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Background: This in vitro study aimed to clarify the combined effect of electric toothbrushing and dentifrice on the removal of artificial stain., Material and Methods: Twenty-five bovine incisors were cut at the cervix and the crown was embedded in auto-cured acrylic resin. Specimens were abraded using #240 SiC paper to obtain a flat enamel surface, and 20 specimens were treated with 10% citric acid / 3% ferric chloride solution followed by 1% tannic acid solution to produce surface staining. They were divided into four groups: 1) brushing with an electric toothbrush and whitening dentifrice (group S+B); 2) brushing with an electric toothbrush and fluoride dentifrice (group S+C); 3) brushing with an electric toothbrush and no dentifrice (group S); and 4) no brushing (control group). The remaining five specimens were used as a baseline. Color values ( L* , a* , and b* were measured before brushing (0 min), and at 1 min, 5 min, 10 min, and 20 min using a microscopic area spectrophotometer. The color change ( ΔE ) was calculated by subtracting the baseline values from the final color values obtained at each time point. The data were statistically analyzed using two-way repeated-measures analysis of variance and Tukey's honest significant difference test as a post hoc test ( p <0.05)., Results: The L* values of groups S+B and S+C increased over time ( p <0.05), but no significant differences were observed in group S and the control group at any of the time points ( p >0.05). Groups S+B and S+C demonstrated greater ΔE values than group S., Conclusions: The combination of electric toothbrushing and dentifrice removed the artificial stain more effectively than brushing without dentifrice. However, the stain removal was limited. The two dentifrices evaluated in this study exhibited similar stain removal effects. Key words: Color change, stain removal, dentifrice, electric toothbrush, whitening effect., Competing Interests: Conflict of interest statement: The authors have no financial relationship with any of the companies whose products are included in this article.

Clinical and Laboratory Standards Institute (CLSI) methods for susceptibility tests of yeast are used in Japan. On the other hand, the methods have some disadvantage; 1) reading at 24 and 48 h, 2) using unclear scale, approximately 50% inhibition, to determine MICs, 3) calculating trailing growth and paradoxical effects. These makes it difficult to test the susuceptibility for yeasts. Old software of RAISUS, Ver. 6.0 series, resolved problem 1) and 2) but did not resolve problem 3). Recently, new software of RAISUS, Ver. 7.0 series, resolved problem 3). We confirmed that using the new software made it clear whether all these issue were settled or not. Eighty-four Candida isolated from Aichi Medical University was used in this study. We compared the MICs obtained by using RAISUS antifungal susceptibility testing of yeasts RSMY1, RSMY1, with those obtained by using ASTY. The concordance rates (±four-fold of MICs) between the MICs obtained by using ASTY and RSMY1 with the new software were more than 90%, except for miconazole (MCZ). The rate of MCZ was low, but MICs obtained by using CLSI methods and Yeast-like Fungus DP 'EIKEN' methods, E-DP, showed equivalent MICs of RSMY1 using the new software. The frequency of skip effects on RSMY1 using the new software markedly decreased relative to RSMY1 using the old software. In case of showing trailing growth, the new software of RAISUS made it possible to choice the correct MICs and to put up the sign of trailing growth on the result screen. New software of RAISUS enhances its usability and the accuracy of MICs. Using automatic instrument to determine MICs is useful to obtain objective results easily.

Aim: To evaluate the effects of choice of insertion route and ultrathin endoscope types., Methods: This prospective study (January-June 2012) included 882 consecutive patients who underwent annual health checkups. Transnasal esophagogastroduodenoscopy (EGD) was performed in 503 patients and transoral EGD in 235 patients using six types of ultrathin endoscopes. Patients were given a choice of insertion route, either transoral or transnasal, prior to EGD examination. For transoral insertion, the endoscope was equipped with a thin-type mouthpiece and tongue depressor. Conscious sedation was not used for any patient. EGD-associated discomfort was assessed using a visual analog scale (VAS; no discomfort 0- maximum discomfort 10)., Results: Rates of preference for transnasal insertion were significantly higher in male (male/female 299/204 vs 118/117) and younger patients (56.8 ± 11.2 years vs 61.3 ± 13.0 years), although no significant difference was found in VAS scores between transoral and transnasal insertion (3.9 ± 2.3 vs 4.1 ± 2.5). Multivariate analysis revealed that gender, age, operator, and endoscope were independent significant predictors of VAS for transnasal insertion, although gender, age, and endoscope were those for transoral insertion. Further analysis revealed only the endoscopic flexibility index (EFI) as an independent significant predictor of VAS for transnasal insertion. Both EFI and tip diameter were independent significant predictors of VAS for transoral insertion., Conclusion: Flexibility of ultrathin endoscopes can be a predictor of EGD-associated discomfort, especially in transnasal insertion.

