Clinical investigation of use of Episil® oral solution in oral mucositis during radiotherapy for head and neck cancer.

Objective: Episil® is a bio adhesive barrier-forming oral liquid gel that has been used in recent years to relieve pain of oral mucositis (OM) with radiotherapy (RT) or chemoradiotherapy (CRT) in head and neck cancer (HNC) patients. We conducted a retrospective analysis of the clinical effects of Episil® on OM in these patients. Study design: Between June 2018 and May 2020, 65 patients with HNC were treated with RT or CRT at our hospital. Results: The median total RT dose was 50 Gy (range, 30-70 Gy) and the completion rate was 63/65 (97%). The median time to OM resolution was 47 (6-90) days and was significantly longer (53 [27-90] days) when the total RT dose was ≥51 Gy (P < 0.001). Episil® was used in 26 patients. Among them, 10 discontinued its use due to ineffective pain relief, usage difficulties, and taste intolerance. The median duration of use was 30 days and was significantly longer (34.5 days) (P < 0.001) when patients experienced pain relief at treatment initiation. Conclusion: Although Episil® has been shown to be effective in improving the pain of OM caused by RT for HNC patients, and medical professionals are required to give careful attention to each patient.

Effects of Warm-up Focused on the Mind-Body on Choral Performance.

OBJECTIVE: In choral performance, a wide variety of musical expression is required to deliver the worldview of the work to the audience. Singers need to regulate their mind-body to be in the optimal state, which includes relaxed concentration and flexible kinesthetic controllability in sensation, expression, and vocalization, for the chorus. Therefore, a choral warm-up focused on the mind-body could be crucial for various musical expressions. However, what kind of warm-up helps the singer achieve the optimal condition for the chorus remains unclear. Here, we investigated the effects of a warm-up method focusing on breathing, physical movement, imagery, and the combination of those factors on singing performance. METHOD: Twenty-five choral singers were randomly assigned to five groups, and then singers for each group online conducted one of five warm-up conditions (breathing / stretching / imagery work / all works / control) and performed singing tasks to evaluate singing performance, including sensation, expression, and vocalization, both subjectively and objectively. Changes in mood were also measured using the second edition of the Profile of Mood States. RESULTS: The results showed that the warm-up with imagery work or all works could objectively and subjectively enhance singing performance. By contrast, the warm-up with breathing or stretching did not significantly improve performance, but did enhance subjective evaluations in general. In addition, no significant correlations were found between the objective performance evaluations and changes in individual mood. CONCLUSIONS: These results suggest that a warm-up focusing on mind-body interventions, especially imagery work, may enhance choral performance, thereby providing new insight for the establishment of more effective choral warm-up methods.

A survey of oral health status, subjective oral symptoms and oral health behaviors among first-year dental students at a Japanese university.

PURPOSE: The rapid deterioration of oral health in young adults is an alarming problem in Japan. The aim of the present study is to investigate the oral health status, subjective oral symptoms and oral health behaviors of dental students. METHODS: Participants were 108 first-year students attending dental school in 2018-2019. Oral examinations were performed to assess dental caries indices, oral hygiene status, gingival bleeding on probing (BOP) and pocket depth. A self-administered questionnaire was used to assess subjective oral symptoms and oral health behaviors. RESULTS: The prevalence of decayed teeth (DT) and gingivitis (BOP ≥ 10%) were 43.5% and 50.0%, respectively. Having DT and gingivitis were significantly associated with poorer oral hygiene. No association was observed between DT and subjective symptoms. Having gingivitis was significantly associated with xerostomia, mouth-breathing and less use of interdental cleaning tools. Multiple logistic regression analysis for gingivitis yielded an odds ratio of 1.41 (95% confidence interval: 1.19-1.67) for plaque score, and 2.75 (1.27-5.98) for xerostomia. CONCLUSION: Since a relatively high ratio of students had DT and gingivitis without clear subjective symptoms, they require regular dental visits for early treatment and oral hygiene maintenance from the start of their time at university.

