RECAM-J 2023-Validation and development of the Japanese version of RECAM for the diagnosis of drug-induced liver injury.

AIM: The diagnosis of drug-induced liver injury (DILI) is challenging. We modified the revised electronic version of the Roussel Uclaf Causality Assessment Method (RUCAM) for the diagnosis of DILI (RECAM), the scoring system developed in US and Spanish cohorts in 2022, and developed RECAM-J 2023 to align with the clinical practice in Japan. In the current study, we introduce RECAM-J 2023 and verify its performance in the context of Japanese patients with DILI. METHODS: After translation of RECAM into Japanese, modifications were made to develop RECAM-J 2023 without any alteration to the scores. To examine the validity and performance of RECAM-J 2023, clinical information on DILI and non-DILI cases in Japan were retrospectively collected. The diagnosis of DILI was made by expert's decision. Then we scored each case using RECAM-J 2023, and calculated area under curve (AUC) values for identification for DILI. RESULTS: We collected data from 538 DILI and 128 non-DILI cases. The sum of highly probable (HP) and probable (PR) cases categorized by RECAM-J 2023 were only 206 (38%) in DILI cases. As the primary cause of low scores was the deduction with missing hepatitis virus markers, which is unlikely to be an issue in prospective applications, we rescored without these deductions. At this time, the sum of HP and PR was raised to 421 (78%). The AUCs of RECAM-J 2023 without deductions were 0.70 and 0.88 for identifying at least HP, and at least PR, respectively. CONCLUSION: RECAM-J 2023, when prospectively used without any missing hepatitis virus markers, provides acceptable performance for identifying at least PR DILI cases in Japanese daily clinical practice.

Safety and effectiveness of SARS-CoV-2 vaccines for patients with intractable hepatobiliary diseases: A multicenter, questionnaire-based, cross-sectional study.

AIM: There are few data regarding the safety and effectiveness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines in patients with intractable hepatobiliary diseases. We conducted a multicenter, questionnaire-based, cross-sectional study to determine the safety and effectiveness of the SARS-CoV-2 vaccines in Japanese patients with intractable hepatobiliary disease. METHODS: Patients aged ≥18 years with autoimmune hepatitis (AIH), primary biliary cholangitis, primary sclerosing cholangitis, Budd-Chiari syndrome, idiopathic portal hypertension, and extrahepatic portal vein obstruction at each center were consecutively invited to join the study. Participants were asked to complete a questionnaire regarding their characteristics, vaccination status, post-vaccination adverse effects, and SARS-CoV-2 infection. Additionally, liver disease status, treatment regimens, and liver function test values pre- and post-vaccination were collected. RESULTS: The survey was conducted from September 2021 to May 2022, and 528 patients (220 AIH, 251 primary biliary cholangitis, 6 AIH- primary biliary cholangitis/primary sclerosing cholangitis overlap, 39 primary sclerosing cholangitis, 4 Budd-Chiari syndrome, 5 idiopathic portal hypertension, and 3 extrahepatic portal vein obstruction) participated in the study. Post-vaccination adverse effects were comparable to those observed in the general population. Post-vaccination liver injuries classified as grade 1 or higher were observed in 83 cases (16%), whereas grades 2 and 3 were observed in only six cases (1.1%); AIH-like liver injury requiring treatment was not observed. Overall, 12 patients (2.3%) were infected with SARS-CoV-2, and only one patient was infected 6 months after the second vaccination. CONCLUSION: SARS-CoV-2 vaccines demonstrated satisfactory safety and effectiveness in Japanese patients with intractable hepatobiliary diseases.

Long-term outcomes of drug-induced autoimmune-like hepatitis after pulse steroid therapy.

