プログラムPDF - 医療系大学院高度臨床専門医養成コース

Transcription

大学院GP採択記念
第一回岡山医療教育国際シンポジウム
プログラム・抄録集
目次
第１９年度大学院教育改革支援プログラム
「医療系大学院高度臨床専門医養成コース」
取り組み実施責任者挨拶
・・・・・
会場案内・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
会場配置図
・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
プログラム
・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
抄録
大学院 GP 採択記念講演・・・・・・・・・・・・・・・・・・・・・・・・・・・
イブニングポスターディスカッション・・・・・・・・・・・・・・・・・・・・
ソプラノ独唱紹介
・・・・・・・・・・・・・・・・・・・・・・・・・・・・・
第一回岡山医療教育国際シンポジウムの開催にあたって
窪木拓男
大学院 GP 取り組み実施責任者
日本では９０年代から，大学院の充実が叫ばれ，重点化等の制度が整備されてきた．しかし，一
方で内容の整備，すなわち実質化は未だ十分でない．医療系臨床大学院において，大学院生は何を
学ぶべきかという議論が十分なされないまま，大学院の定員を増やしてみても，国際的に通用する
大学院はできない．教官は臨床・教育・研究で多忙ななか，世界的な業績を求められており，大学
院教育に費やすことができる時間も限られている．また，大学院生は自分の臨床能力を高めるため
に各臨床分野に所属したにもかかわらず，目的とした臨床能力の開発とはかけはなれた基礎研究の
みに自分の時間を費やさざるを得ないため不満を訴えるものもある．大学院は日本に世界的な業績
をもたらすための（大学院生を使った）ツールと考えるのか，それとも学生のニーズに応えて学生
の能力を向上させるための学生のための学舎であると考えるべきだろうか．もちろん，これらの両
立が望ましいのだろうが，学生を中心とした考え方がある程度なければ，その大学院は人気を失い，
最終的には優れた後継者さえも育たないという状況が生まれてしまうのではないか．この潮流は，
医師主導型（Doctor-oriented system）から患者主導型（Patient-oriented system）へ大きく舵
をとった医療のパラダイムシフトと似通っている．
このように，医療系大学院は，複数の大きなミッションを背負っている．岡山大学大学院医歯薬
学総合研究科では，平成１９年度より，４年生の博士課程一般コースを，臨床技術や臨床決断能力
を教育し，臨床を真剣に科学する「臨床専門医コース」と，優れた基礎研究者を養成する「一般コ
ース」に分割し，各々のコースの目的にしたがって大学院の実質化を進めることとなった．このう
ち，臨床専門医コースは，各学会の専門医制度と同調しながら，学生の臨床能力（知識，技術，態
度）を博士（医学・歯学）にふさわしいレベルにまで向上させ，国民が求める医療の質を担保する
ことが目的である．また，現在の医療の限界を明らかにし，この限界を打破する新たな方策を開拓
し，その有効性を明らかにすることも更なる目的であろう．このためには，臨床疫学的な観点から
臨床を科学し直す必要があるのはもちろんのこと，基礎研究部門と共同し，病態の解明や戦略的治
療法の開発を進める必要がある．これらは，全世界的に進んでいる医療のグローバル化に伴って，
世界的なスタンダードに則って進められる必要があり，教官・大学院生レベルでの国際交流が不可
欠である．幸い，本取り組みの内容が大学院ＧＰ（次ページ参考資料）として認められ，これらに
費やすことができる経済的なサポートを頂いたことは本学にとって大変な幸運である．
一方，医療分野では膨大な知のデータベースが形成されており，これを用いた診療ガイドライン
の作製が進行中である．これらはエビデンスに基づいた臨床決断をサポートする際には大変強力な
ツールとなる．大学院生の能力を効率的になるべく早く世界の最前線にまで高めるためには，これ
らの普遍的な知の共有がまず大前提である．これをどれだけ効率的に行うかが勝負の要であろう．
また，目前の患者においては，この平均値からの逸脱こそが意味があり，このプロセスを指導教員
と大学院生が共有しながら，未来の学生のためにデータベース化することが求められている．この
面で，Information Technology (IT)が大学院教育に及ぼすインパクトは計り知れないし，研究支
援，教育支援においても意義は大きい．これが臨床系大学院の魅力を形成するわけであるから，あ
る意味情報化による大学院教育のビッグバンが起こる可能性がある．
本シンポジウムは，このような時代の医療系大学院教育に欠くことができない，臨床エビデンス
に関する取り組みの最前線を IT 化とともにまとめてみたい．すなわち，国内において，いち早く
臨床研究者育成プログラム（Master of Clinical Research: MCR）を公衆衛生大学院に設立され，
臨床研究教育の最前線でご活躍の京都大学の福原教授，ならびに英国における保険医療改革に携わ
られ，臨床疫学研究，政策立案，日常臨床といった様々な視点から英国医療を観察されてこられた
大阪府立母子医療センターの森先生にご講演を頂く．また，2 名の海外演者を招待し，近年目覚ま
しい発展を遂げている IT を臨床教育に生かす試みについて University of Southern California
の Clark 教授に，また超高齢社会に突入した本邦でますます重要性を増している高齢者，有病者に
対する臨床研修に関して同じく University of Southern California の Mulligan 教授にご講演を
頂き，現状と課題について議論したい．
本取り組みは，本邦の臨床教育の歩みそのものであり，ある意味トライアンドエラーが必要とな
るかもしれない．しかし，本当に魅力的な臨床系大学院を創り，次世代の優れた教員を育てるため
には，間違いなく必要な努力である．今後とも，各位のご協力を賜りたい．
会場案内