Assessment of psychological changes in young children during dental treatment: Analysis of the autonomic nervous activity and electroencephalogram.

BACKGROUND: Understanding the emotional changes in children during dental treatment is necessary for providing stress-free care. AIM: To objectively assess the stress associated with dental treatment in children, based on the autonomic nervous activity and the electroencephalogram (EEG). DESIGN: Twenty-two children aged 4-9 years were recruited from outpatients of a paediatric clinic. Electrocardiogram and EEG were recorded throughout the treatment to analyze the autonomic nervous activities and the powers of brain waves, respectively. Changes in these measurements during each treatment process were evaluated in two age groups: 4-6 years and 6-9 years. RESULTS: Elevations in sympathetic activities accompanied by decreased parasympathetic activities induced by stress were observed during rubber dam setting (RD) in the age group of 4-6 years and during infiltration anesthesia (IA), RD, and cavity preparation with a dental turbine (CP-T) in the age group of 6-9 years. Stress-related beta wave increments in EEG were observed during IA and CP-T in the age group of 6-9 years but not in the age group of 4-6 years. CONCLUSION: Monitoring the autonomic nervous activities during treatments is useful in assessing stresses in a wide age of young children, whereas EEG monitoring is applicable only to children older than 6 years.

Production of therapeutic iduronate-2-sulfatase enzyme with a novel single-stranded RNA virus vector.

The Sendai virus vector has received a lot of attention due to its broad tropism for mammalian cells. As a result of efforts for genetic studies based on a mutant virus, we can now express more than 10 genes of up to 13.5 kilo nucleotides in a single vector with high protein expression efficiency. To prove this benefit, we examined the efficacy of the novel ribonucleic acid (RNA) virus vector harboring the human iduronate-2-sulfatase (IDS) gene with 1,653 base pairs, a causative gene for mucopolysaccharidosis type II, also known as a disorder of lysosomal storage disorders. As expected, this novel RNA vector with the human IDS gene exhibited its marked expression as determined by the expression of enhanced green fluorescent protein and IDS enzyme activity. While these cells exhibited a normal growth rate, the BHK-21 transformant cells stably expressing the human IDS gene persistently generated an active human IDS enzyme extracellularly. The human IDS protein produced failed to be incorporated into the lysosome when cells were pretreated with mannose-6-phosphate, demonstrating that this human IDS enzyme has potential for therapeutic use by cross-correction. These results suggest that our novel RNA vector may be applicable for further clinical settings.

Improvement of Workplace Environment That Affects Motivation of Japanese Dental Hygienists.

Dental hygienists are in high demand due to insufficient workforce and a lack of an effective reinstatement support system. We investigated the reasons for willingness to work by analyzing the survey results of the employment status of Japanese dental hygienists conducted by Japan Dental Hygienists' Association. In total, we mailed 16,113 questionnaires to all members of the association (response rate 53.4%). We carried out statistical analysis to determine the specific items to improve the hygienists' working environment. Fourteen factors of working conditions that they wish to improve were determined. Structural equation modeling showed that a path, "Reduction of work volume", "Reduction of working hours" and "Increased number of holidays" were higher than other items. A decision analysis demonstrated that most of the respondents answered "Yes" to "Improvement in working conditions including higher salary" out of those who answered, "Strongly disagree" for "Do you feel that dental hygienist work is rewarding?". Improving workplace environment is integral to keeping high levels of work motivation and a low turnover rate. Most of the hygienists wish for a salary raise among all the conditions. The transition from conventional work styles to non-conventional flexible working patterns is needed.

Utilization of a novel Sendai virus vector in ex vivo gene therapy for hemophilia A.

