the main causes of oral malodour. It has been demonstrated that there is a high correlation between the intensity of oral malodour and the VSC concentration as measured by GC.

Simultaneous minimally invasive direct coronary artery bypass and repair of a penetrating atherosclerotic ulcer of the descending thoracic aorta: report of a case

A 70-year-old man with a descending aortic aneurysm was admitted to the hospital because of an abnormal chest X-ray. The chest computed tomography and magnetic resonance angiography findings showed a saccular aneurysm at the descending thoracic aorta. A preoperative coronary arteriogram showed 75% stenosis of the left anterior descending coronary artery and 99% stenosis of the right coronary artery. A simultaneous minimally invasive direct coronary artery bypass (MI

Acoustic characteristics of sounds from temporomandibular joints with and without effusion: an MRI study

Joint effusion has been associated with temporomandibular joint (TMJ) pain but can only be diagnosed by magnetic resonance imaging (MRI). For screening of patients with suspected effusion a simple and less expensive method would be desirable. We recorded joint sounds during jaw opening and closing movement from 34 TMJs with internal derangement (ID). Seventeen joints had joint effusion seen on MRI. Spectrograms of the sounds were displayed as waterfall plots showing profiles of the consecutive Hamming windows. If the profiles were similar, as judged by initial evaluation, the displayed pattern was classified as stable. If some profiles were distinctly deviating in their pattern, this was classified as unstable. Joints with effusion showed unstable sound pattern more often than joints without effusion (P < 0.001). It was concluded that TMJ sound analyses have a potential to identify joints with effusion based on their unstable sound pattern.

Quadricuspid aortic valve associated with aortic stenosis and regurgitation

A 75-year-old man with moderate aortic stenosis and regurgitation admitted due to heart failure underwent uneventful aortic valve replacement with a Carpentier-Edwards pericardial bioprosthesis valve. A quadricuspid aortic valve discovered incidentally during surgery consisted of 4 of different sizes and a supernumerary cusp between the right and noncoronary cusps. No coronary abnormality was involved. Resected cusps showed fibrotic thickening with calcification and no sign of previous inflammatory disease. Although quadricuspid aortic valve is a very rare anomaly, its potential for severe valve failure in adulthood should not be neglected.

Iridium-catalyzed transfer hydrogenation of alpha,beta-unsaturated and saturated carbonyl compounds with 2-propanol

The selective transfer hydrogenation of alpha,beta-unsaturated carbonyl compounds to saturated ones was achieved by the use of 2-propanol as a hydrogen donor under the influence of catalytic amounts of [Ir(cod)Cl](2), 1,3-bis(diphenylphosphino)propane (dppp), and Cs(2)CO(3). Thus, a variety of conjugated enones were allowed to react with 2-propanol in the presence of the [Ir(cod)Cl](2)/dppp/Cs(2)CO(3) system to give the corresponding saturated carbonyl compounds in good to excellent yields without formation of allylic alcohols. Both dppp and Cs(2)CO(3) were essential components to achieve the reduction satisfactorily. Additionally, the reduction of carbonyl compounds to alcohols was also promoted by the same catalytic system. When the reaction of a 1:1 mixture of a conjugated ketone and a saturated ketone with 2-propanol was carried out in the presence of [Ir(cod)Cl](2) combined with dppp and Cs(2)CO(3), the reduction of the alpha,beta-unsaturated ketone was found to take place in preference to that of the saturated ketone.

Pulmonary artery aneurysm

Main pulmonary artery aneurysm is an exceedingly rare entity. We present a case of main pulmonary artery aneurysm with patent ductus arteriosus in a sixty-year-old woman. The aneurysm was successfully treated with aneurysmectomy and primary anastomosis of the defect of the main pulmonary artery, and the patent ductus arteriosus was divided. The etiology, operative indication and surgical intervention of main pulmonary artery aneurysm are discussed along with a review of the literature.

Visualization of F-actin filaments by a fluorescently labeled nucleotide analogue

The tightly-bound nucleotide of F-actin was replaced with 1,N6-etheno-adenosine ATP (ADP). An epi-fluorescence optical microscope was modified to visualize efficiently the fluorescent analogue with an excitation-maximum wavelength of 310 nm. This microscope permitted us to visualize single F-actin filaments in solution using the fluorescence of the strongly bound 1,N6-ethenoadenosine nucleotide. Exchange of the tightly-bound nucleotide of F-actin with a free nucleotide in solution at a high temperature was quantitatively estimated by this method, and the results showed good agreement with results from phosphate release measurements.