公共交通／JR 岡山駅より路面電車東山行「県庁通り」下車すぐ
天満屋バスステーションから徒歩３分

駐車場はございません．

〒７００−０８２４
岡山市内山下１−６−２０
ルネスホール（NPO 法人
バンクオブアーツ岡山）
TEL
０８６−２２５−３００３
FAX
０８６−２２５−３０４０
会場配置図
 受付開始は，12:00 からです．
 参加者の方は受付にて，記帳をされ，抄録集，参加章をお受け取りになり，会場内へお
入り下さい．
 クロークへは，中庭から多目的ホール裏側へおまわり下さい．
 クローク終了時間は，19:30 です．
プログラム
13:00
13:05
研究科長挨拶
岡山大学大学院医歯薬学総合研究科
13:05
13:10
研究科長
田中紀章教授
学務委員長
二宮善文教授
大学院 GP 取り組み実施責任者
窪木拓男教授
学務委員長挨拶
岡山大学大学院医歯薬学総合研究科
13:10
13:30
本シンポジウムの趣旨と狙い
13:30 14:30
記念講演１
｢京都大学大学院医学研究科の臨床研究者養成（MCR）コースと臨床研究教育｣
講師：福原俊一教授（京都大学大学院医学研究科医療疫学分野）
座長：窪木拓男教授（岡山大学大学院医歯薬学総合研究科顎口腔機能制御学分野）
14:30 15:30
記念講演２
｢英国卒後医療教育における NICE 診療ガイドラインの役割｣
講師：森臨太郎先生（大阪府立母子保健総合医療センター新生児科企画調査部）
座長：矢谷博文教授（大阪大学大学院歯学研究科顎口腔咬合学分野）
15:30
15:40
コーヒーブレイク
15:40 16:40
記念講演３
｢Why establish an orofacial pain treatment, research and training center in an academic
medical center? and What role does virtual patient education have?｣
講師：Prof. Glenn T. Clark (Division of Diagnostic Sciences, University of Southern California)
座長：中野雅徳教授（徳島大学歯学部口腔保健学科口腔保健福祉学講座）
鱒見進一教授（九州歯科大学顎口腔欠損再構築学分野）
16:40
17:40
記念講演４
｢Establishing a special care dentistry fellowship: rationale, start-up, roadblocks, achievements｣
講師：Prof. Roseann Mulligan (Division of Health Promotion, Disease Prevention and
Epidemiology, University of Southern California)
座長：髙柴正悟教授（岡山大学大学院医歯薬学総合研究科歯周病態学分野）
松尾龍二教授（岡山大学大学院医歯薬学総合研究科口腔生理学分野）
17:40
1.
2.
3.
4.
18:00
ソプラノ独唱
アレルヤ（「モテット」より）
モーツァルト作曲
歌の翼に
メンデルスゾーン作曲
花の街
江間章子作詞／團伊玖磨作曲
メリー・ウィドー・ワルツ(オペレッタ「メリー・ウィドー」より)レハール作曲
ソプラノ：高橋昌子先生（岡山大学教育学部）
ピアノ：大石邦子先生（岡山県演奏家協会）
18:00
18:10
休憩
18:10
19:00
イブニングポスターディスカッション
19:00
閉会の辞
岡山大学歯学部
歯学部長
滝川正春教授
1． Investigation of primitive characteristics of human periodontal ligament cells
○Murakami K, Kawanabe N, Murata S, Yamashiro T
(Department of Orthodontics and Dentofacial Orthopedics, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences)
2． Possible correlation between the craniofacial morphology and the range of lower incisor
and condylar motions during maximal mouth open-close movement
○Kataoka T1, Hashimoto T1, Imai M1, Shiraga N1, Takano-Yamamoto T2, Yamashiro T1
(1 Department of Orthodontics and Dentofacial Orthopedics, Okayama University Graduate School of Medicine,
Dentistry, and Pharmaceutical Sciences, 2 Division of Orthodontics and Dentofacial Orthopedics, Tohoku
University Graduate School of Dentistry)
3． Regulation of cell-cell communication in osteocytes in living bone
○Ishihara Y1, Kamioka H1, Honjo T1, Ueda H1, Takano-Yamamoto T2, Yamashiro T1
Dentistry, and Pharmaceutical Sciences, 2 Division of Orthodontics and Dentofacial Orthopedics, Tohoku
4． Correlation between craniofacial and condylar path asymmetry in patients with facial
asymmetry
○Hashimoto T1, Kuroda S1, Lihua E1, Miyawaki S2, Tanimoto Y1, Takano-Yamamoto T3,
Yamashiro T1
Dentistry and Pharmacentical Sciences, 2 Department of Orthodontics, Field of Developmental Medicine, Health
Research Course, Kagoshima University Graduate School of Medical and Dental Sciences, 3 Division of
Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry)
5． Root proximity affects the success rate of mini-screw anchorage
○ Yamada K 1, Kuroda S1 , Deguchi T 1 , Hee-Moon Kyung2 , Takano-Yamamoto T 3 ,
Yamashiro T1
Dentistry and Pharmaceutical Sciences, 2 Kyungpook National University, Department of Orthodontics, 3
Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry)
6． The three-dimensional morphometry of osteocytes network in chick and mouse calvaria
○Ando R, Sugawara Y, Kamioka H, Yamashiro T
(Department of Orthodontics and Dentofacial Orthopedics, Okayama University Graduate School of Medicine,
7． Expression and role of hedgehog in bone fracture repair
○Okui T1, Shimo T1, Yuasa T2, Kurio N1, Isowa S1, Ibaragi S1, Pacifici M2, Iwamoto M2,
Sasaki A1
(1 Department of Oral and Maxillofacial Surgery, Biopathological Science, Okayama University Graduate School
of Medicine and Dentistry and Pharmaceutical Sciences, 2 Department of Orthopaedic Surgery, Thomas Jefferson
University)
8． The efficacy of a target controlled infusion (TCI) technique plus a bispectral index (BIS)
monitor in intravenous sedation for dental patients with intellectual disability
○Sakaguchi M1, Higuchi H2, Maeda S2, Masahiko Egusa3, Mori T3, Kita F3, Miyawaki T1,2
(1 Department of Disability and Oral Health Sciences and Dental Anesthesiology, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of Dental Anesthesiology, Okayama
University Hospital, 3 Department of Special Care Unit for Patients with Disabilities, Okayama University
Hospital)
9． Relationship between periodontal condition and plasma reactive oxygen metabolites in
patients in the maintenance phase of periodontal treatment
○Irie K, Tamaki N, Maruyama T, Tomofuji T, Ekuni D, Yamanaka R, Takeuchi N,
Yamamoto T
(Department of Oral Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences)
10． Evaluation of bone formation of the bone marrow transplantation in combination with
beta-tricalcium phosphate
○Shirasu N1, Ueno T1, Sakata Y1 , Hirata A2 , Kagawa T3 , Kanou M1 , Sawaki M1 ,
Yamachika E1, Peter K Moy4, Tara Aghaloo4, Sugahara T1
(1 Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of Oral Morphology, Okayama University
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 3 Juuzen Hospital, 4 Oral and
Maxillofacial Surgery, UCLA, School of Dentistry)
11． Histological and immunohistochemical evaluation of human alveolar bone augmentation
with beta-tricalcium phosphate (β-TCP)
○Sawaki M1, Ueno T1, Hirata A2, Shirasu N1, Honda K1, Wakimoto M1, Sugahara T1
(1 Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of Oral Morphology, Okayama University
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences)
12． Overexpression of Smad2 may affect gingival epithelial growth
○Tomikawa K1, Shiomi N1, Shimoe M1, Mineshiba J2, Arai H1, Takashiba S1
(1 Department of Pathophysiology – Periodontal Science, Okayama University Graduate School of Medicine,
Dentistry, and Pharmaceutical Sciences, 2 Department of Periodontics and Endodontics, Okayama University
Hospital)
13． Interaction of CCN2/CTGF with BMP-2 regulate the differentiation of human
chondrocytic and osteoblastic cell line
○Maeda A1, 2, Nishida T1, Aoyama E3, Kawaki H1, Kubota S1, Kuboki T2, Lyons KM4,
Takigawa M1
(1 Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, 2 Department of Oral and Maxillofacial Rehabilitation, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 3 Biodental Research Center,
Okayama University Dental School, 4 Department of Orthopaedic Surgery, University of California Los Angeles)
14． Generation and analysis of transgenic mice overexpressing ccn2/ctgf in chondrocytes
○Tomita N1,2, Hattori T2, Ito S1,2, Aoyama E1,3, Yao M1, Yamashiro T2, Takigawa M1
Dentistry and Pharmaceutical Sciences, 2 Department of Orthodontics and Dentofacial orthopedics, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 3 Biodental Research Center,
Okayama University Dental School)
15． Expression and biological significance of CCN2-associated microRNAs in chondrocytic
HCS-2/8 cells
○Ohgawara T1,2, Kubota S1, Kawaki H1, Kondo S1, Sasaki A2, Takigawa M1
Dentistry and Pharmaceutical Sciences, 2 Department of Oral and Maxillofacial Surgery and Biopathological
Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences)
16． Distribution and gene expressin of EphA4 during long bone development
○Kuroda C1,2, Kubota S1, Kawata K1,2, Minagi S2, Takigawa M1
Dentistry and Pharmaceutical Sciences, 2 Department of Biochemistry and Molecular Dentistry, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences)
17． Relationship between the Mini-Mental State Examination (MMSE) score and regional
cerebral blood flow
○Yoshida H1,2, Terada S2, Oshima E2, Ishihara T2, Ata T2, Ishizu H3, Sato S4, Kuroda S2
(1 Department of Neuropsychiatry, Okayama Ryogo Center, 2 Department of Neuropsychiatry, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 3 Department of Laboratory
Medicine, Zikei Institute of Psychiatry, 4 Department of Radiology, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical Sciences)
18． Overexpression of SOCS3 in T cells reduces T cell-mediated fulminant hepatitis
○Fushimi S, Takahata T, Wakabayashi H, Ogino T, Matsukawa A
(Department of Pathology and Experimental Medicine, Okayama University Graduate School of Medicine,
19． Evaluation about osteoconduction with Ca2+ ion auto-eluted gelatin-ceramics hybrid
materials
○Date H1, Abe N1, Tsuru K2, Furumatsu T1, Sakoma Y1, Yanai H3, Ozaki T1
(1Department of Orthopaedic Surgery, Okayama University Medical School, 2 Department of Bioscience and
Biotechnology, Okayama University School, 3 Department of pathology, Okayama University Medical School)
20． Immunological roles of DEC-205 in H. pylori infection
○Kita M1, Yokota K2, Ayada K3, Takenaka R1 , Kawahara Y1, Okada H1, Yamamoto H1,
Oguma K3
(1 Department of Medicine and Medical Science, Okayama University Graduate School of Medicine, Dentistry
and Pharmaceutical Science, 2 Graduate School of Health Science, Okayama University, 3 Department of
Bacteriology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science)
21． Effects of 2 electric toothbrushes on gingivitis in high school students
○Furuta M1, Yamanaka R1, Mizushima M2, Akhter R1, Yamamoto T1, Watanabe T3
(1 Department of Oral Health, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, 2 Okayama Prefectural Kurashiki Health Center, 3 Kurashiki Medical Center)
22． New method/equipment to detect the lymphatic vessels for lymphatico-venous
anastomosis using fluorescence imaging with Indocyanine green
○Morisada S1, Nakashima M2, Sugiyama N1, Hasegawa K1, Nanba Y1, Kimata Y1
(1 Plastic and Reconstructive Surgery of Okayama University Hospital, 2 Plastic Surgery of Okayama Saiseikai
Hospital)
23． Identification of Genes Involved in Tooth Development
○Uchibe K1,2, Yokoyama S1,3, Hashimoto M1, Shimizu H1, Kuboki T2, Asahara H1,4
(1 Department of Systems Biomedicine, National Research Institute for Child Health and Development, 2
Department of Oral and Maxillofacial Rehabilitation, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, 3 Graduate School of Human Sciences, Waseda University, 4
Department of Molecular and Experimental Medicine, The Scripps Research Institute)
24． Improvement of alveolar bone quality by local bFGF injection - histological and cellular
biological analysis in a rabbit model ○Oshima M, Sonoyama W, Ono M, Shimono K, Hikasa T, Okamoto Y, Tsuchimoto Y,
Matsuka Y, Kuboki T
(Department of Oral and Maxillofacial Rehabilitation, Okayama University Graduate School of Medicine,
25． Response shifts in an Oral Health-Related QoL measure in partially edentulous patients
with dental implants
○Kimura A, Arakawa H, Noda K, Matsuka Y, Kuboki T
26． A retrospective cohort study on survival of adjacent teeth of implant-supported fixed
partial dentures
○Yamazaki S, Arakawa H, Noda K, Matsuka Y, Kuboki T
27． A retrospective cohort study on dental implants survival; Is installation age a risk
factor?
○Noda K, Arakawa H, Kimura A, Yamazaki S, Matsuka Y, Kuboki T
(Department of Oral and Maxillofacial Rehabilitation, Okayama University Graduate School f Medicine,
抄録集
大学院 GP 採択記念講演
記念講演１
京都大学大学院医学研究科の臨床研究者養成（MCR）コース
と臨床研究教育
福原俊一
京都大学大学院医学研究科
医療疫学分野
教授
京都大学大学院医学研究科は，2000 年に基幹分野 11，協力分野 3，寄附講座 1 からなる
我が国最大の公衆衛生専門大学院である社会健康医学系専攻（School of Public Health，
以下 SPH）を設立した．京大に SPH が設置された理由は，複雑化した医療・医学と社会の
ニーズとの間を埋めるインターフェースとしての役割へのニーズがあるからに他ならない．
系統的な講義・実習を内容とするコースワークを年間で 40 以上提供している．従来の臨床
系大学院との連携も視野に入れ，臨床研究にとってもっとも重要な疫学，医療統計，医療
倫理，医療の質評価などの専門家を擁している(www.pbh.med.kyoto-u.ac.jp)．
さらに京大 SPH では，臨床医が臨床の現場に基盤を置きつつ臨床研究と関わるための特
別コースとして，「臨床研究者養成コース（Master of Clinical Research，以下 MCR）」を
2005 年度に学内措置として試験的に開始した．これは臨床経験のある医師・歯科医師に特
化した 1 年制の専門職学位課程（修士）で，実質 4 か月の集中授業・実習の履修で修了に
必要なほとんどの単位を取得できる．1 年間のプログラムで提供できる内容には限界があ
るが，臨床研究の基礎を系統的に学ぶことで，今後現場から研究を発信して医療の質やア
ウトカムの改善につなげようと志す臨床家にとっての第一歩となるよう，修了後に博士課
程院生・研究生として個別指導（メンタリング）を継続的に受けることを可能としている．
教育は，2000 年に設置された社会健康医学系専攻のうち 4
5 分野の教員が協力して担当
している．現在，さまざまなバックグランドを持つ若手・中堅の臨床家が集まり，熱意を
もって臨床研究の方法論を学んでいる．表に本コースのカリキュラムの概要を示す．しか
し，全国の臨床家の潜在的なニーズ，そして社会からの期待に比して，このコースの人的
資源は少なく，現状ではまだ小規模な段階に留まっている(www.mcrkyoto-u.jp)．
本講演では，「なぜ今臨床研究なのか」という原点に戻り，これを画に描いた餅に終わら
せず，具体的な形に可視化するための戦略を皆さんとともに考えたい．
（略歴）
1979年
北海道大学医学部医学科卒業
横須賀米海軍病院にてインタ‐ン
1980年
カリフオルニア大学サンフランシスコ校医学部内科レジデント
1983年
国立病院東京医療センター内科
1990年
ハーバード大学医学部臨床疫学部門及び医療政策部門
1991年
東京大学医学部講師
1992年
ハーバード大学公衆衛生大学院修士課程卒業
2000年
京都大学大学院医学研究科医療疫学分野教授
客員研究員
東京大学教授弊任（平成14年3月まで），客員教授（平成16年3月まで）
Master of Clinical Research Course
in Kyoto University Graduate School of Medicine
Shunichi Fukuhara
Epidemiology and Health Care Research, Kyoto University Graduate School of Medicine
Kyoto University Graduate School of Medicine established School of Public Health (SPH) in 2000
which is the biggest in Japan holding 11 core departments, 3 collaboration departments and 1
department financially maintained by donation. The mission of SPH is to work as interface between
medicine and social needs. SPH is providing more than 40 courses per year including systematic
lectures and practical classes. The school has expertise for epidemiology, medical statistics, medical
ethics and evaluation of quality of medicine.