AIM: Pulse steroid therapy occasionally causes drug-induced autoimmune-like hepatitis (DI-ALH), but the long-term outcome of treated patients is not well known. In this study, we investigated the long-term outcomes of DI-ALH due to pulse steroid therapy. METHODS: We retrospectively reviewed the medical records of 405 patients treated with pulse high-dose methylprednisolone in Kurashiki Central Hospital. The frequency and clinicopathological characteristics of acute liver injury that occurred within 3 months after the therapy were analyzed. The diagnosis of DI-ALH was made according to the revised international autoimmune hepatitis group criteria. RESULTS: Among the 405 patients treated with methylprednisolone, 61 (15.1%) had acute liver injury after the pulse steroid therapy, and DI-ALH was diagnosed in five patients (1.2%). Absence of oral prednisolone tapering after the pulse steroid therapy was a significant risk factor for the subsequent development of DI-ALH (odds ratio 11.9; p = 0.017). One patient was treated with 3 days of intravenous methylprednisolone followed by oral prednisolone. Two patients were treated with glycyrrhizin followed by oral prednisolone due to ineffectiveness of glycyrrhizin. Remission was achieved with glycyrrhizin alone, and spontaneous remission without drug therapy occurred in one patient each. During the median follow-up period of 34 months, no relapse was evident in all the patients without maintenance therapy. CONCLUSIONS: Pulse steroid therapy can cause DI-ALH, especially when subsequent prednisolone is not tapered. Prednisolone is effective for DI-ALH due to pulse steroid therapy, and can be safely withdrawn once remission is achieved.

[Antiemetic Therapy for Vomiting and Nausea Related to Hepatic Arterial Infusion Chemotherapy Using Cisplatin in Patients with Hepatocellular Carcinoma].

Combination therapy using multiple antiemetic drugs is recommended for intravenous administration of cisplatin, a highly emetogenic agent, whereas a 5-HT3 receptor antagonist alone is commonly used in hepatic arterial infusion chemotherapy using cisplatin for hepatocellular carcinoma owing to its less toxicity than that in the intravenous administration. Given that optimal antiemetic therapy is not yet established, we retrospectively investigated the efficacy of antiemetic drugs for hepatic arterial infusion chemotherapy using cisplatin. This study enrolled 72 patients with hepatocellular carcinoma who received hepatic arterial infusion chemotherapy using cisplatin at Kurashiki Central Hospital between January 2011 and May 2019. A 5-HT3 receptor antagonist was used in all cases, while aprepitant and/or dexamethasone were used concomitantly in 6 cases. After chemotherapy, a complete response rate for 5 days was achieved in 73.6% of the patients; however, complete control could be achieved only in 29.2%. During these 5 days, both rates were lower on days 2-5 than on day 1. In addition, younger age was associated with worse control rates. Our findings suggest that more effective antiemetic therapy is needed for hepatic arterial infusion chemotherapy using cisplatin, especially in non-elderly patients.

Efficacy and safety of cold forceps biopsy for diminutive pharyngeal neoplasms: Single-center, prospective pilot study.

BACKGROUND: Management of diminutive pharyngeal neoplasms is controversial. Thus, we conducted a single-center, prospective pilot study to investigate the efficacy and safety of endoscopic excision with cold forceps biopsy (CFB) of these lesions. PATIENTS AND METHODS: Thirty-nine lesions endoscopically diagnosed with narrow-band imaging as pharyngeal neoplasms of 3 mm or smaller were excised with CFB using jumbo biopsy forceps (cap diameter 2.8 mm, jaw volume 12.4 mm3 ). The primary outcome was endoscopically determined local remnant/recurrence rate 3 months after CFB. The secondary outcomes were histopathologically determined local remnant/recurrence rate; risk factors associated with the endoscopic remnant/recurrence; and incidence of intraoperative or delayed bleeding and other adverse events. RESULTS: Histological diagnosis of the 39 CFB-excised lesions were: 11 high-grade dysplasia (28.2%), 22 low-grade dysplasia (56.4%), two basal cell hyperplasia (5.1%) and four atypical squamous epithelium (10.3%).Twenty-seven patients (30 lesions) underwent follow-up endoscopy 3 months after CFB; the endoscopic and pathological local remnant/recurrence rate was 20% (6/30; 95% confidence interval (CI), 7.7-36.6%) and 16.7% (5/30; 95% CI, 5.6-34.7%), respectively. Location of the lesion in the hypopharynx was a significant risk factor associated with the endoscopic local remnant/recurrence (P = 0.049). No significant adverse events occurred. CONCLUSIONS: Cold forceps biopsy with jumbo biopsy forceps appears to be a safe and effective technique for excising diminutive pharyngeal neoplasms. Although small, the excised lesions may have a remarkably high frequency of high-grade dysplasia. (Clinical trial registration number: UMIN000037980).

[Nivolumab‒Induced Severe Thrombocytopenia in a Patient with Advanced Gastric Cancer].