Sendai virus (SeV) vectors are being recognized as a superior tool for gene transfer. Here, we report the transfection efficacy of a novel, high-performance, replication-defective, and persistent Sendai virus (SeVdp) vector in cultured cells and in mice using a near-infrared fluorescent protein (iRFP)-mediated in vivo imaging system. The novel SeVdp vector established persistent infection, and strong expression of inserted genes was sustained indefinitely in vitro. Analysis of iRFP-expressing cells transplanted subcutaneously into NOG, nude, and ICR mice suggests that innate immunity was involved in the exclusion of the transplanted cells. We also evaluated the feasibility of this novel SeVdp vector for hemophilia A gene therapy. This system enabled insertion of full-length FVIII genes, and transduced cells secreted FVIII into the culture medium. Transient FVIII activity was detected in the plasma of mice after intraperitoneal transplantation of these FVIII-secreting cells. Further improvement in methods to evade immunity, such as simultaneous expression of immunomodulatory genes, would make this novel vector a very useful tool in regenerative medicine.

Perception of pungent, gustatory and olfactory stimuli in patients with congenital insensitivity to pain with anhidrosis.

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare disease caused by a mutation in the nerve growth factor (NGF) receptor, which results in an absence of Aδ and C fibers. It can be considered that this defect may also lead to deterioration of oral sensations. The aim of the present study was to clarify the ability of CIPA patients to perceive pungent, gustatory, and olfactory stimuli, which is essential for eating function, and the impact of the defect on dietary habits. Sensitivities to capsaicin and the five basic tastes were evaluated by measuring their threshold values, and dietary habits were examined using a questionnaire. Additionally, odor identification ability was evaluated using the odor stick method. The detection threshold for capsaicin and the recognition threshold for sour taste were significantly higher in the patients than in healthy volunteers. The questionnaire responses showed that the patients consumed spicy food more often. All patients were able to identify the tested odors, except those to which they had not been well accustomed. Since the abilities of CIPA patients to perceive taste and smell were not basically impaired, despite their lower sensitivity to capsaicin, it was suggested that their dietary habits were only minimally affected, except for intake of pungent foods.

A case of acute diffuse large B cell lymphoma in an anti-human T-cell leukaemia virus type 1-positive rheumatoid arthritis patient treated with methotrexate, who died.

A 70-year-old woman was hospitalised due to jaundice and fever. She was diagnosed with rheumatoid arthritis (RA) at 54 years of age. Treatment with methotrexate (MTX) was successful, and her RA was in remission. Five weeks before the hospitalisation, she was diagnosed with optic neuritis due to a decline in the visual acuity of the right eye. She was treated with methylprednisolone pulse therapy, followed by prednisolone (PSL), before the hospitalisation, which were not effective. Blood tests showed increased C-reactive protein (CRP) levels, liver injury, and thrombocytopenia. Abdominal echo revealed numerous enlarged lymph nodes in the hepatic portal region. Malignant lymphoma was suspected due to high serum levels of soluble interleukin-2 receptor. None of the treatments were effective, and she died on the fifth hospital day. Diffuse large B cell lymphoma was diagnosed during the autopsy, which showed infiltration of CD20-positive atypical lymphocytes in almost all organs. Since she was taking MTX, she was diagnosed with immunosuppressive drug-associated lymphoproliferative disease (LPD). Anti-human T-cell leukaemia virus type 1 (HTLV-1) antibody was detected in her serum after her death; however, adult T cell leukaemia/lymphoma was not observed. LPD develops during the treatment of RA with disease modifying anti-rheumatic drugs; however, a rapid clinical course leading to death is rarely observed. Previous reports suggest that T cell dysregulation observed in HTLV-1 may contribute towards the development of B cell lymphoma. We have discussed the possible roles of HTLV-1 in LPD development in this case.

Prioritization of the Skills to Be Mastered for the Daily Jobs of Japanese Dental Hygienists.