Moreover, Kyoto University SPH started Master of Clinical Research Course (MCR) as a trial basis
for clinicians from 2005. MCR is one-year master's degree program where it is possible for the
students to earn credits within 4 months with attending intensive lectures and practical classes.
Although one year program has durational limitation, the MCR course is the first step for clinician
who will improve medical quality and treatment outcome. The students could also have the facility
to continue after graduation by enrolling as PhD students or research students. SPH faculties from
several departments are collaborating for the MCR courses. Currently, methodology of clinical
research is great interest for many young or middle aged clinicians who have different backgrounds.
Table shows the brief summary of the MCR program. However, human resources are limited in the
SPH and the MCR is not so large compared with nation-wide clinician needs and social
expectation.
I will present “Why do we need clinical study now?” and hope to consider with you on the next
strategy for mastering clinical study.
記念講演２
英国卒後医療教育における NICE 診療ガイドラインの役割
森臨太郎
大阪府立母子保健総合医療センター
新生児科
企画調査室長
英国のブレア政権によってはじめられた保健医療改革は卒後医療教育にも影響を及ぼし
ている．専門医制度が各学会同士により連携を取って全国統一になり (PMETB:
Postgraduate Medical Examination and Training Board)，インターン制度も変更してい
る．それに沿って，研修内容も統一水準を満たすように変更された．
コクラン・ライブラリーをはじめ，根拠に基づく医療の母国のひとつである英国では，
疫学の考え方は卒前・卒後医療教育にも浸透してきたが，それと同時にその限界や課題も
明らかになってきた．具体的には，根拠に基づく医療に関して表面的な理解にとどまり，
ランダム化比較試験，システマティック・レビュー，診療ガイドラインの結論をそのまま
自動的に一般診療に適用するような傾向が散見され，このような量的な科学的根拠には現
実の一般患者の視点が反映されていないこともあることなどが挙げられる．
NICE (National Institute for Health and Clinical Excellence) の診療ガイドライン
はブレア政権による保健医療改革の本幹として位置付けられ，根拠に基づく手法を基盤に
して，患者一般参画，医療経済分析，幅広い意見公募などにより患者や受益者の価値観を
包含する新しい発展手法として始められ，定着しつつある．ガイドライン作成メンバーも
公募によって集められ，患者一般代表も同じ権限を持って，客観的な基準をもとに選ばれ，
コクラン共同計画とも協力してしっかりとした量的な科学的根拠を集積しながら，その根
拠をしっかりとしたさまざまな方向から，受益者や社会にとっての価値の置き方という視
点から解釈し，平易な言葉で一般公開されている．
この NICE の診療ガイドラインは英国の卒前教育のみならず，専門医試験に使用されたり，
研修の一環に使用されたりしている．
このことにより，NICE の手法に対する理解も深まり，
一方では医療者―患者関係にも良い影響を及ぼしているのではないかとも考えられる．こ
の NICE の診療ガイドラインの方法論と，科学的根拠に基づく手法が浸透してきた時代にお
ける医療教育の在り方について考察する．
（略歴）
1995 年
岡山大学医学部卒業
1999 年
岡山大学大学院医学研究科博士課程卒業
2004 年
英国・ロンドン大学公衆衛生学・熱帯医学大学院疫学修士課程卒業
2007 年
英国・王立小児保健協会フェロー
現在
大阪府立母子保健総合医療センター
企画調査室長
京都大学大学院医学研究科社会健康医学専攻
非常勤講師
レスター大学医学部・医学社会福祉教育科
客員臨床フェロー
ロンドン大学公衆衛生学・熱帯医学大学院
疫学学外指導教官
NICE methodologies and postgraduate clinical training in the UK
Rintaro Mori
Osaka Medical Center and Research Institute for Maternal and Child Health
The series of the major reconfigurations of the national health system in the UK during the Blair
administration included postgraduate clinical training. Postgraduate training systems run by Royal
Colleges have rigorously been reviewed and standardized with a new organisation called PMETB
(Postgraduate Medical Examination and Training Board).
The Cochrane Collaboration was founded and evidence-based medicine has been actively
penetrated in both under- and post-graduate clinical training the UK, while limitations and issues in
this approach also became evident. These include that superficial understanding of evidence-based
medicine by trainees such as automatic clinical application of results from quantitative evidence
namely that from randomised controlled trials, systematic reviews and clinical practice guidelines
without reflecting patient/public perspectives.
Clinical Practice Guidelines developed by NICE (National Institute for Health and Clinical
Excellence), which employed an “upgraded” evidence based approach reflecting values of
patient/public with patient and public involvement, cost-effective analyses, and extensive
consultations, was a part of the major new health policies by the Blair administration. Guideline
development members are recruited in an objective manner with the same status given to
patient/public representatives, quantitative evidence is rigorously synthesised with a close
collaboration with the Cochrane Collaboration, and the guidelines are made available to all people
reflecting people’s value by using plain English.
These NICE guidelines have been used in both under- and post-graduate clinical training, such as in
postgraduate examinations and as a text in the training. While the methodologies applied by the
NICE guideline are understood by the trainees more, the patient-clinician relationship may be
positively changed. It will be discussed how postgraduate clinical training programme should be in
relation to the NICE methodology in this post-“evidence-based” era.
記念講演３
Why establish an orofacial pain treatment, research and training
center in an academic medical center? and What role does
virtual patient education have?
Glenn T. Clark, DDS, MS
Professor and Director Orofacial Pain and Oral Medicine Center
University of Southern California, School of Dentistry
This 45 minute presentation will address 10 specific questions (see below) and introduce a new educational
system for virtual-patient based, internet-delivered, student training. Dr. Clark’s expertise to address these
questions comes from the fact that he has recently created OFP residency program at the University of
Southern California, School of Dentistry. Moreover, he has been engaged in Virtual patient Education on and
off for 15 years. 1 The 10 questions to be addressed are: 1) Orofacial Pain is not a recognized specialty of the
American Dental Association so why create such an avant garde program? 2) What is the added value that an
OFP center has on students seeking their DDS degree? 3) What is the prevalence of various chronic orofacial
pain problems in the population? 4) Are the current dental specialists that are accredited by the ADA willing
and able to treat patients with chronic facial pain? 5) What is the economic and emotional impact of
persistent orofacial pain? 6) Above and beyond medication management of pain what are procedures that a
competent Orofacial Pain practitioner should be able to perform? 7) What is the average age of patients with
pain and dysfunction of the orofacial region? 8) What educational modalities should be used to train students
in the arena of orofacial pain? 9) What are the general curriculum guidelines that should be used in designing
a program in orofacial pain and where do they come from? 10) Finally, how do you integrate science into the
curriculum so that students appreciate and add to the body of knowledge needed to help patients and better
the underlying understanding of diseases that lead to chronic pain? Finally, this presentation will present and
demonstrate how a virtual patient internet-based education system recently created and deployed so that
students can test their skills against experts in the field of Orofacial Pain. The system to be described could
be used by any educator from any field of dentistry to create and track student performance. In conclusion, it
is hoped that the above 10 questions and the virtual patient education system presentation and the discussion
that ensues will be helpful to the attendees.
1
Clark GT, Koyano, K. and Nivichanov, A. Case-Based Learning for Orofacial Pain and Temporomandibular
Disorders. J. Dent. Educ. 57 : 815-820, 1993.
記念講演４
Establishing a special care dentistry fellowship: rationale,
start-up, roadblocks, achievements
Roseann Mulligan, DDS, MS
Professor and Associate Dean for Community Health Programs
University of Southern California, School of Dentistry
Special needs patients are defined by the existence of medical, mental, emotional or physical problems that
compromise the normal activities of living, including the patient’s ability to receive routine dental care.
Geriatric patients make up the single largest segment of special needs patients. The overall size of this
population continues to grow significantly as people are receiving better medical care, nutrition and social
services and therefore living longer.
Evidence based research is continuing to clarify the linkages between
systemic conditions and oral health and life quality.
David Satcher, Surgeon General, United States (2000)
said, “The mouth is a mirror of the body, it is a sentinel of disease, and it is critical to overall health and
well-being.”
The overwhelming extent of oral disease in these patients has been clearly demonstrated but
in the past, the demand for care had not kept pace due to competing priorities of living. New cohorts of
special needs patients are upping the ante and the demand for oral health care has increased.
Unfortunately, most dental schools burdened by a compacted technique-intensive curriculum offer limited if
any access to learning about and managing special needs patients.
This lecture, will discuss how we as dental educators can manage the challenge of educating future dental
practitioners in caring for these patients. Should we place a special needs educational track into another
existing program, define such learning as a unique discipline within dentistry, or offer unaccredited programs
focused in this area? We will cover the challenges and opportunities relative to each possible strategy in
addition to the importance of balancing a strong didactic curriculum, relevant research activity, and a robust
focus on patient care to ensure the financial viability of the program. Discussion will highlight the University
of Southern California’s response to this social and moral imperative to help even the most disadvantaged
achieve oral health.
抄録集
1
Investigation of primitive characteristics of human periodontal ligament cells
○Murakami K, Kawanabe N, Murata S, Yamashiro T
(Department of Orthodontics and Dentofacial Orthopedics, Okayama University Graduate School
of Medicine, Dentistry and Pharmaceutical Sciences)
It is well accepted that human periodontal ligament (PDL) comprises multipotent stem cells.
To
further delineate the primitive phenotypes of PDL cells, we investigated their morphology, cell
surface antigens’ expression, multilineage differentiation ability, and dye efflux activity. After
obtaining approval from the Ethical Committee, intact permanent teeth were collected from healthy
patients who were undergoing orthodontic treatment at Okayama University Hospital. The PDL
cells isolated from these teeth were cultured, then subjected to following analyses.
Primary human
PDL cells showed fibroblastic spindle shape and capillary network formation.
Flow cytometric
study demonstrated that PDL cells express mesenchymal stem cell markers, including CD29, CD44，
CD71, CD73, CD90, CD105, and CD166.
PDL cells had ability for adipogenic, osteogenic and
neuronal differentiation in lineage-specific culture conditions.
Hoechst dye efflux assay showed
that PDL cells include 3.9% SP cells. This SP profile disappeared more than 90% in the presence
of ABC transporter repressors, verapamil (50 µM) or reserpine (5 µM). Approximately 0.25% of
ABCG2-expressing cells were detected in PDL cells by flow cytometric analysis.
Furthermore,
RT-PCR demonstrated that ABCG2 mRNA expression remarkably correlated with PDL SP
phenotype. Thus, human PDL cells possess mesenchymal and SP phenotypes, indicating their
primitive characteristics as somatic stem cells.
2
Possible correlation between the craniofacial morphology and the range of lower incisor and
condylar motions during maximal mouth open-close movement
○Kataoka T1, Hashimoto T1, Imai M1, Shiraga N1, Takano-Yamamoto T2, Yamashiro T1
(1 Department of Orthodontics and Dentofacial Orthopedics, Okayama University Graduate School
of Medicine, Dentistry, and Pharmaceutical Sciences, 2 Division of Orthodontics and Dentofacial
Orthopedics, Tohoku University Graduate School of Dentistry)
Purpose: The purpose of this study was to evaluate possible association between the craniofacial
morphology and the range of lower incisor and condylar motions during maximal mouth open-close
movement. Materials and Methods: Thirty healthy female subjects aged between 18 and 25 years
were selected from outpatients who had visited the orthodontic clinic of Okayama University
hospital. The subjects included various craniofacial skeletal patterns without history of orthodontic
therapy and severe symptoms of temporomandibular joint dysfunction. The craniofacial
morphology was analyzed using cephalometric evaluation of lateral skull radiographs. Mandibular
movements
were
recorded
using
an
opto-electric
jaw
movement
recording
system
(Gnathohexagraph, JM-2000, GC, Japan) with six degrees of freedom. Then, we examined
correlations between the range of lower incisor and condylar motions during maximal mouth
open-close movement and the cephalometric variables related to craniofacial morphology. Results
and Discussion: The mean values of the range of lower incisor and condylar motions during
maximal mouth open-close movement were 44.5±5.7mm (range 35.4-56.8mm) and 13.3±2.5mm
(range 8.8-18.1mm), respectively. The range of lower incisal motion during maximal mouth
open-close movement was correlated to cephalometric variables, such as Rp-SN, ANB, SNB,
Gonial.A, Ar-Go and Ar-Me. However, the range of condylar motion during maximal mouth
open-close movement was not correlated to any cephalometric variables. Conclusion: The result of
