Four and a half years of experience of a clinician born and raised in Fukushima: discrepancy found through dialogues and practices

Many initiatives to measure the internal and external exposures of the residents of Fukushima have been undertaken since the accident at Fukushima Daiichi nuclear power plant. However, residents have had few, if any, opportunities for face-to-face explanations to understand the meaning of such measurements. Although the personal data of tens of thousands of residents were collected, these data were not analysed adequately, and were therefore not used to implement large-scale programmes to manage/reduce exposures. One of the lessons learned from the Fukushima accident is that it is imperative for the government to implement these measures for radiation protection, and to build an effective functioning service for the residents. The author, as a physician from the region, has worked as an explainer/interpreter of exposure dose measurements to individual residents. Another lesson learned from this experience is that local medical and health professionals can contribute to building a public system for radiation protection, by acting as 'liaising officers' to connect residents, the authorities, and experts from outside the region. This paper describes the author's experience and lessons learned in the hope that this information will be useful in the event of a future accident.

Influence of Thermal Cycling on Flexural Properties and Simulated Wear of Computer-aided Design/Computer-aided Manufacturing Resin Composites

OBJECTIVE

The purpose of this study was to evaluate the influence of thermal cycling on the flexural properties and simulated wear of computer-aided design/computer-aided manufacturing (CAD/CAM) resin composites.

METHODS

The six CAD/CAM resin composites used in this study were 1) Lava Ultimate CAD/CAM Restorative (LU); 2) Paradigm MZ100 (PM); 3) CERASMART (CS); 4) Shofu Block HC (SB); 5) KATANA AVENCIA Block (KA); and 6) VITA ENAMIC (VE). Specimens were divided randomly into two groups, one of which was stored in distilled water for 24 hours, and the other of which was subjected to 10,000 thermal cycles. For each material, 15 specimens from each group were used to determine the flexural strength and modulus according to ISO 6872, and 20 specimens from each group were used to examine wear using a localized wear simulation model. The test materials were subjected to a wear challenge of 400,000 cycles in a Leinfelder-Suzuki device (Alabama machine). The materials were placed in custom-cylinder stainless steel fixtures, and simulated localized wear was generated using a stainless steel ball bearing (r=2.387 mm) antagonist in a water slurry of polymethyl methacrylate beads. Simulated wear was determined using a noncontact profilometer (Proscan 2100) with Proscan and AnSur 3D software.

RESULTS

The two-way analysis of variance of flexural properties and simulated wear of CAD/CAM resin composites revealed that material type and thermal cycling had a significant influence (p<0.05), but there was no significant interaction (p>0.05) between the two factors. The flexural properties and maximum depth of wear facets of CAD/CAM resin composite were different (p<0.05) depending on the material, and their values were influenced (p>0.05) by thermal cycling, except in the case of VE. The volume losses in wear facets on LU, PM, and SB after 10,000 thermal cycles were significantly higher (p<0.05) than those after 24 hours of water storage, unlike CS, KA, and VE.

CONCLUSION

The results of this study indicate that the flexural properties and simulated wear of CAD/CAM resin composites are different depending on the material. In addition, the flexural properties and simulated wear of CAD/CAM resin composites are influenced by thermal cycling.

Distinct Responses of Interleukin-6 and Other Laboratory Parameters to Treatment in a Patient with Polyarteritis Nodosa—A Case Report

The authors describe a patient in whom the serum levels of interleukin-6 (IL-6) and other laboratory parameters were monitored. The IL-6 and C-reac tive protein (CRP) levels, which were extremely high before treatment, declined rapidly with administration of prednisolone. Rheumatoid factor, IgG, and platelets count declined more gradually. Thus, determination of the serum IL-6 level might be useful in diagnosing and monitoring polyarteritis nodosa.

Influence of Etching Mode on Enamel Bond Durability of Universal Adhesive Systems

