われわれは以前に，ニフェジピンによる歯肉増殖症の原因はニフェジピン感受性歯肉線維芽細胞（NIFr）の増殖亢進とアポトーシス低下であること，18α-グリチルレチン酸（18α-GA）はNIFrの塩基性線維芽細胞増殖因子が誘導する細胞増殖と細胞周期に対して抑制的な効果をもつことを報告している．本研究では，NIFrのアポトーシスに対する18α-GAの影響をアポトーシス細胞数の測定，フローサイトメトリー解析，RT-PCR法を用いて検討した．その結果，18α-GAはNIFrのアポトーシス細胞数（Sub-G₁）を増加し，細胞周期のG₀/G₁期細胞を減少すること，そしてアポトーシス抑制因子であるbcl-2のmRNA発現を抑制することが認められた．またp53のmRNA発現に対する18α-GAの影響は認められなかった．これらのことから，ニフェジピンによって発症する歯肉増殖症を抑制するための薬物療法に，18α-GAを応用することができる可能性があると考えられた．

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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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目的：カンジダはカテーテル関連の血流感染に頻繁に関連している．私達は，カンジダのスライム産生と抗真菌薬のバイオフィルム産生の抑制効果を検討した．深在性カンジダ症患者より分離されたCandida albicans, Candida glabrataおよびCandida parapsilosis株を用いてミカファンギン，アムホテリシンBおよびフルコナゾールのポリプロピレン製チユーブにおける検討を行った．C. parapsilosisはC. albicansとC. glabrataより，バイオフィルム産生性が強く認められた．今回の検討でフルコナゾールおよびアムホテリシンBはバイオフィルム産生の抑制を認めなかった．それに対してミカファンギンは今回検討したカンジダ属で，付着菌数の減少およびバイオフィルム産生の抑制が認められた．最も強い影響を及ぼした菌種はC. parapsilosisであった．今回のC. parapsilosisに対する検討結果はカンジダ感染症に対してミカファンギンの有効性を示唆した．

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