this study suggest that the range of lower incisal motion during maximal mouth open-close
movement was correlated to the craniofacial morphology.
3
Regulation of cell-cell communication in osteocytes in living bone
○Ishihara Y1, Kamioka H1, Honjo T1, Ueda H1, Takano-Yamamoto T2, Yamashiro T1
of Medicine, Dentistry, and Pharmaceutical Sciences, 2 Division of Orthodontics and Dentofacial
Orthopedics, Tohoku University Graduate School of Dentistry)
Introduction: The intercellular network of communication among osteocytes is mediated by gap
junctions. Gap junctional intercellular communication (GJIC) is thought to play an important role in
integration and synchronization of bone remodeling. We hypothesized that extracellular pH (pHo)
and extracellular calcium ion concentration ([Ca2+]e), both of which are dynamically altered by
osteoclasts during bone remodeling, affect GJIC among osteocytes. Using Fluorescence
Replacement After Photobleaching (FRAP) analysis we examined the effect of changes in pHo,
[Ca2+]e, and addition of PTH on GJIC in osteocytes in chick calvaria. Additionally, we examined
the role of intracellular calcium on the regulation of GJIC among osteocytes. Methods:
Anti-Connexin43 (Cx43) immunolabelling was used to localize gap junctions in chick calvaria.
GJIC among osteocytes in chick calvariae was assessed using FRAP. Results: Cx43
immunoreactivity was detected in most of the osteocyte processes. FRAP analysis showed
dye-coupling among osteocytes in chick calvariae. In untreated osteocytes, fluorescence intensity
recovered 43.7
2.2 % within 5 min after photobleaching. Pretreatment of osteocytes with 18 α
-GA, a reversible inhibitor of GJIC, significantly decreased fluorescence recovery to 10.7
2.2 %.
When pHo was decreased from 7.4 to 6.9, fluorescence recovery significantly decreased from 43.3
2.9 % to 19.7
2.3 %. Conversely, when pHo was increased from 7.4 to 8.0, fluorescence
recovery was significantly increased to 61.9
4.5 %. When [Ca2+]e was increased from 1 mM to 25
mM, fluorescence recovery was significantly decreased from 47.0 6.1 % to 16.1
2.1 %. In bone
fragments exposed to 1.0-10 nM rPTH for 3 h, replacement of fluorescence was significantly
increased to 60.7
7.2 %. Chelating intracellular calcium ions affected GJIC regulation by [Ca2+]e
and PTH. Conclusion: Our study of cell-cell communication between osteocytes in chick calvaria
showed for the first time that GJIC among osteocytes is regulated by the extracellular environment
and by hormonal stimulation during bone remodeling. This method may be more biologically
relevant to living bone than current methods.
4
Correlation between craniofacial and condylar path asymmetry in patients with facial
asymmetry
○Hashimoto T1, Kuroda S1, Lihua E1, Miyawaki S2, Tanimoto Y1, Takano-Yamamoto T3,
Yamashiro T1
of Medicine, Dentistry and Pharmacentical Sciences, 2 Department of Orthodontics, Field of
Developmental Medicine, Health Research Course, Kagoshima University Graduate School of
Medical and Dental Sciences, 3 Division of Orthodontics and Dentofacial Orthopedics, Tohoku
Purpose: The purpose of this study was to examine the correlation between condylar path length
and craniofacial morphology in patients with mandibular prognathism and deviation, and to
examine the change of condylar path length and temporomandibular joint disorders (TMD) after
intraoral vertical ramus osteotomy (IVRO). Patients and Methods: Sixteen Japanese patients with
mandibular prognathism and deviation were studied. For the correction of mandibular prognathism
and deviation, all patients underwent IVRO. In the case of patients with severe occlusal cant, after
the correction of occlusal cant by Le Fort I osteotomy, IVRO was performed. The change in
craniofacial morphology was assessed with frontal cephalograms and submentovertex radiograms.
The change in condylar path was assessed by using a six degrees-of-freedom measuring device. All
patients were examined temporomandibular joint (TMJ) function. Results: Before treatment,
mandibular deviation was strongly related to the asymmetries of craniofacial morphology and
condylar path length. The rate of incidence of TMJ sounds on the deviated side was significantly
higher than that on the non-deviated side. After treatment, though condylar path length as well as
condylar position was changed bilaterally symmetrical, there was still a significant difference
during protrusive excursion and maximum open-close movement. TMJ sounds had disappeared in
64.3 % of patients. Conclusion: Mandibular deviation was found to be strongly related to the
morphological and functional asymmetries in patients with mandibular prognathism and deviation.
Condylar path length as well as condylar position was improved after the correction of mandibular
deviation with IVRO.
5
Root proximity affects the success rate of mini-screw anchorage
○Yamada K1, Kuroda S1, Deguchi T1, Hee-Moon Kyung2, Takano-Yamamoto T3, Yamashiro T1
of Medicine, Dentistry and Pharmaceutical Sciences, 2 Kyungpook National University,
Department of Orthodontics, 3 Division of Orthodontics and Dentofacial Orthopedics, Tohoku
Introduction: This study evaluated the risk factor of miniscrew failure as orthodontic anchorage.
Thus, we examined the success rates and analyzed the root proximity of the miniscrews. Methods:
Using dental radiographs and three-dimensional CT images, 216 titanium screws in 110 patients
were retrospectively examined. Radiographs were classified into three categories depending on the
distance between the screw and root, Category I; the screws were absolutely separate from the root,
Category II; the apex of the screw appeared to touch the lamina dura, Category III; the body of the
screws was overlaid on the lamina dura. If the orthodontic force could be applied to the screws for 1
year (or until completion of the orthodontic treatment), we recorded the screw anchorage as a
success. Results: The screws showed a high success rate above 80%. The screws placed in the
maxilla had significantly higher success rate than that in the mandible. There was significant
correlation between the success rate and the root proximity of screws. There was significant
difference in the success rate between category I and II or III, or between category II and III.
Although screws in all three categories in the maxilla and in categories I and II in the mandible
showed a high success rate above 75%, screws in category III in the mandible had a low success
rate of 35%. Conclusions: The proximity of miniscrews to the root is a major risk factor for the
failure of screw anchorage. This tendency is more obvious in the mandible.
6
The three-dimensional morphometry of osteocytes network in chick and mouse calvaria
○Ando R, Sugawara Y, Kamioka H, Yamashiro T
(Department of Orthodontics and Dentofacial Orthopedics, Okayama University Graduate School
of Medicine, Dentistry and Pharmaceutical Sciences)
Introduction: Osteocytes are the most numerous cells in bone. Their slender cytoplasmic processes
form a complex intercellular network in bone matrix. It is thought that these processes play an
important roll for functions such as the response to mechanical stress. In the previous study,
osteocyte network morphology is related to age, bone property, and animal species. However, it has
not been reported to compare the three-dimensional (3D) osteocyte network morphology including
processes in different species. In the present study, we observed 3D distribution and morphology of
osteocyte network in embryonic chick and mouse parietal bone, and compared species difference.
Materials and methods: Calvariae were obtained from 16-day-old embryonic chick and
17-day-old embryonic mouse. They were fixed with 3% paraformaldehyde in phosphate-buffer
saline, and then stained with fluorescently labeled phalloidin and observed using a confocal laser
scanning microscope. Morphometric analysis of osteocyte network was performed with IMARIS,
NEURON TRACER and SURPASS software. Result: The distance between osteocytes, volume of
bone compartment occupied by single osteocyte, total length of the processes of single osteocyte,
surface area of single osteocyte, and cell volume of single osteocyte in mouse were significantly
larger than those in chick. The osteocyte density in mouse was significantly less than that in chick.
However, the average number of processes radiating from single osteocyte, the length of osteocyte
processes per 1µm3 bone compartment, and the surface area of osteocytes per 1µm3 bone
compartment were not significantly different between chick and mouse. Discussion: It is revealed
that 3D morphology of osteocyte network between embryonic chick and mouse parietal bone was
different.
7
Expression and role of hedgehog in bone fracture repair
○Okui T1, Shimo T1, Yuasa T2, Kurio N1, Isowa S1, Ibaragi S1, Pacifici M2, Iwamoto M2,
Sasaki A1
(1 Department of Oral and Maxillofacial Surgery, Biopathological Science, Okayama University
Graduate School of Medicine and Dentistry and Pharmaceutical Sciences, 2 Department of
Orthopaedic Surgery, Thomas Jefferson University)
Hedgehog proteins play fundamental roles in the regulation of behavior, proliferation and
differentiation of skeletal cells during embryonic development. Previously we reported that
hedgehogs are transiently expressed during bone fracture repair suggesting that these proteins
regulate skeletal cell function during that process. Since bone marrow cells directly and indirectly
regulate aspects of bone formation, it has remained unclear whether the primary targets of hedgehog
proteins in bone fracture repair are skeletal cells, marrow cells or both.
To address this issue in the
present study, we first analyzed gene expression of Sonic hedgehog (Shh), Indian hedgehog (Ihh),
hedgehog receptor Patched (Ptch) and hedgehog effector Gli1 in a mouse rib bone fracture model.
In situ hybridization revealed that Shh transcripts were broadly detected at fracture sites as early as
6 h from fracture.
To ascertain the nature of cells responding to hedgehog signaling we carried out
a fracture experiment in hedgehog reporter mice (Ptch-LacZ) that harbor b-galactosidase linked to
the promoter regions of Ptch, a direct target gene of hedgehog.
Positive and strong b-galactosidase
signal was broadly found in bone marrow at fracture site within 24 h.
Interestingly we observed
intense reporter signal in many multinucleated and TRAP-positive cells, suggesting that hedgehog
signaling is activated in osteoclasts during bone fracture.
To test whether such signaling has roles
in osteoclasts, we isolated bone marrow cells and CD11b(+) cells from 5 week-old mice and
cultured them in the presence or absence of RANKL.
Exogenous Shh did not induce osteoclast
formation by itself compared to untreated cultures, but it strongly enhanced RANKL-induced
osteoclast formation as determined by TRAP staining and dentin pit formation.
Together, our data
provide strong evidence that hedgehog signaling is activated during bone fracture repair and could
participate in bone formation and remodeling by regulating osteoclast formation as well as
osteoblast differentiation.
8
The efficacy of a target controlled infusion (TCI) technique plus a bispectral index (BIS)
monitor in intravenous sedation for dental patients with intellectual disability
○Sakaguchi M1, Higuchi H2, Maeda S2, Masahiko Egusa3, Mori T3, Kita F3, Miyawaki T1,2
(1 Department of Disability and Oral Health Sciences and Dental Anesthesiology, Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of
Dental Anesthesiology, Okayama University Hospital, 3 Department of Special Care Unit for
Patients with Disabilities, Okayama University Hospital)
Background: A continuous infusion of propofol is very effective in an intravenous sedation for
dental patients with intellectual disability (ID). However, it is difficult to titrate the dose of propofol
for maintaining the proper level of consciousness, and the infusion of excessive dose elicits
perioperative complications and delay of recovery time. Recently, a bispectral index (BIS) monitor,
which is a neurophysiological monitoring device, and a target controlled infusion (TCI) technique
using a computer controlled syringe pump have been developed in a general anesthesia to titrate the
dose of propofol adequately. In this study, we assessed the efficacy of a TCI technique plus a BIS
monitor in the intravenous sedation for dental patients with ID. Methods: After institutional
approval and informed consent, we studied 12 dental patients with ID, randomly divided into two
groups: manually controlled infusion (MCI) group and BIS-TCI group. The patients of MCI group
received the continuous infusion of propofol titrated manually in the usual way. The patients of
BIS-TCI group received the TCI of propofol plus a BIS monitor. Differences in the efficacy
between the MCI group and the BIS-TCI group were analyzed. Results and Conclusion: In the
BIS-TCI group, the average infusion rate of propofol was significantly lower than that in the MCI
group. The infusion dose of propofol could be easily titrated in the BIS-TCI group. The results