The purpose of this study was to determine the enamel bond durability of three universal adhesives in different etching modes through fatigue testing. The three universal adhesives used were Scotchbond Universal, Prime&Bond Elect universal dental adhesive, and All-Bond Universal light-cured dental adhesive. A single-step self-etch adhesive, Clearfil S³ Bond Plus was used as a control. The shear bond strength (SBS) and shear fatigue strength (SFS) to human enamel were evaluated in total-etch mode and self-etch mode. A stainless steel metal ring with an internal diameter of 2.4 mm was used to bond the resin composite to the flat-ground (4000-grit) tooth surfaces for determination of both SBS and SFS. For each enamel surface treatment, 15 specimens were prepared for SBS and 30 specimens for SFS. The staircase method for fatigue testing was then used to determine the SFS of the resin composite bonded to the enamel using 10-Hz frequencies for 50,000 cycles or until failure occurred. Scanning electron microscopy was used to observe representative debonded specimen surfaces and the resin-enamel interfaces. A two-way analysis of variance and the Tukey post hoc test were used for analysis of the SBS data, whereas a modified t-test with Bonferroni correction was used for the SFS data. All adhesives in total-etch mode showed significantly higher SBS and SFS values than those in self-etch mode. Although All-Bond Universal in self-etch mode showed a significantly lower SBS value than the other adhesives, there was no significant difference in SFS values among the adhesives in this mode. All adhesives showed higher SFS:SBS ratios in total-etch mode than in self-etch mode. With regard to the adhesive systems used in this study, universal adhesives showed higher enamel bond strengths in total-etch mode. Although the influence of different etching modes on the enamel-bonding performance of universal adhesives was found to be dependent on the adhesive material, total-etch mode effectively increased the enamel bond strength and durability, as measured by fatigue testing.

Endovascular Stenting for Pseudoaneurysms of the Cervical Carotid Artery

The authors report two cases of pseudoaneurysm of the cervical carotid artery treated with endovascular stenting. One patient presented with cerebral ischemia due to traumatic carotid dissection and underwent stent placement 3 weeks after injury when the wide-necked pseudoaneurysm was seen to enlarge at the dissecting portion.

The aneurysm thrombosed while the carotid artery remained patent without ischemic complications for 2 years. The other patient developed repeated massive bleeding from an exposed pseudoaneurysm at the right carotid-subclavian junction resulting from radiotherapy for thyroid cancer with subsequent skin infection.

Since skin grafting failed and two attempts at coil embolization resulted in compaction with recurrent enlargement of the aneurysm, endovascular stenting was performed with endosaccular coil packing between the stent struts. Hemostasis was achieved for 2 months. Both cases illustrate successes of the stent in highly difficult situations.

Mechanical Properties and Sliding-impact Wear Resistance of Self-adhesive Resin Cements

The present study determined the mechanical properties and impact-sliding wear characteristics of self-adhesive resin cements. Five self-adhesive resin cements were used: G-CEM LinkAce, BeautiCem SA, Maxcem Elite, Clearfil SA Automix, and RelyX Unicem 2. Clearfil Esthetic Cement was employed as a control material. Six specimens for each resin cement were used to determine flexural strength, elastic modulus, and resilience according to ISO specification #4049. Ten specimens for each resin cement were used to determine the wear characteristics using an impact-sliding wear testing apparatus. Wear was generated using a stainless-steel ball bearing mounted inside a collet assembly. The maximum facet depth and volume loss were determined using a noncontact profilometer in combination with confocal laser scanning microscopy. Data were evaluated using analysis of variance followed by the Tukey honestly significantly different test (α=0.05). The flexural strength of the resin cements ranged from 68.4 to 144.2 MPa; the elastic modulus ranged from 4.4 to 10.6 GPa; and the resilience ranged from 4.5 to 12.0 MJ/m3. The results for the maximum facet depth ranged from 25.2 to 235.9 μm, and volume loss ranged from 0.0107 to 0.5258 mm3. The flexural properties and wear resistance were found to vary depending upon the self-adhesive resin cement tested. The self-adhesive cements tended to have lower mechanical properties than the conventional resin cement. All self-adhesive resin cements, apart from G-CEM LinkAce, demonstrated significantly poorer wear resistance than did the conventional resin cement.

The Effect of Phosphoric Acid Pre-etching Times on Bonding Performance and Surface Free Energy with Single-step Self-etch Adhesives

OBJECTIVE

The purpose of this study was to evaluate the effect of phosphoric acid pre-etching times on shear bond strength (SBS) and surface free energy (SFE) with single-step self-etch adhesives.

METHODS

The three single-step self-etch adhesives used were: 1) Scotchbond Universal Adhesive (3M ESPE), 2) Clearfil tri-S Bond (Kuraray Noritake Dental), and 3) G-Bond Plus (GC). Two no pre-etching groups, 1) untreated enamel and 2) enamel surfaces after ultrasonic cleaning with distilled water for 30 seconds to remove the smear layer, were prepared. There were four pre-etching groups: 1) enamel surfaces were pre-etched with phosphoric acid (Etchant, 3M ESPE) for 3 seconds, 2) enamel surfaces were pre-etched for 5 seconds, 3) enamel surfaces were pre-etched for 10 seconds, and 4) enamel surfaces were pre-etched for 15 seconds. Resin composite was bonded to the treated enamel surface to determine SBS. The SFEs of treated enamel surfaces were determined by measuring the contact angles of three test liquids. Scanning electron microscopy was used to examine the enamel surfaces and enamel-adhesive interface.