Purpose: Incidence of ocular injury caused by the solar eclipse of 2009 has been investigated using the questionnaire of the Japan Committee of the International Year of Astronomy 2009., Methods: The questionnaire was available to the public on the website., Results: Answers were obtained from 14 people (12 men, 2 women), aged from sixteen to fifty-four. All had looked at the sun either with the naked eye or through some shading device (plastic sheet, plastic bag, compact disc, etc.) the safty of which is unknown. Reported symptoms included a sense of incongruity, heat, pain, central scotoma or visual disturbance, classified into four periods of duration. Three people with transient symptoms watched the eclipse with the naked eye for one minute in cloudy weather. Three people with symptoms lasting for one day and three people with symptoms lasting for one week had watched it with the naked eye and some shading device for 10 minutes in cloudy weather. Five people with symptoms lasting for more than one week watched the eclipse with the naked eye and through some sort of device in fine or slightly cloudy weather. Three people consulted their ophthalmologist., Conclusions: Those who reported adverse symptoms did not comply with the instructions for safe watching of the eclipse and the duration of the symptoms depended on the weather and the type of device used.

We present a case of asystole due to anaphylactoid reaction after vaginal disinfection with povidone iodine under epidural anesthesia combined with general anesthesia. A 71-year-old woman was scheduled to undergo total cystectomy due to vesical cancer, invading into the wall of the vagina. After induction of anesthesia, epidural injection with 10 ml of 1% lidocaine and cleansing the vagina with povidone iodine solution were done at the same time. Shortly thereafter, sudden hypotension and bradycardia and asystole occurred. Multiple doses of epinephrine, chest compression, transcutaneous pacing and defibrillation were required to restore her spontaneous circulation. The surgery was cancelled. She stayed a night at the intensive care unit, and was discharged without any neurological complications the next day. The serum concentration of histamine increased to 7.0 microg x l(-1), but that of tryptase was within normal ranges when spontaneous circulation returned. The serum concentration of total iodine increased to 57.9 microg x dl(-1), which did not reach the toxic level. These results suggest that the circulatory collapse was probably caused by anaphylactoid reaction to povidone iodine. Epidural anesthesia may have worsened the circulatory collapse.

A 66-year-old man was scheduled for endoscopic right uretherectomy under general anesthesia. On the pre-anesthesia examination, the patient had no respiratory symptoms. An informed consent for endotracheal intubation by a trainee for emergency medical technician was obtained on the examination. General anesthesia was induced with propofol, ketamine, and fentanyl. The trainee ventilated the patient easily with facemask and succinylcholine was administered. On the attempt of endotracheal intubation by the trainee with video-laryngoscope (X-LITE VIDE), a huge epiglottic cyst was observed. Tracheal intubation was done safely by the responsible anesthesiologist. Laryngofiberscopic finding showed no respiratory sequlae such as bleeding from the cyst. Although the patient had been informed about the cyst before the surgery, he did not disclose it as he did not have any symptom from the cyst. This case suggest that unpredictable airway problem could occur in any anesthetic practice. The video-laryngoscope was useful in such a case to prevent fatal complication developing on endotracheal intubation by a trainee, and also it is a good tool to show the trainee how severe the cyst related-airway trouble would be.

