Journal of Medical and Dental Sciences最新文献

Background and aims: Because of the low penetration rate of transient elastography (TE) or its limitations in patients with obesity, narrow intercostal spaces, or ascites, the physical appearance of the liver as visualized using ultrasonography (US) is still thought to provide important information for the prediction of liver fibrosis. We examined the accuracy of various US signs when assessing the presence of liver cirrhosis, compared with TE.

Methods: We enrolled 189 patients who had undergone both conventional US and TE examinations. We then assessed the associations between US parameters of the liver (surface, edge, and parenchymal texture) or the US score (sum of each parameter score), and the presence of liver cirrhosis as determined based on a liver stiffness measurement (LSM) of >15.

Results: A significant increase in the LSM was observed according to the liver surface score (P < 0.001), liver edge score (P < 0.001), parenchymal texture score (P < 0.001), and US score (P < 0.001). The areas under the curves (AUROC) for the prediction of an LSM >15 for the liver surface, liver edge, parenchymal texture, and the US score were 0.859, 0.768, 0.837, and 0.902, respectively. The AUROC of the US score was higher than that of the APRI score (0.823) or the FIB-4 index (0.804). Using an optimal cut-off value of 3.5, the sensitivity and specificity of the US score were 0.815 and 0.858, respectively.

Conclusions: The US score was clinically useful for the diagnosis of an LSM >15. The US score can be used as a substitute for TE data in patients with obesity, narrow intercostal spaces, or ascites or in hospitals where TE is unavailable.

Background: Anticancer drugs for targeted molecular therapies have been applied to the treatment of lung cancer. Since the effects of medicine for adenocarcinoma (ADC) or squamous cell carcinoma (SQCC) differ, the ability to discriminate these lesions is important. In the present study, we examined whether ADC and SQCC could be distinguished using low-vacuum scanning electron microscopy (LVSEM) to examine cytopathological specimens.

Methods: Thirty-seven cases of bronchoscopic samples were retrospectively examined using LVSEM on the surface structures of the cancer cells.

Results: Among the Pap-stained slides, 81.1% of the cases could be distinguished: 96.2% of the ADC cases were distinguishable, and 45.5% of the SQCC cases were distinguishable. Among the significant findings for ADC using LVSEM, a spherical shape (73.1%), long filaments (65.4%), dense filaments (80.8%), and depression (57.7%) were seen. Among the significant findings for SQCC as observed using LVSEM, however, a flat shape (81.8%), sparse filaments (72.7%), and non-filament (81.8%) were seen. The overall accuracy of diagnosis using LVSEM was 83.8%: 80.8% for ADC and 90.9% for SQCC. The accuracy of a combination of Papstained slides and LVSEM was 97.3%.

Conclusions: The LVSEM method is useful as an ancillary examination for cytopathology after the classification of Pap-stained slides.

With the development of technology, the knowledge and skills needed to become a dentist are increasing. Computer-assisted simulation learning materials have been utilized for dental education because of their high efficiency and efficacy. However, it is not well understood which material design is strongly associated with an education effect. We therefore investigated the effects of interactivity with learning materials on learners' knowledge acquisition, memory retention, and anxiety reduction. Learning effects and degree of anxiety were compared between dental residents who learned using an interactive-type material, which required decision making and provided feedback (Group I, n=26), and those who learned using a display-type material, which merely displayed the appropriate action on a computer screen (Group D, n=23). Quiz scores immediately after learning and 3 weeks later were significantly higher in Group I than those in Group D (p<0.001 and 0.016, espectively). Regarding anxiety, state anxiety after learning with interactive material was significantly decreased in Group I (p<0.05), whereas no significant change was observed in Group D. Our results suggest that interactivity with computerassisted simulation materials is more effective for knowledge acquisition, memory retention, and anxiety reduction.

Patients with unilateral sensorineural hearing loss (UHL) often complain of hearing difficulties in noisy environments. To clarify this, we compared brain activation in patients with UHL with that of healthy participants during speech perception in a noisy environment, using functional magnetic resonance imaging (fMRI). A pure tone of 1 kHz, or 14 monosyllabic speech sounds at 65‒70 dB accompanied by MRI scan noise at 75 dB, were presented to both ears for 1 second each and participants were instructed to press a button when they could hear the pure tone or speech sound. Based on the activation areas of healthy participants, the primary auditory cortex, the anterior auditory association areas, and the posterior auditory association areas were set as regions of interest (ROI). In each of these regions, we compared brain activity between healthy participants and patients with UHL. The results revealed that patients with right-side UHL showed different brain activity in the right posterior auditory area during perception of pure tones versus monosyllables. Clinically, left-side and right-side UHL are not presently differentiated and are similarly diagnosed and treated; however, the results of this study suggest that a lateralityspecific treatment should be chosen.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. A common characteristic of ALS pathology is cytoplasmic inclusions primarily composed of transactive response DNA-binding protein of 43 kDa (TDP-43). Production of TDP-43 in the central nervous system is strictly regulated, but it is not known whether this is also true in the skin of ALS patients. We found a gradual but significant reduction in epidermal TDP-43 mRNA expression with illness progression in ALS patients with upper-limb onset. However, the immunoblotting analysis revealed more TDP-43 protein in the skin of patients with upper-limb onset than of those with other onsets. There was no correlation between the TDP-43 mRNA expression and protein levels, indicating that the mechanism of TDP-43 autoregulation in the patients' skin gradually failed. ALS diagnosis depends on clinical signs and electrophysiological findings, making early diagnosis difficult. TDP-43, as quantified by immunoblot analysis of biopsied skin, is a potential new biomarker of ALS.

The aim of this study was to examine the effectiveness of interactive simulation materials with decision making in knowledge acquisition and anxiety reduction. Dental students in their fourth year at Tokyo Medical and Dental University were randomly divided into Groups I and D. Participants read a scenario, learned with interactive-type (Group I) or display-type (Group D) learning materials about pulpectomy, and took the State-Trait Anxiety Inventory-JYZ, a quiz for measuring learning effects, and a questionnaire for evaluation of the material. Except for requesting decision making in the interactive-type material, the contents of both materials were the same. The results were compared using the unpaired Student's t-test, Fisher's exact test, and the two-way repeated measures ANOVA with the Bonferroni post hoc test. The mean quiz score was significantly higher in Group I than in Group D (I: 75.4±1.4, D: 60.6±2.7, p<0.001). There was no significant correlation between the groups and the responses except for one question about operability (p<0.05). A significant main effect on state anxiety was found between examination points (p<0.001), and state anxiety significantly increased after reading the scenario (p<0.001) and reduced after learning (p<0.001). Interactive simulation materials with decision making might be effective in knowledge acquisition.