RESULTS

The specimens with phosphoric acid pre-etching showed significantly higher SBS and SFEs than the specimens without phosphoric acid pre-etching regardless of the adhesive system used. SBS and SFEs did not increase for phosphoric acid pre-etching times over 3 seconds. There were no significant differences in SBS and SFEs between the specimens with and without a smear layer.

CONCLUSION

The data suggest that phosphoric acid pre-etching of ground enamel improves the bonding performance of single-step self-etch adhesives, but these bonding properties do not increase for phosphoric acid pre-etching times over 3 seconds.

Measurement and comparison of individual external doses of high-school students living in Japan, France, Poland and Belarus-the 'D-shuttle' project

Twelve high schools in Japan (of which six are in Fukushima Prefecture), four in France, eight in Poland and two in Belarus cooperated in the measurement and comparison of individual external doses in 2014. In total 216 high-school students and teachers participated in the study. Each participant wore an electronic personal dosimeter 'D-shuttle' for two weeks, and kept a journal of his/her whereabouts and activities. The distributions of annual external doses estimated for each region overlap with each other, demonstrating that the personal external individual doses in locations where residence is currently allowed in Fukushima Prefecture and in Belarus are well within the range of estimated annual doses due to the terrestrial background radiation level of other regions/countries.

Donor site selection and clinical outcomes of nipple-areola skin-sparing mastectomy with immediate autologous free flap reconstruction: A single-institution experience

BACKGROUND

The objective of this study was to examine the clinical outcomes of immediate breast reconstruction using perforator flaps from different donor sites, and to characterize the trends among these flaps.

METHODS

We retrospectively reviewed 136 consecutive patients who underwent immediate breast reconstruction using free flaps after skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM). The whole breast was pathologically analyzed in 5-mm sections. Breast reconstruction was performed using the deep inferior epigastric perforator (DIEP) flap, gluteal artery perforator (GAP) flap, and posterior medial thigh perforator (PMTP) flap. Patient characteristics were compared among donor sites.

RESULTS

NSM was converted to SSM because of intraoperative subareolar tumor positivity in 7 of 107 patients. Eleven patients had positive margins in permanent sections. All but one patient had a positive horizontal margin in the peripheral direction. The 5-year recurrence-free survival rate was 91.9%. The locoregional recurrence rate was 5.1% with a mean follow-up observation period of 75 months. DEIP, GAP, and PMTP flaps were used in 64 (47.1%), 38 (27.9%), and 34 (25.0%) patients, retrospectively. DIEP flaps were used in older patients and those with a higher body mass index. GAP flaps were used in younger patients. DIEP and GAP flaps were used for larger breasts, and PMTP flaps for smaller breasts.

CONCLUSION

NSM or SSM with immediate perforator flap breast reconstruction is an oncologically acceptable surgical option. We believe that age, desire to have children, body mass index, and excised breast volume are valuable factors for selecting the optimal donor site.