Dental hygienists require proficiency in a wide variety of job skills. Dental hygienists should master their job skills step by step, and the prioritization of these steps is important. In this study, we investigated the frequency at which Japanese dental hygienists performed daily jobs and attempted to classify the jobs according to the proficiency levels. The aim of this study was to surmise the order in which skills should be mastered in terms of priority and to investigate the relationship between daily jobs and the motivation for completing jobs. The Japan Dental Hygienists' Association conducts a survey on the employment status of dental hygienists in Japan every five years. The questionnaire is distributed to all members of the Japan Dental Hygienists' Association. In this study, the responses of 3,807 dental hygienists who worked at dental clinics were analyzed. We analyzed 77 kinds of daily jobs and the items regarding the motivation to work. For the analysis, item response theory (IRT), structural equation modeling (SEM), and logistic regression analysis were applied. According to the item response curve, the jobs were classified into 11 clusters. The jobs classified into Cluster 1 were the jobs that most of the average-proficiency Japanese dental hygienists performed. Scaling and root planing were the representative jobs in Cluster 1. Performing the jobs classified into Cluster 5 clearly discriminated whether the dental hygienists were performing multiple jobs. Jobs concerning care for elderly or disabled patients were classified into Cluster 5. Jobs concerning gerodontology, implants, management of staff, and consultations were significantly associated with the motivation to perform jobs. Polishing and adjustment of orthodontic apparatuses was negatively associated with the motivation to perform jobs. Understanding the features of each daily job of dental hygienists is important for planning dental hygienists' lifelong educational programs and evaluating their skill levels and proficiency levels. The results presented in this study may help to reveal the characteristics of dental hygienists' daily jobs.

Synchrony of the first division as an index of the blastocyst formation rate during embryonic development.

Purpose: To devise an uninvasive selection system for human embryos with high developmental potential after a single oocyte retrieval cycle by comparing the in vitro and in vivo effectiveness of first division synchrony against subsequent embryonic developmental stages. Methods: The effects of using assisted reproductive technology on 948 embryos that were produced in 137 cycles were examined by dividing the embryos into "early cleavage" (first division within 25.90 hours) and "late cleavage" (first division at or after 25.90 hours) groups and comparing the blastocysts and good-quality blastocyst formation rates between the two groups. These two groups were each divided further into "high synchrony" (first division synchrony within 3.96 hours) and "low synchrony" (first division synchrony at or after 3.96 hours) groups. The blastocysts, good-quality blastocyst formation rates, and pregnancy rates were compared among these four groups. Results: Both the blastocysts and good-quality blastocyst formation rates were significantly higher in the early-cleavage groups than in the late-cleavage groups. The blastocyst formation rate of the latter was also significantly increased in the high-synchrony, compared with the low-synchrony, group. Conclusion: First division synchrony in a single oocyte retrieval cycle could be a useful assessment of the blastocyst formation rate that enables the selection of viable embryos at an early stage of culture.

Selection of human blastocysts with a high implantation potential based on timely compaction.

PURPOSE: Recently, we established a noninvasive system for selecting human blastocysts with a high pre-transfer implantation potential based on first and second division patterns. The present study was carried out to improve the selection system. METHODS: Embryos that completed first and second divisions within 25.90 and 37.88 h after culture, respectively, were selected using a time-lapse incubator. We examined the effects of compaction and blastocyst formation times on pregnancy rates after transferring these embryos at the blastocyst stage. RESULTS: The completion of compaction and blastocyst formation times (79.93 and 97.47 h after culture, respectively) of embryos resulting in pregnancies after transfer were significantly (P < 0.01) shorter than those (86.46 and 100.34 h after culture, respectively) of embryos that failed to induce pregnancies. Embryo selection based on completion of compaction time improved pregnancy rates (40.9 vs. 74.6%, P < 0.01). CONCLUSIONS: Of the embryos that formed two cells during the first division within 25.90 h after culture and four cells during the second division within 37.88 h after culture, those that completed compaction within 79.93 h after culture before reaching the blastocyst stage had a high implantation potential.

The Successful Treatment of Myeloperoxidase Antineutrophil Cytoplasmic Antibody-positive Hypertrophic Pachymeningitis in Patients with the Limited Form of Granulomatosis with Polyangiitis Using Methotrexate: Two Case Reports.