Fine profile of actomyosin motility fluctuation revealed by using 40-nm probe beads

The displacement of colloidal gold beads only 40 nm in diameter can be detected with spatial and temporal resolutions of 2.8 nm and 0.5 msec by using an optical setup in which two laser beams are reflected on the same field of a prism surface, forming interference fringes in an evanescent field adjacent to the prism surface, and the changes in scattering intensity that occur when the beads move across the fringes are measured in optical microscopic images. Results obtained when using this setup and actin-bound gold beads to measure the movement of actin filaments on myosin motor molecules revealed the fine profile of movement fluctuation and that the duty time of a single stroke of myosin motors is less than 10-20 milliseconds.

Direct observation of a central bare zone in a native thick filament isolated from the anterior byssus retractor muscle of Mytilus edulis using fluorescent ATP analogue

To investigate the existence of a central bare zone in native thick filaments isolated from the anterior byssus retractor muscle (ABRM) of blue mussels (Mytilus edulis), the filaments were observed by fluorescence and dark-field microscopy after being incubated in the presence of Ca2+ with the fluorescent ATP analogue, Cy3-EDA-ATP. Filaments appeared under dark-field illumination as thin rods with tapered ends of length 5-30 microm. Fluorescence microscopy revealed that Cy3-EDA-ATP was bound to these filaments, except near their center. Although the boundary between this central non-fluorescent zone and fluorescent regions was not clearly defined, there was a trend for the width of the central non-fluorescent zone to increase with thick filament length (correlation coefficient = 0.45; n = 142). When Cy3-EDA-nucleotides bound to thick filaments were displaced by excess ATP, fluorescent images disappeared with a rate constant of 0. 024 s-1, close to the turnover rate of Cy3-EDA-ATP by myosin on the native thick filaments. These results indicate that each native thick filament isolated from the ABRM has a central bare zone, but its boundary was not sharply resolved.

Unidirectional movement of fluorescent microtubules on rows of dynein arms of disintegrated axonemes

Tetramethylrhodamine-labelled microtubules were observed to move on rows of dynein arms of sea urchin sperm axonemes exposed by elastase-induced sliding disintegration. The microtubules moved towards the flagellar tip at a velocity of 3.1+/−2.1 microm second-1 (mean +/− s.d., n=53) in the presence of 0.1 mM ATP at 22 degrees C, but none moved towards the sperm head. We also examined the polarity of microtubule binding to axonemal doublet microtubules in the absence of ATP by using microtubules brightly labelled at their minus-ends. In 140 of 210 microtubules studied, they bound to axonemal microtubules with a parallel polarity. These results suggest that tightly packed dynein arms on the outer doublet microtubules of sperm axoneme preferentially bind microtubules to themselves with the same polarity as that of the axoneme and that they generate a force to move only these microtubules in the direction away from the sperm head.

Clinical observations of noncoping overdenture abutments protected by tannin-fluoride preparation

STATEMENT OF PROBLEM

The exposed dentin of overdenture abutments can lead to caries. Therefore chemical protection is needed to prevent caries. Considering that dentin contains both organic and inorganic components, reinforcement of both components should give reasonable results. Tannin-fluoride preparation strengthens both the organic and inorganic components of teeth.

PURPOSE

This study examined whether the tannin-fluoride preparation protects noncoping abutments.

MATERIAL AND METHODS

Thirty-one subjects aged 36 to 86 years participated in the clinical trial. A trial autopolymerizing resin containing the preparation or a conventional autopolymerizing resin was applied to the inner surface of the denture base, which was in contact with the abutments. When there were autopolymerizing resin group abutments, there was also at least one preparation group abutment under the overdenture.

RESULTS

The incidence of caries in the preparation and autopolymerizing resin groups were 0% and 0%, respectively, for the first 2 years, 4.5% and 0%, respectively, during the 3- to 4-year period, 13.8% and 75%, respectively, during the 5- to 8-year period, and 10% and 15%, respectively, in total. Gingival crevicular fluid demonstrated a tendency to decrease in both groups over time.

CONCLUSION

The trial autopolymerizing resin containing the preparation has a long-term caries prevention effect, and helps to maintain gingival health. Without adding clinical steps, abutments can be protected by the tannin-fluoride preparation.

Hardness and fracture toughness of four commercial visible light-cured composite resin veneering materials

Four commercial visible light (VL)-cured composite resin veneering materials with a dentine shade were examined for their Knoop hardness and fracture toughness. Composite specimens were classified into three groups. The first group was cured by VL only, the second group was cured by VL and post-cured by VL and the third group was cured by VL and post-cured by heat. It became evident that one composite containing four-functional urethane monomer had both hardness and fracture toughness greater than those of the other three composites containing two-functional urethane monomer. The filler content (vol%) in the composite tended to be linearly proportional to both hardness and fracture toughness. Post-curing by VL and heat were proven to effectively increase both hardness and fracture toughness of once light-cured composites. These results suggest that the clinical performance (e.g. wear resistance and colour stability) of VL-cured composite resin veneering materials might be improved with the aid of post-curing.