Here, we report a case of severe thrombocytopenia induced by nivolumab. A 70‒year‒old woman with advanced gastric cancer was treated with nivolumab. After the first dose, she noticed an erythematous rash. During the second cycle, fever and purpura on the lower extremities were also noted. Laboratory examinations revealed severe thrombocytopenia of grade 4, mild hemolytic anemia, leukopenia, and coagulopathy. Immune‒related adverse events(irAE)were suspected, and we started 40 mg(0.7 mg/kg)prednisolone(PSL)per day. Her symptoms and laboratory data immediately improved. However, when we reduced the dose of PSL, she developed rash and thrombocytopenia again. We increased the dose of PSL to 40 mg, which was effective for improving these abnormalities. We then gradually reduced the PSL, paying attention to avoid a relapse of irAEs. We could not restart chemotherapy thereafter, and she died from progression of gastric cancer. As shown in this case, PSL is effective for immune‒related thrombocytopenia; however, determining how to reduce the dose of PSL and when to restart chemotherapy requires careful consideration.

Impact of submucosal saline solution injection for cold snare polypectomy of small colorectal polyps: a randomized controlled study.

BACKGROUND AND AIMS: Cold snare polypectomy (CSP) of small colorectal polyps is widely used. However, the technique is still troubled by insufficient resection depth, which may prevent precise pathologic evaluation. In this study, we investigated whether submucosal injection of saline solution helps to achieve deeper resection in CSP. METHODS: The study was a single-center, prospective, randomized trial. Patients with small (3- to 10-mm diameter) nonpedunculated adenomatous or sessile serrated colorectal polyps were randomly allocated to either conventional CSP (C-CSP) or CSP with submucosal injection (CSP-SI). Primary outcome was the rate of complete muscularis mucosae (MM) resection, defined by the proportion of MM under the tumor more than 80% of the tumor's horizontal dimension. Secondary outcomes were the rates of negative lateral and vertical margins, fragmentation of resected specimens, conversion to hot snare mucosal resection, intraprocedural bleeding, delayed bleeding, and perforation. RESULTS: Two hundred fourteen patients were randomly assigned to the CSP-SI (n = 107) or C-CSP (n = 107) group. The rate of complete MM resection was 43.9% in the CSP-SI group and 53.3% in the C-CSP group, a statistically insignificant difference. The rates of negative lateral margin and vertical margin (42.3% and 56.7%, respectively) in the CSP-SI group were significantly lower than those (58% and 76%) in the C-CSP group (P = .03 and P = .006, respectively). There was no polypectomy-related major bleeding or perforation. CONCLUSIONS: Saline solution injection into the submucosa did not improve the resection depth of CSP of small colorectal polyps, and the method resulted in lower rates of negative lateral and vertical margins of resected lesions. (Clinical trial registration number: UMIN000037980.).

Characterization of oral bacteria in the tongue coating of patients with halitosis using 16S rRNA analysis.

There are many studies on the relationship between the tongue coating and halitosis, but few have evaluated the bacterial community present in the tongue coating. This study identified bacteria in the tongue coating in individuals with and without halitosis using 16S rRNA analysis. Forty subjects (mean age, 46.1 ± 15.8 years) who visited the halitosis clinic at the University Dental Hospital between 2016 and 2017 were divided into halitosis (n = 32) and non-halitosis (n = 8) groups according to results from an organoleptic test (OT). Additional measurements via gas chromatography (GC) and the Breathtron® instrument confirmed the groupings as the H2S, CH3SH, (CH3)2S, and total volatile sulphur compounds (VSC) levels were significantly higher in the halitosis group than in the non-halitosis group. Bacterial diversity was higher in the halitosis group; the median (quartile) values of the Shannon index were 4.46 (4.21, 4.67) in the halitosis group and 3.80 (3.45, 4.30) in the non-halitosis group. Additionally, the median (quartile) values of the Chao-1 index were 84.0 (77.2, 95.0) in the halitosis group and 71.3 (65.0, 81.5) in the non-halitosis group. These differences in bacterial composition and diversity may further the understanding of causes and treatments for halitosis.

Post-polypectomy bleeding in hot-snare polypectomy of colonic polyps under continued warfarin or short interruption of direct oral anticoagulants.