suggest that a TCI technique plus a BIS monitor is more effective method in the intravenous
sedation for dental patients with ID than the usual method.
9
Relationship between periodontal condition and plasma reactive oxygen metabolites in
patients in the maintenance phase of periodontal treatment
○Irie K, Tamaki N, Maruyama T, Tomofuji T, Ekuni D, Yamanaka R, Takeuchi N, Yamamoto T
(Department of Oral Health, Okayama University Graduate School of Medicine, Dentistry and
Pharmaceutical Sciences)
Background: Relationship between systemic anti-oxidative status and periodontal conditions has
been investigated in epidemiological studies.
However, little literature is available with regard to
the correlation between systemic reactive oxygen species and periodontal condition. The purpose
of this cross-sectional study was to investigate the relationship between plasma reactive oxygen
metabolites and periodontal condition in patients in the maintenance phase of periodontal treatment.
Methods: Seventy-seven subjects (mean age: 59.6 years), who had entered a periodontal
maintenance program, were examined for probing pocket depth and clinical attachment level as
periodontal parameters.
Plasma levels of reactive oxygen metabolites and biological antioxidant
potential were determined with a free radical electric evaluator. The relationship between plasma
and periodontal parameters were analyzed. Results: Plasma level of reactive oxygen metabolites
was positively correlated with probing pocket depth (p < 0.05) and clinical attachment level (p <
0.01). When subjects were divided into two groups according to the level of reactive oxygen
metabolites, subjects with reactive oxygen metabolites > 400 CARR U had significantly higher
probing pocket depth (p < 0.05) and clinical attachment level (p < 0.01), compared to the subjects
with reactive oxygen metabolites ≤ 400 CARR U.
On the other hand, plasma level of biological
antioxidant potential was not significantly correlated with the periodontal parameters. Conclusions:
These findings show a positive association between plasma oxidative status and periodontal
conditions. Therapeutic approach to systemic oxidative stress might be useful to improve
periodontal health in patients in the maintenance phase of periodontal treatment.
10
Evaluation of bone formation of the bone marrow transplantation in combination with
beta-tricalcium phosphate
○Shirasu N1, Ueno T1, Sakata Y1, Hirata A2, Kagawa T3, Kanou M1, Sawaki M1, Yamachika E1,
Peter K Moy4, Tara Aghaloo4, Sugahara T1
(1 Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of Oral Morphology,
Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 3
Juuzen Hospital, 4 Oral and Maxillofacial Surgery, UCLA, School of Dentistry)
Objectives: A bone marrow graft could be expected to be suitable material for bone and cartilage
repair. Bone marrow is known to be a rich source of osteogenic, chondrogenic, and angiogenic cells.
In the present study, we investigated the osteogenic potential of bone marrow combined with a
beta-tricalcium phosphate (beta-TCP) graft in the rat calvarial defect model. Materials and
Methods: Sprague-Dawley rats were randomly divided into the following 4 treatment groups:
beta-TCP/ bone marrow graft (TBG): beta-TCP only graft (TG): bone marrow graft (BG): control.
Specimens were taken at 5, 7, and 30 days after grafting. Sections were examined under light
microscopy. Results: At 5 days after grafting, new bone formation around beta-TCP granules were
seen in the group of TBG. At 7 days after grafting, new bone formation developed in the defect of
the group of TBG. New bone in the defect of BG group was seen. At 30 days after grafting, in the
group of TBG, new bone formation developed in the defect and covered the defect totally. They
showed bone marrow like structure in the defect. In the group of BG, new bone with bone marrow
structure appeared in the defect. The defect was not filled with new bone. In the group of TG and
the control group, no new bone formation in the defect was seen. Discussion and Conclusion: The
grafted bone marrow showed bone formation in the rat calvarial defect. The combination of
beta-TCP showed significant increase of newly formed bone.
11
Histological and immunohistochemical evaluation of human alveolar bone augmentation with
beta-tricalcium phosphate (β-TCP)
○Sawaki M1, Ueno T1, Hirata A2, Shirasu N1, Honda K1, Wakimoto M1, Sugahara T1
(1 Department of Oral and Maxillofacial Reconstructive Surgery, Okayama University Graduate
School of Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of Oral Morphology,
Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences)
Application of dental implants is difficult in patients with large bone defects and insufficient bone
volume. In these cases, bone augmentation is required in order to obtain correct placement or
sufficient retention of the implant. Many studies show that beta-tricalcium phosphate (β-TCP) is a
suitable bone-graft substitute for clinical use. However, histological studies of grafted β-TCP in
human alveolar bone samples are limited. In the present study, we evaluated the efficacy of β
-TCP grafted in human alveolar bone histologically and immunohistochemically.
We analyzed four cases (three cases of sinus lifting, one case of veneer grafting). Bone
augmentation was performed withβ-TCP
(OSferion® ,Olympus, Tokyo Japan), autogeneous
bone and platelet-rich plasma (PRP) under local anesthesia. Four or six months later, biopsies were
taken at the time of implant placement and processed for hard tissue histology. These samples were
analyzed by hematoxylin and eosin (HE) staining, tartrate-resistant acid phosphatase (TRAP)
staining, and immunohistochemically.
Histologically, new bone formation onβ-TCP and resorption ofβ-TCP were observed. Runx2
positive and OPN positive cells were attached toβ-TCP particles. TRAP positive multinucleated
giant cells adhered toβ-TCP.
These findings revealed that resorption ofβ-TCP and new bone formation in human alveolar bone
occur in a manner identical to that of previous animal experiments. The current investigation also
suggests thatβ-TCP grafted in human alveolar bone is resorbed and replaced by newly formed
bone. Runx2 positive, OPN positive and TRAP positive cells may play important roles in this
process.
12
Overexpression of Smad2 may affect gingival epithelial growth
○Tomikawa K1, Shiomi N1, Shimoe M1, Mineshiba J2, Arai H1, Takashiba S1
(1 Department of Pathophysiology – Periodontal Science, Okayama University Graduate School of
Medicine, Dentistry, and Pharmaceutical Sciences, 2 Department of Periodontics and Endodontics,
Okayama University Hospital)
Currently, GTR membrane, Pletelet Rich Plasma (PRP) are clinically applied to the periodontal
regenerative surgery and growth factors such as BMP-2 and FGF are also applied at the basic
research level. However, the ratio of successful periodontal regeneration is not always so high
because it’s very difficult to avoid the down-growth of junctional epithelium onto dental root
surfaces in the regeneration process. Recently, members of transforming growth factor-β (TGF- β)
superfamily are known as crucial regulators for epithelial growth. Transduction of TGF- β signaling
depends on the phosphorylation and activation of Smad proteins. Previous study showed that
Smad2 overexpression mice under the control of keratin 14 promoter (K14-Smad2 mice) were
generated, and K14-driven Smad2 was specifically and highly expressed in epidermis. Another
previous study showed that these mice have delayed skin healing. Therefore, to increase the ratio of
successful periodontal regeneration, it is important to regulate this gene in epidermis during healing
or regeneration process. We hypothesized that overexpression of Smad2 in epidermis might avoid
the down-growth of junctional epithelium in the periodontal regeneration process. However, our
project has just begun, so we would like to introduce our aim and experimental design. Objective:
To examine whether K14-Smad2 mice have delayed gingival epithelial growth after the tooth
extraction. Methods: 10 week-old mice were used. K14-Smad2 mice were genotyped by PCR as
previously described (Ito et al, 2001). Next, we are going to extract maxillary second molars with a
dental explorer in both wild type (WT) and K14-Smad2 mice (TG). Gingival epithelial growth will
be compared between WT and TG after extraction. Results: We hope the results will be presented
in the meeting.
13
Interaction of CCN2/CTGF with BMP-2 regulate the differentiation of human chondrocytic
and osteoblastic cell line
○Maeda A1, 2, Nishida T1, Aoyama E3, Kawaki H1 , Kubota S1, Kuboki T2, Lyons KM4 ,
Takigawa M1
(1 Department of Biochemistry and Molecular Dentistry, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of Oral and Maxillofacial
Rehabilitation, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, 3 Biodental Research Center, Okayama University Dental School, 4 Department of
Orthopaedic Surgery, University of California Los Angeles)
Objective: CCN family2/connective tissue growth factor (CCN2/CTGF: CCN2) and bone
morphogenetic protein (BMP)-2 promote the differentiation of chondrocytes and osteoblasts.
Although these factors have similar function, effect of CCN2-BMP-2 complex on the differentiation
of these cells is unclear. We demonstrate here the effect of interaction of CCN2 with BMP-2 on the
differentiation of human chondrocytic and osteoblastic cell line, HCS-2/8 and SaOS-2. Methods:
We tested interaction of CCN2 with BMP-2 by immunoprecipitation-Western blot analysis and
binding assay. We also performed real-time PCR analysis in HCS-2/8 cells and measured alkaline
phosphatase
(ALP)
activity
in
SaOS-2
stimulated
by
CCN2-BMP-2
complex.
Immunohistochemistry was performed to detect localization of CCN2 and BMP-2 in growth plate
of Ccn2 deficient mouse. Results: CCN2 was detected in HCS-2/8 or SaOS-2 cell lysate
immunoprecipitated by anti-BMP-2. CCN2 or BMP-2 stimulated expression of type II collagen and
aggrecan in HCS-2/8, and ALP activity in SaOS-2 cells but CCN2-BMP-2 complex did not
stimulate. Furthermore, in wild type growth plate, CCN2 co-localized with BMP-2 at the
pre-hypertrophic region, whereas BMP-2 localized at the proliferative region in Ccn2 deficient.
Conclusion: These findings suggest that CCN2 interacts with BMP-2, and that CCN2-BMP-2
complex modifies the differentiation of chondrocytes and osteoblasts stimulated by CCN2 and
BMP-2, respectively. Difference in localization of BMP-2 between wild type and Ccn2 deficient
growth plate may suggest CCN2 regulates the localization of BMP-2 in growth plate.
14
Generation and analysis of transgenic mice overexpressing ccn2/ctgf in chondrocytes
○Tomita N1,2, Hattori T2, Ito S1,2, Aoyama E1,3, Yao M1, Yamashiro T2, Takigawa M1
Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of Orthodontics and Dentofacial
orthopedics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, 3 Biodental Research Center, Okayama University Dental School)
Objective: CCN2/CTGF is highly expressed in prehypertrophic chondrocytes, and in vitro studies
of chondrocytes and analysis of ccn2-deficient mice show that it promotes proliferation,
differentiation, and maturaration of growth plate chondrocytes. However, there is no direct evidence
showing that CCN2 promotes cartilage development and growth. For understanding the functions of
CCN2 in vivo, we generated transgenic mice (tg) overexpressing the ccn2 gene in cartilage under
the control of the type Ⅱ collagen (Col2a1) promoter. Methods: HA-tagged ccn2/ctgf cDNA was
inserted to downstream of 6 kb-Col2a1-enhancer/promoter followed by IRES-LacZ and the fusion
reporter gene was injected into mouse ooytes. LacZ staining was performed to detect the location of
the overexpressed gene, and the level of the overexpression of ccn2 mRNA in cartilage and protein
was analyzed. Changes in morphology and CCN2 distribution in tg mice was investigated by
immunohistochemistry. To analyze changes in gene expression, chondrocytes were isolated and
cultured before RNA extraction. Results: X-gal staining of new born mice showed transgene
expression in all cartilage. Overexpressed ccn2 mRNA and CCN2 protein were detected in tg
cartilage. The length of tibia was prolonged depending on the overexpression level of ccn2 mRNA.
Cell proliferation was accelerated in the resting zone in addition to the growth plate. TUNEL assay
shows accelerated apoptosis in cartilage-bone transition. Bone density of cancellous bone and
thickness of cortical bone were increased in tg mice by peripheral quantitative computed
tomography (pQCT) analysis. Cultured chondrocytes isolated from tg mice showed enhanced
expression of col2a1, col10a1 and aggrecan mRNA and accumulation of proteoglycans.
Furthermore, expression of vascular invasion factors such as vegf and mmp9 mRNA was also
enhanced. Conclusion: Overexpression of CCN2 in cartilage promotes growth of cartilage during
endochondral ossification, resulting in prolonged long bones.
15
Expression and biological significance of CCN2-associated microRNAs in chondrocytic