Recent findings have indicated a close relationship between myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-positive hypertrophic pachymeningitis and the limited form of granulomatosis with polyangiitis (GPA). In Japan, MPO-ANCA-positive hypertrophic pachymeningitis predominantly occurs in elderly individuals. We herein describe the cases of two patients with MPO-ANCA-positive hypertrophic pachymeningitis associated with the limited form of GPA who were successfully treated with a combination of corticosteroids and methotrexate. Although methotrexate has been shown to be less effective than cyclophosphamide for inducing the remission of GPA in patients with organ-threatening diseases, its safety and efficacy may make it a useful alternative treatment modality for patients with the limited form of GPA who show meningeal involvement.

Formation of atomically ordered and chemically selective Si-O-Ti monolayer on Si0.5Ge0.5(110) for a MIS structure via H2O2(g) functionalization.

Si0.5Ge0.5(110) surfaces were passivated and functionalized using atomic H, hydrogen peroxide (H2O2), and either tetrakis(dimethylamino)titanium (TDMAT) or titanium tetrachloride (TiCl4) and studied in situ with multiple spectroscopic techniques. To passivate the dangling bonds, atomic H and H2O2(g) were utilized and scanning tunneling spectroscopy (STS) demonstrated unpinning of the surface Fermi level. The H2O2(g) could also be used to functionalize the surface for metal atomic layer deposition. After subsequent TDMAT or TiCl4 dosing followed by a post-deposition annealing, scanning tunneling microscopy demonstrated that a thermally stable and well-ordered monolayer of TiOx was deposited on Si0.5Ge0.5(110), and X-ray photoelectron spectroscopy verified that the interfaces only contained Si-O-Ti bonds and a complete absence of GeOx. STS measurements confirmed a TiOx monolayer without mid-gap and conduction band edge states, which should be an ideal ultrathin insulating layer in a metal-insulator-semiconductor structure. Regardless of the Ti precursors, the final Ti density and electronic structure were identical since the Ti bonding is limited by the high coordination of Ti to O.

Low temperature thermal ALD of a SiNx interfacial diffusion barrier and interface passivation layer on SixGe1- x(001) and SixGe1- x(110).

Atomic layer deposition of a silicon rich SiNx layer on Si0.7Ge0.3(001), Si0.5Ge0.5(001), and Si0.5Ge0.5(110) surfaces has been achieved by sequential pulsing of Si2Cl6 and N2H4 precursors at a substrate temperature of 285 °C. XPS spectra show a higher binding energy shoulder peak on Si 2p indicative of SiOxNyClz bonding while Ge 2p and Ge 3d peaks show only a small amount of higher binding energy components consistent with only interfacial bonds, indicating the growth of SiOxNy on the SiGe surface with negligible subsurface reactions. Scanning tunneling spectroscopy measurements confirm that the SiNx interfacial layer forms an electrically passive surface on p-type Si0.70Ge0.30(001), Si0.50Ge0.50(110), and Si0.50Ge0.50(001) substrates as the surface Fermi level is unpinned and the electronic structure is free of states in the band gap. DFT calculations show that a Si rich a-SiO0.4N0,4 interlayer can produce lower interfacial defect density than stoichiometric a-SiO0.8N0.8, substoichiometric a-Si3N2, or stoichiometric a-Si3N4 interlayers by minimizing strain and bond breaking in the SiGe by the interlayer. Metal-oxide-semiconductor capacitors devices were fabricated on p-type Si0.7Ge0.3(001) and Si0.5Ge0.5(001) substrates with and without the insertion of an ALD SiOxNy interfacial layer, and the SiOxNy layer resulted in a decrease in interface state density near midgap with a comparable Cmax value.

Association of anti-aminoacyl-transfer RNA synthetase antibody and anti-melanoma differentiation-associated gene 5 antibody with the therapeutic response of polymyositis/dermatomyositis-associated interstitial lung disease.

