We have previously suggested that the population of nifedipine-sensitive fibroblasts in nifedipine responder cells (NIFr cells) obtained from hyperplastic gingival tissue of nifedipine-reactive patients was greater than that in nifedipine non-responder cells (NIFn cells) obtained from non-hyperplastic gingival tissue of nifedipine-nonreactive patients. It has also been reported that 18α-glycyrrhetinic acid (18α-GA) significantly induced apoptosis in human cancer cells whose replication rate was slow, by inhibiting the onset of progression. In this study, we focused on how 18α-GA affects apoptosis in NIFr cells and decreases their number. Semi-confluent cells were arrested in DMEM substituted by 0.5% FBS for 24 h, stimulated by various concentrations of 18α-GA, and then apoptosis assay, flow cytometry analysis, and RT-PCR analysis were performed. Apoptosis assay and flow cytometry analysis showed that 18α-GA increased the number of cells that underwent apoptosis and decreased G₀/G₁ phase cells in NIFr. The mRNA expression of bcl-2, the suppressor for apoptosis, was suppressed by 18α-GA in NIFr cells; however, the mRNA expression of p53 was not changed. Since 18α-GA induces apoptosis though suppressing mRNA expression of bcl-2 in NIFr cells, it might be useful for reducing gingival fibroblasts and thus reducing gingival overgrowth caused by nifedipine.

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Among patients receiving treatment in dental clinics, those complaining of chronic superficial glossodynia are frequently encountered in clinical practice. It was recently revealed that most of these painful episodes are caused by candida infection, and as a treatment strategy, episodes of glossodynia can be relatively easily relieved by antifungal mouthwash or its oral preparation. Candidal glossodynia can be classified into two groups based on clinical findings, that is, glossodynia accompanied by erythema due to atrophied lingual membrane; erythematous candidiasis and that accompanied by pseudomembrane adhered to the membrane surface; pseudomembranous candidiasis.
In this study, the potential difference between 5 strains isolated from 5 erythematous candidiasis and 5 strains isolated from 5 pseudomembranous candidiasis among patients at random. The drug sensitivity test previously performed by using four kinds of antifungal drug, miconazole, itraconazole, amphotericin B and nystatin, all of the drugs showed good drug sensitivity against the 10 strains of C. albicans isolated, besides of the subsequent test on the biochemical properties using a fungal identification kit for pathogenic yeasts, Api-C-Auxanogram^®, no significant difference was detected between the two groups examined.
Then it was examined by referring to the various cellular responses to human gingival epithelial cells derived from isolated Candida albicans.
Individual C. albicans strains isolated in the two groups; 5 strains each, were then sensitized with cultured keratinocytes in order to determine the levels of inflammatory cytokines including Interleukin 1β, Interleukin 6, and Interleukin 8 by ELISA method, for comparison.
In the present study, however, there was no difference in the time to expression of IL-6 and IL-8 between the erythromatous and pseudomembranous groups and both indexes were found to have increased significantly during the period of sensitization from 3 to 12 hours. In addition, the production of cytokines was promoted in the pseudomembranous candidiasis group as compared with the erythromatous candidiasis group with a significant difference noted between the two groups.
From the evidence mentioned above, there is a distinct difference in the cytokine levels produced by the isolated fungi by referring to the clinical symptoms in relation to the inflammatory statuses between erythromatous and pseudomembranous candidal glossodynia, besides the various clinical findings detected by visual examination.