Clasping system with rotational path of insertion Part 3. Clinical application

This study investigated the retentive forces of rotational path clasping systems. Twelve rotational path removable partial dentures were applied in the clinical field and the retentive forces of the dentures were measured. The following results were obtained; 1. Retentive forces of the 12 dentures were varied from 187g to 1,380g. 2. As distances between abutment teeth increased from 10.9 mm to 27.7 mm, the retentive forces decreased accordingly (r = -0.56; p < 0.05). 3. As the inclination of the proximal surfaces was increased from 0 degrees to 50 degrees, the retentive forces showed a tendency to increase (r = +0.47). 4. Longer distances between abutment teeth as well as smaller inclination of proximal surface were present in three patients who answered that their dentures showed movement while eating. From these results, it became clear that the distance between abutment teeth and the inclination of the proximal surfaces greatly influenced the retention of the rotational path clasping system in the clinical field.

Root surface caries of denture wearers in middle-aged and elderly people

With an increasing number of elderly people retaining natural dentition, the number of exposed root surfaces and root surface caries is increasing. A total of 100 people, aged from 38 to 86, were examined for exposed root surfaces and root surface caries. Denture wearers and non-denture wearers were examined. The following results were obtained; 1. The percentages of exposed root surfaces were significantly higher (P < 0.05) in the 60's and 70's age groups. Root surface caries showed a tendency to increase until people were in their 60's. 2. Denture wearers had more exposed root surfaces (P < 0.05) and were more likely to have root surface caries than non-denture wearers. Denture wearers showed a tendency to have more severe grades of root surface caries than non-denture wearers. 3. Concerning denture wearers, there were not significant differences in the percentages of exposed root surfaces of buccal and proximal surfaces facing edentulous space. However, proximal surfaces facing edentulous space were more prone to root surface caries than buccal surfaces (P < 0.05).

[A case of pulmonary malignant lymphoma associated with localized amyloid plaque]

A 51-year-old woman admitted to our hospital. Chest X-ray film showed infiltrations in left S4 region, which had been pointed out since two years before. On exploratory thoracotomy, lingual segmentectomy was performed because no metastatic lesions were found in the mediastinal and hilar lymph nodes. Pathological and immunohistological examinations revealed findings corresponding to pulmonary malignant lymphoma (diffuse, small cell type, B cell) with amyloid plaque. The patient is doing well 20 months after operation without any signs of recurrence. The clinical and histological findings of this case may suggest a close relationship between malignant lymphoma and production of amyloid.

[A case of intrathoracic goiter composed of two tumors]

A 70-year-old female was referred to our hospital because of swelling at her frontal neck and an abnormal shadow on a chest X-ray film. CT scan and MRI showed a 11.0 x 7.5 cm well-demarcated tumor in the upper mediastinum. Thyroidal scintigraphy revealed an slight accumulation, leading to a diagnosis of intrathoracic goiter. During operation the mass was found to be composed of two tumors. The upper tumor was attached with fibrous adhesion to the right lobe of cervical thyroid but no connection. Histological examination showed follicular but not malignant adenoma of the thyroid.

[An adult case of left ventricular-right atrial communication with a false aneurysm of membranous septum]

A case of left ventricular-right atrial (LV-RA) communication associated with a false aneurysm of membranous septum is presented. The patient was a 51-year-old woman. Using a left ventriculography this case was diagnosed preoperatively as LV-RA communication. We found that the right atrium was directly communicated with the left ventricle through a fibrous membranous aneurysm adhering to the septal leaflet of the tricuspid valve. It was suggested that a false aneurysm, made by jet lesion from the left ventricle, perforated to the right atrium. So the current case was considered an acquired infravaluvular type LV-RA communication formed in the course of the natural closure of the membranous ventricular septal defect.

A new sectional partial denture utilizing lock mechanism for an upper removable partial denture

A new sectional partial denture utilizing lock mechanism (lock denture) has been developed. Utilizing the lock mechanism, two parts of sectional partial denture are locked together easily and tightly. A lock denture has been constructed for an upper removable partial denture, has been worn for over three months and has clinically been proven to obtain good function and esthetics.