Simulated Wear of Self-Adhesive Resin Cements

One of the primary areas of concern with luting agents is marginal gap erosion and attrition. The purpose of this laboratory study was to evaluate bulk and marginal slit (gap) generalized wear of self-adhesive resin cements. Three self-adhesive resin cements were used in this study: G-CEM LinkAce (LA), Maxcem Elite (ME), and RelyX Unicem2 Automix (RU). A custom stainless-steel fixture with a cavity 4.5 mm in diameter and 4 mm deep was used for simulated generalized (bulk) wear. For simulated marginal gap wear, a two-piece stainless-steel custom fixture was designed with a slit (gap) 300 μm wide and 3 mm in length. For both wear models, 20 specimens each for each of the three adhesive cements were made for both light-cure and chemical-cure techniques. The cured cements were polished with a series of carbide papers to a 4000-grit surface and subjected to 100,000 cycles using the slit (gap) wear model and 400,000 cycles for generalized (bulk) wear in a Leinfelder-Suzuki (Alabama machine) wear simulator (maximum load of 78.5 N). Flat-ended stainless-steel antagonists were used in a water slurry of poly(methylmethacrylate) beads for simulation of generalized contact-free area wear with both wear models. Before and after the wear challenges, the specimens were profiled with a Proscan 2100 noncontact profilometer, and wear (volume loss [VL] and mean facet depth [FD]) was determined using AnSur 3D software. Two-way analysis of variance (ANOVA) and Tukey post hoc tests were used for data analysis for the two wear models. Scanning electron microscopy (SEM) was used to examine polished surfaces of the resin cements and the worn surfaces after the wear challenges. The two-way ANOVA of VL using the generalized (bulk) wear model showed a significant effect among the three resin cement materials for the factor of resin cement (p<0.001) and the interaction of the cement and cure method (p<0.001), but not for the cure method (p=0.465). The two-way ANOVA for FD also found a significant difference for the factor of resin cement (p<0.001) and the interaction of the resin cement and cure method (p<0.001), but not for the cure method (p=0.277). The simulated generalized (bulk) wear for the light-cure groups was as follows: VL (mm(3)): RU 0.631 (0.094), LA 0.692 (0.112), and ME 1.046 (0.141) and FD (μm): RU 43.6 (6.5), LA 47.0 (7.7), and ME 72.5 (9.9). The simulated generalized (bulk) wear for the chemical-cure groups was as follows: VL (mm(3)): LA 0.741 (0.105), RU 1.231 (0.234), and ME 1.305 (0.143) and FD (μm): LA 50.7 (7.2), RU 84.5 (16.1), and ME 91.7 (10.2). Simulated wear using the slit (gap) model for the light-cure groups was as follows: VL (mm(3)): RU 0.030 (0.006), LA 0.031 (0.006), and ME 0.041 (0.009) and FD (μm): RU 49.6 (5.7), LA 57.2 (8.4), and ME 70.9 (10.7). The wear values for the chemical-cure slit (gap) groups were as follows: VL (mm(3)): LA 0.031 (0.004), ME 0.038 (0.007), and RU 0.045 (0.009) and FD (μm): LA 53.9 (6.7), ME 63.5 (9.1), and RU 74.2 (12.9). Pearson correlation tests revealed a strong relationship between the two wear models for the light-cure groups and a good relationship for the chemical-cure groups. The observations using SEM showed differences in filler particle shape and size among the cements and the resultant effect of the wear challenges. The worn surfaces of each cement were essentially the same for both light-cure and chemical-cure methods. The bulk wear model and new slit (gap) model for evaluation of simulated generalized wear of luting agents demonstrated significant differences (p<0.05) in relative wear among three self-adhesive resin cements and between visible light- and chemical-cure techniques.

Effect of Phosphoric Acid Pre-etching on Fatigue Limits of Self-etching Adhesives

The purpose of this study was to use shear bond strength (SBS) and shear fatigue limit (SFL) testing to determine the effect of phosphoric acid pre-etching of enamel and dentin prior to application of self-etch adhesives for bonding resin composite to these substrates. Three self-etch adhesives—1) G- ænial Bond (GC Corporation, Tokyo, Japan); 2) OptiBond XTR (Kerr Corp, Orange, CA, USA); and 3) Scotchbond Universal (3M ESPE Dental Products, St Paul, MN, USA)—were used to bond Z100 Restorative resin composite to enamel and dentin surfaces. A stainless-steel metal ring with an inner diameter of 2.4 mm was used to bond the resin composite to flat-ground (4000 grit) tooth surfaces for determination of both SBS and SFL. Fifteen specimens each were used to determine initial SBS to human enamel/dentin, with and without pre-etching with a 35% phosphoric acid (Ultra-Etch, Ultradent Products Inc, South Jordan, UT, USA) for 15 seconds prior to the application of the adhesives. A staircase method of fatigue testing (25 specimens for each test) was then used to determine the SFL of resin composite bonded to enamel/dentin using a frequency of 10 Hz for 50,000 cycles or until failure occurred. A two-way analysis of variance and Tukey post hoc test were used for analysis of SBS data, and a modified t-test with Bonferroni correction was used for the SFL data. Scanning electron microscopy was used to examine the area of the bonded restorative/tooth interface. For all three adhesive systems, phosphoric acid pre-etching of enamel demonstrated significantly higher (p&lt;0.05) SBS and SFL with pre-etching than it did without pre-etching. The SBS and SFL of dentin bonds decreased with phosphoric acid pre-etching. The SBS and SFL of bonds using phosphoric acid prior to application of self-etching adhesives clearly demonstrated different tendencies between enamel and dentin. The effect of using phosphoric acid, prior to the application of the self-etching adhesives, on SBS and SFL was dependent on the adhesive material and tooth substrate and should be carefully considered in clinical situations.