HCS-2/8 cells
○Ohgawara T1,2, Kubota S1, Kawaki H1, Kondo S1, Sasaki A2, Takigawa M1
Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of Oral and Maxillofacial Surgery
and Biopathological Sciences, Okayama University Graduate School of Medicine, Dentistry and
Pharmaceutical Sciences)
CCN2/connective tissue growth factor (CTGF) is one of the classic members of the CCN family.
CCN2 plays an important role in endochondral bone formation, and the gene expression is under
the strict control at both transcriptional and post-transcriptional stages for normal growth of long
bones. We have characterized the post-transcriptional control mechanism through the
3’-untranslated region (3’-UTR) of CCN2 gene until present, but have mainly analyzed the control
mechanism by the proteins, which specifically recognize the RNA elements. In this study, the
control mechanism by noncoding RNA (ncRNA) through 3’-UTR of the CCN2 gene was
investigated.
MicroRNAs (miRNA) are a major class of ncRNA, and are short RNA molecules regulating the
expression of specific mRNAs. In our in silico analysis, we predicted miRNA18a (miR-18a) which
leads CCN2 mRNA to translation interference, and examined whether it would control CCN2 gene
expression in chondrocytes, in which CCN2 plays a major role in their differentiation. We first
analyzed small molecule RNA extracted from HCS-2/8 cells, which is known to retain a
chondrocytic phenotype with a high level expression of CCN2, and checked the expression of
miR-18a therein. Interestingly, the expression of miR-18a in HCS-2/8 cells was lower than the
other cells expressing CCN2. This finding suggests a possibility that miR-18a is one of the factors
to control CCN2 production to enable the high CCN2expression in chondrocytes. By transfecting
mature miR-18a with reporter constructs to HCS-2/8 and other cells, we succeeded in obtaining the
result that supports the findings predicted in silico and also suggest a complexity of
miRNA-mediated regulation of CCN2 in chondrocytes.
16
Distribution and gene expressin of EphA4 during long bone development
○Kuroda C1,2, Kubota S1, Kawata K1,2, Minagi S2, Takigawa M1
Medicine, Dentistry and Pharmaceutical Sciences, 2 Department of Biochemistry and Molecular
Dentistry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences)
0bjective: The long bone develops from the cartilage anlage and grows through the endochondral
ossification to form a skeleton, while the marrow develops as the hematopoietic organ.
In this process, mesenchymal and hematopoietic cells exchange information through various
cytokines and growth factors via those receptors. In our previous study, we detected EphA4, which
was the one of the tyrosine kinase type receptors. in a human chondrocytic cell line, HCS-2/8.
Here, we have obtained new findings concerning the gene expression and distribution of EphA4 in
the long bone tissue. Methods: Immunohistochemical analysis was performed with a developing
mouse long bone sections. Also, we comparatively examined ephA4 mRNA levels among cell lines
and the chondrocytes at various differentiation stages by PCR methods. Furthermore, we evaluated
subcellular localization of EphA4 in osteoblastic cells (SaOS-2) by immunofluorescence. Results:
EphA4 was detected in the hypertrophic chondrocyte layer and the ossification region, but it was
hardly detected in the proliferating chondrocytes. We also obtained a result that agreed with the
data above, using an in vitro differentiation system of mouse growth cartilage cells. In addition, the
expression of ephA4 mRNA was higher in osteoblastic (SaOS-2) cells than in HCS-2/8 and HeLa
cells. Localization of EphA4 in SaOS-2 was strongly observed in cytoplasm, as well as the cell
surface. Discussion: These results suggest that EphA4 is critically involved in skeletal formation or
bone metabolism, because of its dictinct localization in the hypertrophic layer and ossification
region in growth plate and strong ephA4 expression in SaOS-2 cells. The role of EphA4 in
endochondral ossification is not clear yet, but investigation is currently underway mainly through
the analysis of the interaction with its typical ligands, ehprins.
17
Relationship between the Mini-Mental State Examination (MMSE) score and regional
cerebral blood flow
○Yoshida H1,2, Terada S2, Oshima E2, Ishihara T2, Ata T2, Ishizu H3, Sato S4, Kuroda S2
(1 Department of Neuropsychiatry, Okayama Ryogo Center, 2 Department of Neuropsychiatry,
Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 3
Department of Laboratory Medicine, Zikei Institute of Psychiatry, 4 Department of Radiology,
Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences)
The Mini-Mental State Examination (MMSE) is frequently used to assess the cognitive function of
patients with neurological diseases. The purpose of this study is to investigate associations between
regional cerebral blood flow (rCBF) and MMSE score in demented patients.
We studied sixty-five outpatients (thirty-two patients with Alzheimer disease (AD), nine patients
with frontotemporal dementia (FTD), seven patients with vascular dementia (VaD), five patients
with dementia with Lewy bodies (DLB), three patients with other diseases and nine normal
elderlies) retrospectively.
99m
Tc-ECD SPECT was performed, and the images were analyzed
objectively using 3DSRT, fully automated rCBF quantification software. Segmental CBF (sCBF,
area-weighted mean rCBF value for each of the 24 segments) and sCBF ratio (each sCBF divided
by the cerebellum sCBF) were calculated.
The MMSE scores showed significant correlation with age (r=-0.337, P<0.01), years of education
(r=0.269, P<0.05) and sCBF ratio as followings: bilateral parietal (right; r=0.454, P<0.01, left;
r=0.523, P<0.01), bilateral angular (right; r=0.449, P<0.01, left; r=0.506, P<0.01), left temporal
(r=0.523, P<0.01), left posterior cerebral (r=0.410, P<0.01), bilateral pericallosal (right; r=0.470,
P<0.01, left; r=0.480, P<0.01), bilateral hippocampus (right; r=0.544, P<0.01, left; r=0.506,
P<0.01). Additionally, stepwise multiple regression analysis revealed that right hippocampus sCBF
ratio (β=0.373, P<0.01) and left parietal sCBF ratio (β=0.328, P<0.01) had significant contribution
(adjusted R2=0.354, P<0.01) to the variance of the MMSE scores.
In conclusion, a decrease of rCBF in right hippocampus and left parietal lobe correlated with the
MMSE total score.
18
Overexpression of SOCS3 in T cells reduces T cell-mediated fulminant hepatitis
○Fushimi S, Takahata T, Wakabayashi H, Ogino T, Matsukawa A
(Department of Pathology and Experimental Medicine, Okayama University Graduate School of
T cells have been implicated in the progression of virus-associated hepatitis and autoimmune
hepatitis in which cytokines play a crucial role. Cytokines exert their biological functions through
janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway and activation of
STAT1 and STAT3 is shown to be important in T cell-mediated liver injury model induced by
ConcanavalinA (ConA). SOCS proteins are feedback inhibitors of cytokine receptor signaling by
inhibiting the JAK-STAT signal transduction pathway, but their role in T-cell mediated fulminant
hepatitis are not fully elucidated. In the present study, we attempted to explore the role of SOCS3 in
ConA-induced hepatitis model. Mice with a cell-specific overexpression of SOCS3 in T cells
(SOCS3Tg) and wild-type (WT) control mice were treated with intravenous injection of ConA (15
mg/kg). ConA-induced hepatitis was significantly alleviated in SOCS3Tg mice relative to the WT
mice, as evidenced by decreased serum ALT level and reduced hepatic necrosis/damaged area in
the liver sections. Serum levels of cytokines were next investigated, which demonstrated that Th-1
cytokines that include IL-12, IFNg and CXCL9/MIG were significantly reduced in SOCS3Tg mice
as compared to the WT mice. Expression of T-bet, a Th1-associated transcription factor, was
decreased in SOCS3Tg-liver although there was no difference in the hepatic level of GATA-3
expression, a Th2-associated transcription factor. These results suggest that forced expression of
SOCS3 in T cells is protective in ConA-hepatotoxicity by altering cytokine balance, in favor of Th2
response.
19
Evaluation about osteoconduction with Ca2+ ion auto-eluted gelatin-ceramics hybrid materials
○Date H1, Abe N1, Tsuru K2, Furumatsu T1, Sakoma Y1, Yanai H3, Ozaki T1
(1Department of Orthopaedic Surgery, Okayama University Medical School, 2 Department of
Bioscience and Biotechnology, Okayama University School, 3 Department of pathology, Okayama
University Medical School)
Tsuru K. developed the natural polymer-siloxane hybrid biomaterial with high osteoconductivity
and cellular affinity with the sol-gel method and succeeded in the apatite formation in vitro. This
material is sponge-like and can be formed to any shapes such as sheet, pellet, column, and beads by
changing a mixing contents and pored rate. This was developed to cure the bony defect, cause to
non-union, infection or tumor, and accelerated healing at tendon to bone interface. We examined
whether a new hybrid material which automatically released Ca2+ ion could promote ossification in
vivo.
Materials were transplanted into the muscle of the hind limb of the nude mouse at the six weeks
aged. Evaluation was perfomed by using a histological examination, a X-ray analysis at the time of
0, 1, 2, 4, 6 and 8 weeks after operation. The calcification density had been increased with Ca2+ ion
concentration dependently. In addition, the formation of the hydroxyapatite was similarly detected
on the surface of the implant by X-ray diffraction.
The hydroxyapatite formation in the dependency of the concentration of the Ca2+ ion in vivo
means the newly developed scaffold had highly osteoconductive potential.
20
Immunological roles of DEC-205 in H. pylori infection
○Kita M1, Yokota K2, Ayada K3, Takenaka R1, Kawahara Y1, Okada H1, Yamamoto H1,
Oguma K3
(1 Department of Medicine and Medical Science, Okayama University Graduate School of
Medicine, Dentistry and Pharmaceutical Science, 2 Graduate School of Health Science, Okayama
University, 3 Department of Bacteriology, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Science)
DEC-205 functioned on dendritic cells as an antigen uptake receptor targeting its cargo to
intracellular compartments where it is processed for presentation to T cells. We reported that DNA
microarray study indicated that mRNA expression of lymphocyte antigen 75 (DEC-205) in patients
with gastritis was markedly increased in circulating lymphocytes stimulated by HSP60.
In the present study, we focused role of DEC-205 in Helicobacter pylori infection. Monocytic cell
lines (NOMO-1) were stimulated with H. pylori antigens, and the expression of DEC-205 was
investigated. The cell line was differentiated to macrophage by PMA before bacterial stimulations.
Expression of surface DEC205 was analyzed by FACS. Protein and mRNA expression of DEC-205
were detected by Western blotting and RT-PCR, respectively. Expression of DEC-205 on CD14
positive macrophage in human gastric mucosa was also investigated by immunostaining. DEC-205
was expressed in PMA differenciated macrophage cells.
Bacterial stimulation enhanced DEC-205
expression on macrophage cells. Immnunostaining of H. pylori stimulated macrophage indicated
that endocytosis of H. pylori into macrophage was associated with DEC-205. Double positive cells
of DEC-205 and CD14 in gastric mucosa were increased in H. pylori infected patients and DEC205
positive macrophages invaded into gastric pits of H. pylori positive gastric mucosa. In contrast,
some reports indicated the interaction of DEC-205 with IL4 receptor is closely associated with
tumor development. We are studying association with gastric cancer induced by H. pylori and
expression of DEC-205.
21
Effects of 2 electric toothbrushes on gingivitis in high school students
○Furuta M1, Yamanaka R1, Mizushima M2, Akhter R1, Yamamoto T1, Watanabe T3
(1 Department of Oral Health, Okayama University Graduate School of Medicine, Dentistry and
Pharmaceutical Sciences, 2 Okayama Prefectural Kurashiki Health Center, 3 Kurashiki Medical
Center)
Objectives: Teenagers are particularly susceptible to gingivitis, and the prevalence of gingivitis
increases with age. Effects of electric toothbrushes for maintaining gingival health in adults are well
known but not in teenagers. Thus, we evaluated the ability of electric toothbrushes Oral-B®
ProfessionalCare® 8000 (PC) and Sonicare® elite® e9800 (SE). Design: This study had a matched,
parallel, examiner-blind design. Subjects: Dental examination was performed at a high school in all
1st-3rd grade students and 59 students were diagnosed to have gingivitis. Of the 59 enrolled
subjects, 48 provided evaluable data. Methods: Examinations include probing depth, bleeding on
probing (BOP) and plaque index (PlI) on 10 index teeth at baseline. Subjects were instructed to
brush twice daily for 2 min without dentifrices. They were given professional instructions for about
5 min on the use of either toothbrush. The probing depth, BOP, PlI and gingival abrasion were