The city of Higashi Yamato is located in the northern part of Tama, Suburbs of Tokyo, and the population of Higashi Yamato is approximately 80,000. The Higashi Yamato visiting nursing station was opened in April 1998. As of April 2006, we have over 100 patients, and the aggregate visiting nursing services have provided more than 600 cases. Our station's uniqueness is that forty percent of the patients have malignant neurological disorders and are terminal stage patients, and that they are all covered by medical care insurance. We also provide nursing services to patients who are expected to be dying peacefully at home averaging 4 patients per month. Higashi Yamato Hospital, attached to the visiting nursing station, is an acute phase hospital and has 274 beds. The average hospital stay for our patients was 13 days in 2005. We promote an early discharge from the hospital for patients who have a high need of medical and nursing care and for the patients who are at the terminal stage. However, there were many cases where visiting nursing care services were provided because of a local care manager's request rather than a visiting nursing care need for patients who will be discharged soon from the hospital and for those expecting to have the service. In reality, we have observed a family being felt that his or her patient was pushed out from the hospital, a family who has no confidence in taking a nursing task at home, and a family who could not cope with the patient's changing condition. Therefore, we wanted resolve these observed problems urgently to create close cooperation with the hospital in order to provide continued nursing care after a patient is discharged from the hospital and to have home medical care safely. As a result, we planned a visit to the ward on a weekly basis starting on February 2006. We report here because we had a good result.

A 3-year-old girl with neuroblastoma was scheduled for intraoperative radiation therapy. Prior to surgery, meetings were held to ensure the safety during transfer between the operating room and the radiation unit because those units were placed on the different floors in our hospital. In the operating room the patient was anesthetized with propofol, fentanyl and ketamine (PFK). After the resection of the tumor, the patient was moved to the radiation unit. All personnel had to leave the treatment room while the radiation was administered, which required 3 minutes. During the transfer and treatment, the following apparatus were effective to ensure the patient's safety; mobile respiratory and cardiovascular monitors, closed-circuit television to observe the monitors and patient, and a portable gas powered ventilator. The total intravenous anesthesia with PFK was used throughout all scheduled procedures. For patients treated with intraoperative radiation therapy, the administration of inhalation anesthetics should be discontinued to supply 100% oxygen, which enhances the effect of irradiation, and to avoid the complexity of the transfer with an anesthetic machine. This discontinuation, however, may cause the cardiovascular instability. It seems that total intravenous anesthesia has advantages over inhalation anesthesia for patients who undergo intraoperative radiation therapy.

A 69-year-old man with chronic renal failure was scheduled for artero-venous shunt surgery for sustained hemodialysis. On the pre-anesthesia interview, the patient complained of no respiratory symptom. Chest x-ray showed some tracheal deviation. There was no past history of the respiratory system such as bronchitis, bronchial asthma, tumor, trauma or previous tracheal intubation. General anesthesia was induced smoothly with thiopental and suxamethonium. Face mask ventilation could be done easily. The vocal cord was exposed fully by standard McIntosh laryngoscope. However, a neither ID 7.5 nor 6.5 mm tracheal tube could be inserted into the trachea. Then, a size 4.0 laryngeal mask airway (LMA) was inserted smoothly and ventilation was maintained adequately. The surgery was done smoothly. Seven days after, bronchofiber scopic findings showed tracheal stenosis. The cause was unknown but not from inflammation or tumor. The patient complained no respiratory distress after the surgery. In such unpredictable tracheal stenosis with easy mask ventilation, LMA is a considerable option for respiratory management.

The problem of whether recombinant mtDNAs are created in mammalian cells has been controversial for many years. We show convincing evidence for the very rare creation of recombinant mtDNA haplotypes by isolating human somatic hybrid cells and by generating mice carrying two different mtDNA haplotypes. To avoid misinterpretation of PCR-jumping products as recombinants, we used purified mtDNAs for cloning and sequencing. The results showed that only three of 318 clones of mtDNA purified from mouse tissues corresponded to recombinant mtDNA haplotypes, whereas no recombinants were found in human somatic hybrid cells. Such an extremely low frequency of mtDNA recombination does not require any revision of important concepts on human evolution that are based on its absence. Considering the high concentration of reactive oxygen species around the mtDNA and its frequent strand breakage, recombinant clones would correspond to gene conversion products created by repair of nucleotide mismatches.