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Introduction: The critical pathway (CP) is a comprehensive systematized patient care plan for a specific procedure. At our institution, a CP for oral infection was implemented in December 2005. The aims of this study were to evaluate the CP for the procedure for this disease, and confirm the standardization of health care.
Methods: All patients after the implementation of the CP were included as subjects. For evaluation, clinical and economic parameters were used. As clinical parameters, the score according to the criteria for the evaluation of the clinical efficacy of antimicrobial drugs and the response rate were evaluated. In addition, the relationship between the dose of NSAIDs and pain scale was analyzed. As economic parameters, the mean length of hospital stay and medical cost were compared between patients before and after the CP implementation.
Results: The subjects consisted of 45 patients from the CP implementation to December 2008. During hospitalization, the drug efficacy score or the response rate did not significantly differ among groups or according to the severity of the disease. The median dose of NSAIDs was 1 tablet at day 1 and 2 tablets at days 2 and 3. The median score using the pain scale was 3 at days 1 and 2 and 2 at day 3. The rate of patient's compliance with the length of hospital stay was 82.2%. All reasons for the absence of compliance were due to the patients. The 45 patients after the CP implementation were compared with 31 patients before the PC implementation. The mean length of hospital day before the CP implementation was 7.05 ± 5.51 days, being significantly longer than that after the implementation (p = 0.022). The mean medical cost before the CP implementation was 24,109.68 ± 26,087.95 points, being significantly higher than that after the implementation (p = 0.012).
Conclusion: The results of this study confirmed the validity of the CP for oral infection at our department, and showed the possibility for new criteria for the dose of NSAIDs and pain score. The CP reduced the length of hospital stay and medical cost.

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Pain at the site of intravenous injection of propofol is a common clinical problem. This study was designed to evaluate the efficacy of pretreatment with a different concentration of lidocaine, with or without a tourniquet, to decrease the intensity of injection pain when providing intravenous sedation using 1% Diprivan Injection-Kit (PFS) administered by the Target Controlled Infusion (TCI) method.
Methods: 147 female patients undergoing oral day care surgery under local anesthesia with intravenous sedation were randomly assigned to one of 7 groups. No premedication was administered. Patients in group C (n = 21) serving as the control group were pretreated with 0.9% normal saline solution and immediately infused with propofol (PFS) using the TCI mode of a Diprifusor; Patients in group L0.5 (n = 21), L1.0 (n = 21) and L2.0 (n = 21) were pretreated with 0.5%, 1.0% or 2.0% lidocaine (0.5 mg/kg) respectively and immediately infused with propofol (PFS) using the TCI mode of the Diprifusor; Patients in group TL0.5 (n = 21), TL1.0 (n = 21) and TL2.0 (n = 21) were pretreated with 0.5%, 1.0% or 2.0% lidocaine (0.5 mg/kg) respectively along with tourniquet application for 60 seconds followed by propofol (PFS) infusion using the TCI mode of a Diprifusor.
Within 20-60 seconds of starting propofol injection, patients were asked to report any discomfort and rate their pain as being absent, mild, moderate or severe. The degree of pain was subsequently scored as: 0: no pain; 1: mild pain; 2: moderate pain; 3: severe pain.
Results and Conclusions: There were significant changes in all groups except group L0.5 in the median value of the pain score compared to group C. No significant change of the median value of the pain score was found among groups L0.5, L1.0 and L2.0, and among groups TL0.5, TL1.0 and TL2.0. The median value of the pain score in group TL1.0 was significantly lower than in group L1.0 and the highest incidence of no pain was found in group TL1.0. Consequently, in cases without application of a tourniquet, both 1.0% and 2.0% lidocaine were equally effective for reducing injection pain of propofol, and application of a tourniquet with pretreatment with 0.5%, 1.0% or 2.0% lidocaine is expected to be even more effective in reducing injection pain of propofol. When using 1% lidocaine, it is suggested that applying a tourniquet would produce a significant difference in attenuating injection pain.

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Background: Candida has been found to be frequently associated with catheter-related bloodstream infection, we examined biofilm formation of Candida and effect of antifungal agents.
Methods: The effect of micafungin, amphotericin B, and fluconazole on biofilm formation of Candida albicans, Candida glabrata, and Candida parapsilosis, recovered from clinically documented systemic infections, on polypropylene tubes was determined.
Results: C. parapsilosis strains formed a mature biofilm while C. albicans and C. glabrata strains formed a premature biofilm. In the presence of amphotericin B or fluconazole, no effect was observed on biofilm formation or viable cells within the biofilm layer. On the other hand, micafungin decreased biofilm formation and viable cell counts within the biofilm layer of Candida strains, especially for C. parapsilosis.
Conclusion: Inhibitory effects of micafungin on biofilm formation of C. parapsilosis may be indicative of the excellent efficacy of micafungin against Candida infection.

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