BACKGROUND: We attempted to clarify whether the presence of anti-aminoacyl-transfer RNA synthetase antibody (anti-ARS Ab) or anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab) is associated with the therapeutic response of polymyositis/dermatomyositis-associated interstitial lung disease (PM/DM-ILD). METHODS: We retrospectively investigated 22 patients with PM/DM-ILD (10 positive for anti-ARS Ab and nine positive for anti-MDA5 Ab) for whom antibody analysis of conserved serum was possible. We assessed mortality in the first three months as the therapeutic response in the acute phase and compared changes in clinical data for up to one year considered as the chronic phase. We classified the clinical changes over the year into three groups: Improvement (increased % vital capacity [%VC] or diffusing capacity of the lung for carbon monoxide [%DLCO]≥10 or 15%), deterioration (decreased %VC or %DLCO≥10 or 15%), and no change (remainder of the changes). The extent of abnormality demonstrated by high-resolution computed tomography (HRCT) was scored. RESULTS: Positivity for anti-MDA5 Ab, but not for anti-ARS Ab, was associated with mortality in the first 3 months. Evaluation of the therapeutic response in the first year showed that positivity for the anti-ARS Ab, but not for the anti-MDA5 Ab, was associated with an improvement in %DLCO and a decline in the serum KL-6 levels. Positivity for the anti-ARS Ab or negativity for anti-MDA5 Ab was associated with a greater decrease in bronchial dilatation as seen by HRCT. CONCLUSIONS: Anti-ARS and anti-MDA5 Abs are associated with the therapeutic response of PM/DM-ILD.

Development of an oral health-related self-efficacy scale for use with older adults.

AIM: Self-efficacy is considered to be an important factor influencing behavior change; however, there are no existing tools to measure self-efficacy in the context of oral health among older adults. The purpose of the present study was to develop the Geriatric Self-Efficacy Scale for Oral Health (GSEOH) for use with older adults, and to evaluate its reliability and validity. METHODS: The self-administered questionnaire was completed by 646 Japanese older people. The draft version of the scale consisted of 35 items that were generated to measure the three dimensions of personal beliefs in tooth brushing, observing own oral health status and oral function. We carried out a principal components factor analysis with promax rotation, and investigated the scale's internal consistency and construct validity. RESULTS: The final version of the scale consisted of three dimensions measured with 20 items. Cronbach's alpha of the GSEOH total scale was 0.924. There were significant differences (P < 0.05) in total scores on the GSEOH for the change process of oral health behavior, and in relation to self-rated oral health. CONCLUSIONS: We developed the GSEOH, with three factors and 20 items, and confirmed its reliability and validity. More studies are necessary to investigate the cross-cultural validity and reliability with larger samples from other countries. Geriatr Gerontol Int 2017; 17: 1406-1411.

Developmental ability of embryos produced from oocytes with fragile oolemma by intracytoplasmic sperm injection.

PURPOSE: In intracytoplasmic sperm injection (ICSI) of oocytes with a fragile oolemma (fragile oocytes), breakage can occur at injection. In this study, we produced embryos from oocytes with a fragile and normal oolemma (normal oocytes) by ICSI and compared their ability to be fertilized and develop in vitro. We also investigated whether fragile oocyte-derived embryos could implant after blastocyst transfer to determine whether fragile oocytes should be used for assisted reproductive technology treatment. METHODS: Oocytes were divided into three groups-normal oocytes from cycles containing no fragile oocytes (group A), normal oocytes from cycles containing at least one fragile oocyte (group B), and fragile oocytes (group C), and their fertilization abilities after ICSI and the developmental abilities of resultant embryos were compared. RESULTS: The fertilization rate in group C (65.3 %) was significantly (P < 0.01) lower than those in groups A (84.6 %) and B (86.9 %), and the degeneration rate in group C (24.2 %) was significantly (P < 0.01) higher than those in groups A (0.71 %) and B (0.28 %). However, there were no significant differences in the blastocyst formation rates (59.7-67.5 %) of embryos among the different groups. In addition, the pregnancy rate after transfer of blastocysts in group C (50.0 %) was not significantly different from those in groups A (35.6 %) and B (45.8 %). CONCLUSIONS: The fertilization ability after ICSI of fragile oocytes is lower than that of normal oocytes but the resultant embryos have the same developmental ability as those of normal oocyte-derived embryos.