recorded after 2, 4 and 8 weeks. Results: During the study period, the multiple comparisons test
showed a statistically significant improvement in all indices for both powered toothbrushes. There
was no statistically significant difference between the two groups in any indices. There were 4 sites
of gingival abrasion in PC and 0 in SE. At 8 weeks, no gingival abrasion was observed in either
group. Conclusions: PC and SE improved gingivitis in high school students. The use of both
electric toothbrushes can be considered safe till 8 weeks.
22
New method/equipment to detect the lymphatic vessels for lymphatico-venous anastomosis
using fluorescence imaging with Indocyanine green
○Morisada S1, Nakashima M2, Sugiyama N1, Hasegawa K1, Nanba Y1, Kimata Y1
(1 Plastic and Reconstructive Surgery of Okayama University Hospital, 2 Plastic Surgery of
Okayama Saiseikai Hospital)
Purpose: Microscopic lymphatico-venous anastomosis has been established as one of the surgical
treatment for lymphedema with recent progress of microsurgical techniques. However its
effectiveness depends on the statement of lymphatic vessels detected and anastomosed, in some
patients, it is hard and time consuming to detect a functional lymphatic vessel even if the operator is
well trained. To overcome the difficulty we suggest the use of fluorescence imaging with
Indocyanine green and near infrared spectroscopy. Materials and methods: We treated
lymphedema in the lower extremity with lymphatico-venous anastomosis using fluorescence
imaging as a pre-operative assessment. 0.05ml of Indocyanine green (5mg/ml) was injected locally
at several point of lower extremity. The fluorescence image was obtained by a near infrared
spectroscopy Photo Dynamic Eye (Hamamatsu photonics, Japan). Results: We could observe the
fluorescence image that the injected Indocyanine green was drained into subcutaneous lymphatic
vessels and flew proximally as a line up to the groin region. On the other hand, the undrained dye
diffused. We could expose the subcutaneous lymphatic vessel under a microscope at the point
fluorescence image appeared clearly . The equipment could detect the lymphatic vessels within 2cm
depth from the skin surface. Conclusions: Fluorescence imaging with Indocyanine green is very
useful to detect the lymphatic vessels which retain perfusion ability. Shorter operation time
and
better result could be obtained. It is non invasive procedure that we suppose pre- and post-operative
assessments are also available even in outpatient clinic. However there still remain some problems
to discuss. The most important one is that there is no report of the dynamic flow of lymph of normal
human. So this is our theme of study.
23
Identification of genes involved in tooth development
○Uchibe K1,2, Yokoyama S1,3, Hashimoto M1, Shimizu H1, Kuboki T2, Asahara H1,4
(1 Department of Systems Biomedicine, National Research Institute for Child Health and
Development, 2 Department of Oral and Maxillofacial Rehabilitation, Okayama University
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 3 Graduate School of Human
Sciences, Waseda University, 4 Department of Molecular and Experimental Medicine, The Scripps
Research Institute)
Regeneration of tooth is one of the ultimate goals of dental medicine. Recent studies have
demonstrated that murine tooth can be generated by cell-mediated methods（Ohazama A. et al. J
Dent Res 2004, Nakao K. et al. Nat Methods 2007）. However, the lack of our knowledge on
molecular mechanism of tooth development has hampered the total control of tooth shape, size and
polarity. This is partially because numerous genes that play essential roles in tooth development still
remain unidentified. Transcription factors play a central role in gene expression and regulate wide
spectrum of biological processes. The aim of this study is to identify the cluster of transcription
factors implicated in tooth development in order to gain more insight into the developmental
mechanism of tooth. Based on the gene expression database developed at National Research
Institute for Child Health and Development (Tokyo, Japan), 166 out of 1,551 genes were found to
be expressed in the maxillary and madibular prominences and thus were selected for further
analysis. Among these candidates, 32 genes were newly identified as potential factors associated
with tooth development based on the expression patterns detected by in situ hybridization assays
with frontal sections of E13.5 and E14.5 mouse embryos. These results would contribute to
elucidating the mechanisms of tooth development and to improving the technology for regeneration
of tooth.
24
Improvement of alveolar bone quality by local bFGF injection - histological and cellular
biological analysis in a rabbit model ○Oshima M, Sonoyama W, Ono M, Shimono K, Hikasa T, Okamoto Y, Tsuchimoto Y,
Matsuka Y, Kuboki T
(Department of Oral and Maxillofacial Rehabilitation, Okayama University Graduate School of
Basic fibroblast growth factor (bFGF) is known to have multiple roles in bone development and
regeneration. Although it is already reported that bFGF accelerates the healing of periodontal bony
defect, its effect on local bone quality is not clarified yet. In this study, recombinant human bFGF
was injected into bone marrow spaces of the rabbit mandible, then bone quality was examined
histologically and bone morphometric parameters were analyzed by mCT. In addition, bone marrow
cells were isolated, and the effects of bFGF on these cells were examined in vitro in terms of
osteogenesis and osteoclastogenesis. Ilium or tibia was used as a control against mandible.
Four weeks after injection (100 µg of bFGF), accelerated bone formation was obviously observed
in the mandible, but not in the tibia. mCT analysis revealed that several parameters (i.e. bone
volume/tissue volume, trabecular thickness, and trabecular number) were significantly improved in
mandible. Cell proliferation, assessed by MTS assay, was enhanced by bFGF in osteogenic cells
both from the mandible and the ilium. Although the calcified nodule formation of cells from the
ilium was suppressed by bFGF, that of cells from the mandible was not. Osteoclastogenesis,
analyzed by TRAP staining, was suppressed by high-dose (10-9M) bFGF, and enhanced by
low-dose (10-12M) bFGF in bone marrow cells both from the mandible and the ilium. However, the
number of mature multinucleated osteoclasts derived from the iliac bone marrow was more than
that from the mandibular bone marrow.
These results suggest that local bFGF injection can be one of the suitable strategies to improve
alveolar bone quality, possibly due to a different nature of the mandibular bone marrow from other
bone marrow.
25
Response shifts in an Oral Health-Related QoL measure in partially edentulous patients with
dental implants
○Kimura A, Arakawa H, Noda K, Matsuka Y, Kuboki T
Purpose: When individuals experience changes in their health states, they may alter their internal
standards, values, or conceptualization of quality of life (QoL). Such 'response shifts' can affect or
distort QoL outcome measurement, which is of particular concern when evaluating medical
interventions. The purpose of this study was to determine whether the response shift could be
observed in and how the response shift could affect the Oral Health-Related QoL (OHQoL)
measurement in dental implant patients.
Materials and Methods: The subjects of this study were consecutive series of partially edentulous
patients who were installed implant-supported fixed restoration at Okayama University Hospital.
They were asked to answer a self-administered OHQoL questionnaire before and after the treatment,
as well as to answer a set of 7 questions to retrospectively rate their pre-treatment QoL
(Then-OHQoL) levels. Forty five patients (mean age: 52.0±11.6, female/male: 31/14) answered
those questions completely. The subjects were divided in two groups [low (n=23) and high QoL
groups (n=22)] by the median of their total 7 OHQoL scores before treatment (Pre-OHQoL). In the
both groups, Pre-OHQoL levels were compared with their Then-OHQoL levels.
Results: Their raw Pre-OHQoL scores were not correlated with their raw Then-OHQoL scores
(p=0.87). The median of Then-OHQoL score was significantly lower than that of the Pre-OHQoL
score in the high QoL group（p<0.01）, while no significant difference was observed in the low QoL
group.
Conclusion: Response shift phenomena were actually observed in the partially edentulous patients
with dental implants, especially in the high Pre-OHQoL group, whose Then-OHQoL scores were
significantly lower than those Pre-OHQoL scores.
26
A retrospective cohort study on survival of adjacent teeth of implant-supported fixed partial
dentures
○Yamazaki S, Arakawa H, Noda K, Matsuka Y, Kuboki T
Purpose: Implant-supported fixed partial dentures (IFDs) have possibility to protect the teeth
adjacent to the edentulous space. However, there are few studies to investigate survival of the
adjacent teeth surrounding IFDs. The purpose of this study was to compare trouble rate between
teeth adjacent to IFDs and abutment teeth of fixed-partial dentures (FPDs). Methods: The sample
patients had received prosthodontic therapy for their bounded edentulous space not-exceeding two
missing teeth at Okayama university hospital. The IFD group was consecutive series of patients
who were installed the IFDs from February 1990 to March 2007. FPD group was selected by
matching age, sex and missing tooth number with IFD group. Final samples of IFD and FPD groups
were 61 and 66 patients, respectively. The outcome variables were tooth troubles of the adjacent
teeth of IFDs and the abutment teeth of FPDs, such as extraction, recurrent flare of acute
periodontitis or loss of prosthesis. Non-trouble (survival) rates were compared between them by
Kaplan-Meier analysis and risk factors for the troubles were identified using Cox proportional
hazard regression model. Results: The eight-year cumulative non-trouble rate of IFD group was
significantly higher than that of FPD group (IFD and FPD groups was 92.1 and 59.3% respectively
(p = 0.02)). The Cox hazard model showed that the tooth trouble was significantly related to
non-vitality of dental pulp (relative ratio: 2.72; 95% confidence interval: 1.01 to 7.31) and not to the
treatment group difference (IFD or FPD). Conclusion: This study suggests that IFDs have
possibility to protect the teeth adjacent to the edentulous space because IFDs do not need to injure
the adjacent teeth.
27
A retrospective cohort study on dental implants survival; Is installation age a risk factor?
○Noda K, Arakawa H, Kimura A, Yamazaki S, Matsuka Y, Kuboki T
Purpose: Aging is believed as a risk for dental implants failure. However, there are few clinical
studies depicting relationship between installation age of the dental implants and its successful
osseointegration and longitudinal survival. The purpose of this study were to compare clinical
success rates of osseointegration (SRO) between two age groups (> or = 65, and < 65 years old) and
to assess whether the installation age could be related to longitudinal survival rates of the dental
implants (LSR). Methods: This retrospective cohort study included 327 consecutively treated
patients (> or = 65 and < 65 years old was 60 and 267 patients, respectively) with 797 rough surface
dental implants in Okayama University Hospital from February 1990 to March 2007. The major
outcome variables were SRO and LSR. SRO difference between the two groups was analyzed by
logistic regression analysis. Risk factors for loss of the dental implants were estimated using a Cox
hazard model with an intention-to-treat regime. Results: There was no significant difference
between the two age groups on SRO (> or = 65 / < 65 yrs old: 98.6, 98.3%, p = 0.78). The Cox
hazard model showed that the installation age was not a risk for longitudinal survival of the dental
implants (p = 0.17). Conclusion: These results suggest that installation age of the dental implants
was not related to dental implants failure with recent rough surface dental implants.
ソプラノ独唱
ソプラノ独唱紹介
＜演奏会曲目＞
1. アレルヤ（「モテット」より）
モーツァルト作曲
2. 歌の翼に
メンデルスゾーン作曲
3. 花の街
江間章子作詞／團
4. メリー・ウィドー・ワルツ（オペレッタ「メリー・ウィドー」より）
伊玖磨作曲
レハール作曲
＜プロフィール＞
高橋
昌子
先生（ソプラノ）
本名虫明眞砂子．愛知県立芸術大学音楽学部声楽科卒業．同大学院修了後，イタリア国立
ヴェルディ音楽院に留学．2003 年∼2004 年文部科学省在外研究員として米国インディアナ
州立大学に留学．矢部禮子，小島琢磨，東
敦子，Ｒ．リッチの諸氏に師事．桑原賞（愛
知県知事賞）受賞．第 21 回日伊声楽コンコルソ第 1 位受賞．日本演奏連盟賞受賞．ＮＨ
Ｋ洋楽オーディションに合格．2001 年第 43 回岡山県文化奨励賞を受賞．オペラでは，津
山国際音楽祭オペラ「魔笛」のパミーナ，岡山シンフォニ一ホール開館記念オペラ「ワカ
ヒメ」のワカヒメ（初演・再演），倉敷音楽祭オペラ「ラ・ボェーム」のミミ，
「夕鶴」の
つう等を演ずる．第 31 回ソフィア国際音楽祭「フォーレレクイエム」のソプラノソロ，
「第九」のソプラノソロのほか，全国二期会サミットコンサート出演，インディアナ大学，
名古屋，岡山にてソロリサイタル開催など幅広く活動している．昨秋開催された「まなび
ピアおかやま」では，国歌斉唱を務めた．
現在，岡山大学教育学部教授，中国二期会，神戸波の会各会員．
大石
邦子
先生（ピアノ）
大阪教育大学特設音楽課程ピアノ専攻卒業．大阪にてモーツァルト没後 200 年記念コンサ
ート，「21 世紀のアーティスト」シリーズで大阪ＣＭＣアカデミア管弦楽団と 3 度共演，
ソロ，2 台のピアノ等の演奏会に出演．岡山にて「クリスマスチャリティーコンサート」
「名曲タイム」等に出演．またブルガリア国立室内管弦楽団，ニュージーランド弦楽四重
奏団と共演． 1999∼2002 年，シンガポール在住中にチャリティーコンサート，ピアノリ
サイタルを開催．帰国後もステファン・キーロフ弦楽四重奏団と共演など幅広く活動して
いる．田中紘二，小柳芳子，ジョン・シャープリーの諸氏に師事． 2002 年ブタペストピ
アノマスタークラスでチャパ・キラー氏に師事．現在，岡山県演奏家協会会員．