BACKGROUND: Newly published guidelines of the Japanese Gastroenterological Endoscopy Society (JGES) suggest to consider endoscopic procedures with high risk of bleeding without stopping warfarin and with stopping direct oral anticoagulants (DOACs) only on the day of the procedure. In this study, we aimed to test the validity of these recommendations. PATIENTS AND METHODS: We retrospectively reviewed medical records of 344 patients with anticoagulant therapy who underwent hot-snare polypectomy between January 2012 and October 2018. Patients (n = 132) with interruption of anticoagulants (3-7 days for warfarin and 2-3 days for DOACs before the procedure) and without heparin-bridging were excluded. Among the remaining 212 patients, the incidence of post-polypectomy bleeding was compared between the following 2 patient groups: patients who had interruption of anticoagulants with heparin-bridging (HB group, n = 139) and patients treated according to the new JGES guideline (FG group, n = 73). RESULTS: The rate of post-polypectomy bleeding (PPB) in FG group (9.6%) was not significantly different from that in HB group (12.9%, p = 0.5). In subgroup analysis, the incidence of bleeding in patients with warfarin (12.2%) and with DOAC (6.3%) in FG group was not significantly different from corresponding figures in HB group (14.2%, 0%). In multivariate analysis, number of resected polyps was associated with PPB, but the administration of anticoagulants according to the new guidelines was not a significant risk factor for PPB (p = .98). CONCLUSIONS: Our study affirms the recommendations of JGES for the management of anticoagulants in patients who undergo colonic polypectomy regarding post-polypectomy bleeding.

[Sclerosing mesenteritis diagnosed using computed tomography- and ultrasound-guided needle biopsy -utility of the coaxial technique].

Here, we report the case of an 82-year-old woman with sclerosing mesenteritis diagnosed using needle biopsy under the guidance of computed tomography (CT) and ultrasound (US). The patient manifested appetite loss, weight loss, and epigastric pain. CT of the abdomen and pelvis revealed increased density of the mesentery adjacent to the small bowel along with enlarged lymph nodes. Hence, we suspected sclerosing mesenteritis but also considered malignancies, such as lymphoma. We then performed CT- and US-guided needle biopsy with coaxial technique. We inserted an introducer needle by verifying its location using CT and extracted multiple specimens using a finer needle that passed through the introducer without incident. The collected specimens were adequate and histological diagnosis revealed sclerosing mesenteritis. We treated the patient with corticosteroids, and her symptoms and radiographic findings improved. Thus, the coaxial technique was a useful and minimally invasive tool for the diagnosis of sclerosing mesenteritis.

Prevalence and risk factors of halitosis in Japanese school children.

BACKGROUND: Little data are available regarding halitosis in Japanese children. The aim of the current study was to investigate the prevalence and risk factors associated with halitosis in Japanese elementary and junior high school children. METHODS: The subjects consisted of 520 elementary (1st-6th grade: boys, n = 284; girls, n = 236) and 248 junior high (7th-9th grade: boys, n = 136; girls, n = 112) school children aged 6-15 years in Saitama Prefecture, Japan. A self-administered questionnaire survey; halitosis measurement using an organoleptic assessment method; and clinical oral examination were conducted. RESULTS: Overall, 44.9% of subjects had halitosis. The proportion of boys with halitosis was 43.6% and that of girls was 46.6%. On logistic regression analysis, grade and tongue coating were significant predictors of halitosis. The 7th-9th graders were significantly more likely to have halitosis than 1st-3rd graders (OR, 1.83; P = 0.007). Subjects with area of tongue coating score 2 or 3 were 5.51-fold more likely to present with halitosis (P < 0.001) than those with area of tongue coating score 0 or 1. Similarly, subjects with thickness of tongue coating score 2 or 3 were 3.28-fold more likely to have halitosis than those with thickness of tongue coating score 0 or 1 (P < 0.001). CONCLUSIONS: Halitosis in the school children is not a rare condition; instead, its occurrence is relatively high. Therefore, inclusion of a halitosis prevention and management component in school oral health programs would lead to the promotion of overall oral health.

Early Childhood Caries and Risk Factors in Vietnam.