Localized and Generalized Simulated Wear of Resin Composites

A laboratory study was conducted to examine the wear of resin composite materials using both a localized and generalized wear simulation model. Twenty specimens each of seven resin composites (Esthet•X HD [HD], Filtek Supreme Ultra [SU], Herculite Ultra [HU], SonicFill [SF], Tetric EvoCeram Bulk Fill [TB], Venus Diamond [VD], and Z100 Restorative [Z]) were subjected to a wear challenge of 400,000 cycles for both localized and generalized wear in a Leinfelder-Suzuki wear simulator (Alabama machine). The materials were placed in custom cylinder-shaped stainless steel fixtures. A stainless steel ball bearing (r=2.387 mm) was used as the antagonist for localized wear, and a stainless steel, cylindrical antagonist with a flat tip was used for generalized wear. A water slurry of polymethylmethacrylate (PMMA) beads was used as the abrasive media. A noncontact profilometer (Proscan 2100) with Proscan software was used to digitize the surface contours of the pretest and posttest specimens. AnSur 3D software was used for wear assessment. For localized testing, maximum facet depth (μm) and volume loss (mm3) were used to compare the materials. The mean depth of the facet surface (μm) and volume loss (mm3) were used for comparison of the generalized wear specimens. A one-way analysis of variance (ANOVA) and Tukey post hoc test were used for data analysis of volume loss for both localized and generalized wear, maximum facet depth for localized wear, and mean depth of the facet for generalized wear. The results for localized wear simulation were as follows [mean (standard deviation)]: maximum facet depth (μm)—Z, 59.5 (14.7); HU, 99.3 (16.3); SU, 102.8 (13.8); HD, 110.2 (13.3); VD, 114.0 (10.3); TB, 125.5 (12.1); SF, 195.9 (16.9); volume loss (mm3)— Z, 0.013 (0.002); SU, 0.026 (0.006); HU, 0.043 (0.008); VD, 0.057 (0.009); HD, 0.058 (0.014); TB, 0.061 (0.010); SF, 0.135 (0.024). Generalized wear simulation results were as follows: mean depth of facet (μm)—Z, 9.3 (3.4); SU, 12.8 (3.1); HU, 15.6 (3.2); TB, 19.2 (4.8); HD, 26.8 (6.5); VD, 29.1 (5.5); SF, 35.6 (8.4); volume loss (mm3)—Z, 0.132 (0.049); SU, 0.0179 (0.042); HU, 0.224 (0.044); TB, 0.274 (0.065); HD, 0.386 (0.101); VD, 0.417 (0.076); SF, 0.505 (0.105). The ANOVA showed a significant difference among materials (p&lt;0.001) for facet depth and volume loss for both localized and generalized wear. The post hoc test revealed differences (p&lt;0.05) in localized and generalized wear values among the seven resin composites examined in this study. The findings provide valuable information regarding the relative wear characteristics of the materials in this study.

Coffee but not green tea consumption is associated with prevalence and severity of hepatic steatosis: the impact on leptin level

BACKGROUND/OBJECTIVES

Most of the studies that have investigated the association between coffee consumption and hepatic steatosis have been experimental and small-scale clinical studies. As a result, epidemiological studies are scarce. To clear the association, we conducted a cross-sectional study and investigated the effects of coffee consumption with those of green tea consumption.

SUBJECTS/METHODS

We analyzed 1024 Japanese male workers. The diagnosis of hepatic steatosis was based on ultrasonography. We divided coffee and green tea consumption into the following three categories: non-drinker; 1-2 cups/day and ⩾3 cups/day. To investigate the association between hepatic steatosis and coffee or green tea consumption, we calculated the odds ratio (OR) and adjusted the means of leptin levels on each severity of hepatic steatosis.

RESULTS

A total of 265 of our subjects (25.9%) were diagnosed with hepatic steatosis. The ORs of the group of subjects who drank >3 cups of coffee/day was significantly lower compared with that of the noncoffee drinker group (OR 0.59, 95% confidence intervals 0.38-0.90, P=0.03). Although there was a significant difference between coffee consumption and leptin level only in the asymptomatic group, we found a decreasing trend in the asymptomatic and moderate-severe hepatic steatosis group. We did not find the same relationships in green tea consumption.

CONCLUSIONS

Although we did not find an association between hepatic steatosis and green tea consumption, coffee may have beneficial effects on hepatic steatosis. In addition, we produced one possible hypothesis that coffee consumption negatively associates with leptin levels in hepatic steatosis.