プログラムPDF - 医療系大学院高度臨床専門医養成コース

Transcription

Similar documents

Pharmaceutical Medicine - æ¥æ¬è£½è¬å»å¦ä¼ï¼JAPhMedï¼

äºä¾çºè¡¨ï¼åæ·ç§å¦ã»ã³ã¿ã¼ pdfå½¢å¼

TIMELY TOPICS - IUSD P - Irvine Unified School District

ï¹ å² è¨ ï¹ é· å å ä¼ ã èª ã

Ê¨ÊµÊÊ¶Ê£ÊµÉ¬Ê¡Ê·ËÊÈ¶È¹ Í·ÈºÈ¬È

Organization and Unit Members

å¼å¸å¨ææçãå¯¾è±¡ ã¨ã ãAspoxicillinã¨Piperacillinã® äºéç²æ¤æ³

DECEMBER 2013 - Walnut Grove Buddhist Church

ä¸é«å¹´é½¢ç·å¥³ã«ãããè¶é³æ³¢æ³ãç¨ããè¸µéª¨éª¨

Document

å - ç¬¬15åæ¥æ¬æå é½¢å»å¦ä¼ç·ä¼

Free Reading “How to” Books Embracing Open-Access

How to Fill in the Application for Certificate of Eligibility

第 37 回日本微小循環学会総会

æ¥ - ç¬¬15åæ¥æ¬æå é½¢å»å¦ä¼ç·ä¼

ããã°ã©ã - ç¬¬15åæ¥æ¬æå é½¢å»å¦ä¼ç·ä¼

My Dubai Trip - Bengali Association of Tokyo Japan

22646s.indd 16 2014/03/19 20:50

開催の案内 - 日本歯周病学会