OBJECTIVE: To investigate caries prevalence and examine its relationship with socioeconomic status and oral health behavior of Vietnamese kindergarten children. STUDY DESIGN: The study was carried out on 1,028 children aged 2-5 years in six kindergartens in Thua Thien Hue province, Vietnam. Information about socioeconomics and oral health behaviors was collected through a self-administered questionnaire, and oral health status by clinical dental examination. RESULTS: Clinical dental examination found that overall caries prevalence and mean dmft were 89.1% and 9.32. Caries prevalence and mean dmft increased greatly from two years to three years old, and gradually developed from three years to five years old. A logistic regression revealed that caries had an inverse relationship with mothers' educational level and a positive relationship with the habit of retaining food in the mouth for a long time in two-year-old children. Prolonged breastfeeding, more frequent sweets consumption, no thumb sucking habit, and higher modified debris index score were the risk factors for caries among three-to-five-year-old children. CONCLUSIONS: This study indicated a high prevalence of caries and related risk factors such as low mother's educational level and inappropriate oral health behavior among kindergarten children in Vietnam.

Two cases of acute gastric dilation after radiofrequency catheter ablation for supraventricular arrhythmia.

We describe our experience with two cases of acute gastric dilation after radiofrequency catheter ablation (RFCA) for supraventricular arrhythmia. After the RFCA procedure, patients experienced epigastric pain, abdominal distension, and vomiting. Computed tomography showed marked dilation of their stomachs, but without apparent obstruction of the gastric antrum or the duodenum. Esophagogastroduodenoscopy and upper gastrointestinal series revealed significant gastroparesis. We considered that gastric hypomotility had been induced by vagus nerve injury after RFCA. Peristaltic stimulants effectively improved the patients' symptoms by improving gastric motility. There have been few reports of acute gastric dilation after RFCA in Japan to date, but the possibility of encountering this condition is expected to increase in parallel with the recent increased use of RFCA. Therefore, gastroenterologists should be alert to this rare complication.

Evaluation of English Websites on Dental Caries by Using Consumer Evaluation Tools.

PURPOSE: To evaluate the quality of patient-oriented online information about dental caries using existing consumer evaluation tools and to judge the efficacy of these tools in quality assessment. MATERIALS AND METHODS: The websites for the evaluation were pooled by using two general search engines (Google and Yahoo!). The search terms were: 'dental caries', 'tooth decay' and 'tooth cavity'. Three assessment tools (LIDA, DISCERN and FRES) were used to evaluate the quality of the information in the areas of accessibility, usability, reliability and readability. RESULTS: In total, 77 websites were analysed. The median scores of LIDA accessibility and usability were 45.0 and 8.0, respectively, which corresponded to a medium level of quality. The median reliability scores for LIDA (12.0) and DISCERN (20.0) both corresponded to low level of quality. The readability was high with the median FRES score 59.7. CONCLUSION: The websites on caries had good accessibility, usability and readability, while reliability of the information was poor. The LIDA instrument was found to be more convenient than DISCERN and can be recommended to lay people for quick quality assessment.

[Abnormal Low Blood Pressure after Induction of General Anesthesia in a Patient on Medication for Depression].

A patient under medication for depression underwent orthopedic surgery for osteoarthritis of the knee four times. For the second surgery, general anesthesia was induced with propofol, remifentanil, and rocuronium. Immediately after induction, she developed severe hypotension that was resistant to vasopressors. The hypotension likely resulted from the effect of psychotropic drugs, including levomepromazine, olanzapine, and clomipramine, which she had been receiving for a long time. Although her blood pressure recovered, the surgery was cancelled. We performed spinal anesthesia for the subsequent surgery to minimize interactions between anesthetic and psychotropic agents. A continuous infusion of the local anesthetic bupivacaine through a epidural catheter was started during the surgery. Although her general condition was stable during surgery, she developed hypotension after returning to the ward. We suspected an interaction with the psychotropic agents, and thus stopped infusion of the local anesthetic, after which, her blood pressure gradually increased. The first and fourth surgeries were performed uneventfully under spinal anesthesia. This case suggests that anesthesiologists should pay special attention to the interaction between anesthetic and psychotropic agents during anesthesia. Further, psychotropic drug withdrawal before surgery should be considered, if possible. Moreover, vasopressin may be utilized to treat catecholamine-resistant hypotension.

Saliva viscosity as a potential risk factor for oral malodor.