Clinical studies on marginal gingiva around abutment tooth (Part 3). Effect of tannin-fluoride preparation on gingival health

It was examined whether the tannin-fluoride preparation (HY preparation), which might have a caries-reductive, plaque inhibiting and astringent action, could reduce the incidence of gingival inflammation around abutment teeth. Zinc oxide eugenol cement mixed with the HY preparation was packed in the cavity prepared in the resin base facing the abutment tooth. Gingival crevicular fluid (Periotron units:GCF), gingival index (GI), plaque index (PlI) and probing depth around the abutment teeth were measured over a 3 month period. The following results were obtained: 1. GCF decreased at month 1 and showed low values at months 2 and 3. 2. GI showed a decreasing tendency. 3. PlI and probing depth did not show obvious changes. These results indicate that the tannin-fluoride preparation reduces gingival inflammation around abutment teeth.

Suppression of the powdery mildew pathogen by chitinase microinjected into barley coleoptile epidermal cells

An exogenous chitinase from Streptomyces griseus was introduced into coleoptile epidermal cells of barley (Hordeum vulgare) by microinjection, and the effect of injected chitinase on the growth or development of the powdery mildew pathogen (Erysiphe graminis f. sp. hordei) was examined. Prior to microinjection, an enzymatic degradation of fungal haustorium, the organ taking nutrients from host plant cells, was examined by treating fixed coleoptile epidermis harboring haustoria with this enzyme. The result showed that haustoria were effectively digested by chitinase, suggesting the effectiveness of chitinase treatment for suppressing the fungal development. Microinjection of chitinase was conducted using living coleoptile tissues inoculated with the pathogen. Epidermal cells in which the haustorial primordia had been formed, or in which the haustoria had matured, were selected as targets for injection. The result clearly indicated that injection at the stage of primordium formation was effective in completely digesting haustoria and suppressing the subsequent formation of secondary hyphae of the pathogen. In microinjection after haustorial maturation, hyphal elongation was considerably suppressed though there was no detectable morphological change in the haustoria. Thus, the present study provides the experimental basis for genetically manipulating barley to produce transgenic plants resistant to the powdery mildew disease.

Clasping system with rotational path of insertion. 2. Relation between mesio-distal distance of edentulous space and retentive force

The rotational path of insertion differs substantially from the conventional path or perpendicular path of insertion. With a rotational path, one segment of the partial denture is seated first, then the remainder of it is rotated into position. One segment of this system is the rigid retentive component with a long occlusal rest and the other is the conventional clasp. This study examined the influence of mesio-distal distance of the edentulous space, the point of the displacing force, the undercut of rigid retentive component and the inclination of the abutment tooth on the retention of this system. The following results were obtained: 1) Retention of the denture was the lowest when a displacing force was applied at the conventional clasp part under the conditions of mesio-distal distances with edentulous spaces of 10, 20 and 30 mm, respectively. 3) Retention showed a tendency to decrease progressively as the proximal undercut on the rigid retentive component was changed to 2.0, 1.5, 1.0 and 0.5 mm, respectively. The values of the decreasing ratio of retentive forces were almost the same regardless of the mesio-distal distance of the edentulous space. 4) Retention of the denture was improved when a tilted tooth was used as an abutment tooth on the rigid retentive component side.

Transient expression of the β-glucuronidase gene introduced into barley coleoptile cells by microinjection

A β-glucuronidase gene was introduced directly into barley (Hordeum vulgare L. cv. Kobinkatagi) coleoptile cells by microinjection and transient expression of the gene was examined. Inner epidermis tissue of coleoptiles was excised and injected with plasmid DNA, pBI221, carrying cauliflower mosaic virus 35S promoter, β-glucuronidase gene, and a nopaline synthase polyadenylation region. Histochemical assay for β-glucuronidase production showed positive enzyme activity only in coleoptile cells injected with plasmid DNA. Expression of the β-glucuronidase gene was examined chronologically using honogenates of injected coleoptile tissues. Glucuronidase activity first appeared after 6 hr, reached the maximum level 24 hr after injection, and decreased afterwards. These results suggest that microinjection of coleoptile tissues may be a useful approach for the genetic engineering of Gramineae plants in which protoplast regeneration is difficult.

[Three cases of spontaneous rupture of the oesophagus (Boerhaave's syndrome)]

We reported three cases of spontaneous rupture which were surgically treated with direct suture method. One patient was operated on within eight hours after rupture with good results. In two patients diagnoses were made more than two days after rupture. One had esophageal fistula, but completely recovered after cervical oesophageal fistula, and another died of multiple organ failure. In this syndrome, early diagnosis and surgical treatment are essential for acceptable results. For early diagnosis, we emphasized on the presence of roentgenologic mediastinal and cervical emphysema. In patients for whom diagnosis was delayed and post-operative leakage at the oesophageal suture line occurred, temporarily fistulation of the cervical oesophagus proved to be effective in exclusion and diversion of the ruptured segment.