Chronic hypoxia has been newly proposed as a common mechanism of tubulointerstitial fibrosis in the progression of various chronic inflammatory renal diseases, where PAI-1 plays an important role in the accumulation of extracellular matrix (ECM) through inhibition of plasmin-dependent ECM degradation. In the present study, we investigated the presence of PAI-1 in renal tubular cells by immunostaining renal biopsy samples. We also closely examined the effects of hypoxia and TNF-alpha on PAI-1 expression in cultured human proximal renal tubular cells (HRCs). Confluent cells growth-arrested in DMEM for 24h were exposed to hypoxia (1% O2) and/or TNF-alpha at 10 ng/ml for 24 hours. Amounts of PAI-1 protein and mRNA after stimulation were measured by ELISA and TaqMan quantitative PCR, respectively and compared to those in cells incubated under control conditions (18% O2 without TNF-alpha). HIF-1alpha was demonstrated by immunoblot analysis. In crescentic glomerulonephritis, clusters of proximal tubules were specifically stained for PAI-1. Treatment of 24 hours with hypoxia, TNF-alpha and their combination induced a 2.7-fold, a 1.8-fold, and a 4.6-fold increase in PAI-1 protein secretion, and produced a 3.6-fold, a 3.3-fold, and a 12.1-fold increase at the PAI-1 mRNA level, respectively. Immunoblot analysis revealed that hypoxia-inducible factor-1alpha (HIF-1alpha) was markedly accumulated in the nuclear fraction after 16-hours exposure of HPTECs to hypoxia but not to TNF-alpha. In conclusion, hypoxia induces PAI-1 expression via remarkable nuclear accumulation of HIF-1alpha in HRCs. TNF-alpha can enhance this hypoxia-induced PAI-1 expression.

Plasminogen activator inhibitor-1 (PAI-1) may contribute to renal fibrosis because of its involvement in matrix (ECM) accumulation through inhibition of plasmin-dependent ECM degradation. The aim of this study is to determine urinary PAI-1 concentrations and its intrarenal localization in patients with various renal diseases and to identify inducers for PAI-1 expression in human cultured proximal renal tubular cells (HRCs). Urinary PAI-1 concentrations were significantly higher in patients with overt diabetic nephropathy (DN, n=36) than in proliferative glomerulonephritis (PGN, n=8), nephrotic syndrome (NS, n=10) and healthy controls (n=12). Urinary PAI-1 concentrations (ng/gCr) were directly correlated with urinary N-acetyl glucosaminidase (NAG) levels (r=0.58, p<0.05). As for intrarenal localization of PAI-1 antigen, strong stainings for PAI-1 were observed in proximal tubular cells of renal biopsy samples from patients with DN, while no stainings for PAI-1 were found in renal tissues of PGN or NS. Immunoblot analysis revealed the presence of PAI-1 protein in whole cell lyzates from HRCs grown to semiconfluency. Exposure of growth-arrested HRCs with hypoxia (1% O2) or TNF-alpha (10 ng/ml) for 24 hours increased the secretion rate of PAI-1 protein by about 2.0-fold, while 24-hour treatment with high glucose (450 mg/dl) did not increase PAI-1 secretion at all, compared with that of the control cells under normal glucose (100 mg/dl) and normoxia (18% O2). These findings suggest that PAI-1 expression is upregulated especially in the proximal renal tubular cells of DN, which may be explained partially by hypoxia and inflammatory cytokines but not high glucose.

Ultrasonography is very useful for detection of deep vein thrombosis. The purpose of this paper is to show a method for detecting them efficiently by high resolution transducer and color Doppler system. We examined patients in the supine and prone positions. To detect the venous flow easily and differentiate thrombi from simple venous dilatation, some maneuvers are useful; one is pushing the vein area using the transducer on examination, the second is breathing overload, and the last is so-called milking. We can find throombi in the external iliac or femoral veins of patients who have symptoms of lower leg swelling, however, we need to better detect venous thrombi in the lower leg in patients with a history of pulmonary embolism. Because deep venous thrombi are increasing, the role of ultrasound will expand in the future.

Graduates from Jichi Medical School are obligated to work at rural clinics or hospitals, where most of them are the only medical doctor in the house. To understand how these graduates actually use laboratory examinations, what examinations they found most important in their practice, and when they were confident of their laboratory techniques, we designed a questionnaire to address these questions. Many respondents reported that their institutions had electrocardiographs, abdominal and/or cardiac ultrasonographs, urinalysis test paper, and portable blood glucose meters, and more than half of them reported having used these instruments without assistance in emergency situations. Moreover, a majority of the respondents said that they considered it important that a physician is able to use these instruments without the help of other staff members. Proficiency in many laboratory techniques was obtained and physicians were confident during their first postgraduate clinical practice. These responses clearly show the importance and usefulness of covering examination techniques and the principles of laboratory medicine in medical education and the first postgraduate clinical practice.