OBJECTIVES: The objective of this study was to assess whether saliva viscosity, measured by a viscometer, was a predictor of oral malodor. MATERIALS AND METHODS: The subjects were 617 patients who visited an oral malodor clinic. The organoleptic test (OT) was used for diagnosis of oral malodor. An oral examination assessed the numbers of teeth present and decayed teeth as well as the presence or absence of dentures. Further, periodontal pocket depths (PD), gingival bleeding, dental plaque and tongue coating were investigated. Unstimulated saliva were collected for 5 min. Saliva viscosity was measured with a viscometer. Logistic regression analysis with oral malodor status by OT as a dependent variable was performed. Possible confounders including age, gender, number of teeth present, number of decayed teeth, number of teeth with PD ≥ 4 mm, number of teeth with bleeding on probing, presence or absence of dentures, plaque index, area of tongue coating, saliva flow rate, saliva pH and saliva viscosity were used as independent variables. RESULTS: Saliva viscosity (p = 0.047) along with the number of teeth with PD ≥4 mm (p = 0.001), plaque index (p = 0.037) and area of tongue coating (p < 0.001) were significant variables for oral malodor. Subjects with a higher number of teeth with PD ≥ 4 mm (OR = 1.32), plaque index (OR = 2.13), area of tongue coating (OR = 3.17) and saliva viscosity (OR = 1.10) were more likely to have oral malodor compared to those with lower values. CONCLUSIONS: The results suggested that high saliva viscosity could be a potential risk factor for oral malodor.

Evaluation of a Russian version of the oral health literacy instrument (OHLI).

BACKGROUND: Oral health literacy has become a popular research area in the last decade; however, to date no health literacy instruments in the Russian language exist. The objectives of this study were to develop a Russian version of the Oral Health Literacy Instrument (OHLI) and to examine its reliability and validity. METHODS: A convenience sample of patients who visited the dental division of the district hospital in Belarus was used in the study. The OHLI, created originally in English, was modified to adapt it to characteristics of routine dental services in Belarus and then translated into Russian, followed by back-translation. Participants completed a self-administered socio-demographic questionnaire, an oral health knowledge test and the Russian version of the OHLI (R-OHLI). Bivariate and multivariate statistical analyses, including multiple regression modeling, were performed to examine reliability and validity of the R-OHLI. RESULTS: Participants were 281 adult patients aged from 18 to 60 years, with a mean age of 33.1 ± 12.2; 64.1% of them were women. Cronbach's alpha values for the two sections (reading comprehension and numeracy) and the total R-OHLI were 0.853, 0.815 and 0.895, respectively. The mean total R-OHLI score was 77.2 ± 14.5; the mean reading comprehension and numeracy scores were 39.5 ± 7.5 and 37.8 ± 8.8, respectively. The R-OHLI was significantly correlated to the oral health knowledge test. Pearson's correlation coefficients between the oral health knowledge test and the reading comprehension, numeracy and total R-OHLI were 0.401, 0.258, and 0.363, respectively (p < 0.001). Women, participants with a university degree, and those who visited a dentist at least once a year had significantly (p < 0.05) higher mean scores for each section (reading comprehension, numeracy) and for total R-OHLI compared to their counterparts. CONCLUSIONS: The R-OHLI showed good internal consistency and test-retest reliability. It was significantly associated with the oral health knowledge test, socio-demographic and behavioral factors. Therefore, the R-OHLI was proved to be a reliable and valid oral health literacy instrument for Russian-speaking people.

Taste hyposensitivity in Japanese schoolchildren.

BACKGROUND: There is some research on taste disorder/hyposensitivity in special groups such as the elderly or patients presenting with specific taste problems, however few studies have been conducted among young populations. The objectives of this study were to estimate the prevalence of taste hyposensitivity and to investigate the relationship between taste hyposensitivity and oral health status in Japanese schoolchildren. METHODS: Subjects were 237 primary and 112 junior high school students in Saitama Prefecture, Japan. In total, 349 (boys: 181, girls: 168) students aged 6-15 years participated in the study. Oral examinations and whole-mouth taste tests using four tastes (sweet, salt, sour and bitter) solutions were conducted on the subjects. A subject who could not recognize the taste of the solution was defined as demonstrating hyposensitivity. RESULTS: Hyposensitivity was observed in 6.3% of all subjects for sweet-taste, 14.3% for salt-taste, 20.9% for sour-taste and 6.0% for bitter-taste. The prevalence of sweet, sour and bitter-taste hyposensitivity decreased as the subjects' grade advanced. In contrast, the prevalence of salt-taste hyposensitivity increased in 7th-9th grade subjects. Furthermore, the prevalence of bitter-taste hyposensitivity was significantly higher in males than females among 1st-3rd graders.Taste hyposensitivity had little association with oral health status, such as decayed teeth, filled teeth, dental plaque, gingival status and tongue coating. CONCLUSIONS: In this study, taste hyposensitivity was observed in 6.0%-20.9% of the students. There was little association between taste hyposensitivity and oral health status. The current study implies that the factors affecting the taste hyposensitivity in children may different from those in the elderly. Therefore it is necessary to further investigate the causes of taste hyposensitivity among younger generation.

Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines.

This systematic review and meta-analysis reports on outcomes and hepatic toxicity rates after stereotactic body radiation therapy (SBRT) for liver-confined hepatocellular carcinoma (HCC) and presents consensus guidelines regarding appropriate patient management. Using the Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines, a systematic review was performed from articles reporting outcomes at ≥5 years published before October 2022 from the Embase, MEDLINE, Cochrane, and Scopus databases with the following search terms: ("stereotactic body radiotherapy" OR "SBRT" OR "SABR" OR "stereotactic ablative radiotherapy") AND ("hepatocellular carcinoma" OR "HCC"). An aggregated data meta-analysis was conducted to assess overall survival (OS) and local control (LC) using weighted random effects models. In addition, individual patient data analyses incorporating data from 6 institutions were conducted as their own subgroup analyses. Seventeen observational studies, comprising 1889 patients with HCC treated with ≤9 SBRT fractions, between 2003 and 2019, were included in the aggregated data meta-analysis. The 3- and 5-year OS rates after SBRT were 57% (95% confidence interval [CI], 47%-66%) and 40% (95% CI, 29%-51%), respectively. The 3- and 5-year LC rates after SBRT were 84% (95% CI, 77%-90%) and 82% (95% CI, 74%-88%), respectively. Tumor size was the only prognostic factor for LC. Tumor size and region were significantly associated with OS. Five-year LC and OS rates of 79% (95% CI, 0.74-0.84) and 25% (95% CI, 0.20-0.30), respectively, were observed in the individual patient data analyses. Factors prognostic for improved OS were tumor size <3 cm, Eastern region, Child-Pugh score ≤B7, and the Barcelona Clinic Liver Cancer stage of 0 and A. The incidence of severe hepatic toxicity varied according to the criteria applied. SBRT is an effective treatment modality for patients with HCC with mature follow-up. Clinical practice guidelines were developed on behalf of the International Stereotactic Radiosurgery Society (ISRS).

Association between parity and dentition status among Japanese women: Japan public health center-based oral health study.

BACKGROUND: Several studies have shown that parity is associated with oral health problems such as tooth loss and dental caries. In Japan, however, no studies have examined the association. The purpose of this study was to determine whether parity is related to dentition status, including the number of teeth present, dental caries and filled teeth, and the posterior occlusion, in a Japanese population by comparing women with men. METHODS: A total of 1,211 subjects, who participated both in the Japan Public Health Center-Based (JPHC) Study Cohort I in 1990 and the dental survey in 2005, were used for the study. Information on parity or number of children was collected from a self-completed questionnaire administered in 1990 for the JPHC Study Cohort I, and health behaviors and clinical dentition status were obtained from the dental survey in 2005. The association between parity or number of children and dentition status was analyzed, by both unadjusted-for and adjusted-for socio-demographic and health behavioral factors, using a generalized linear regression model. RESULTS: Parity is significantly related to the number of teeth present and n-FTUs (Functional Tooth Units of natural teeth), regardless of socio-demographic and health behavioral factors, in female subjects. The values of these variables had a significantly decreasing trend with the rise of parity: numbers of teeth present (p for trend = 0.046) and n-FTUs (p for trend = 0.026). No relationships between the number of children and dentition status were found in male subjects. CONCLUSION: Higher-parity women are more likely to lose teeth, especially posterior occluding relations. These results suggest that measures to narrow the discrepancy by parity should be taken for promoting women's oral health. Delivery of appropriate information and messages to pregnant women as well as enlightenment of oral health professionals about dental management of pregnant women may be an effective strategy.