Genome-Wide Association Study Identifies Risk Variants for Lichen Planus in Patients With Hepatitis C Virus Infection.

BACKGROUND & AIMS: There is a close relationship between hepatitis C virus (HCV) infection and lichen planus, a chronic inflammatory mucocutaneous disease. We performed a genome-wide association study (GWAS) to identify genetic variants associated with HCV-related lichen planus. METHODS: We conducted a GWAS of 261 patients with HCV infection treated at a tertiary medical center in Japan from October 2007 through January 2013; a total of 71 had lichen planus and 190 had normal oral mucosa. We validated our findings in a GWAS of 38 patients with HCV-associated lichen planus and 7 HCV-infected patients with normal oral mucosa treated at a medical center in Italy. RESULTS: Single-nucleotide polymorphisms in NRP2 (rs884000) and IGFBP4 (rs538399) were associated with risk of HCV-associated lichen planus (P < 1 × 10-4). We also found an association between a single-nucleotide polymorphism in the HLA-DR/DQ genes (rs9461799) and susceptibility to HCV-associated lichen planus. The odds ratios for the minor alleles of rs884000, rs538399, and rs9461799 were 3.25 (95% confidence interval, 1.95-5.41), 0.40 (95% confidence interval, 0.25-0.63), and 2.15 (95% confidence interval, 1.41-3.28), respectively. CONCLUSIONS: In a GWAS of Japanese patients with HCV infection, we replicated associations between previously reported polymorphisms in HLA class II genes and risk for lichen planus. We also identified single-nucleotide polymorphisms in NRP2 and IGFBP4 loci that increase and reduce risk of lichen planus, respectively. These genetic variants might be used to identify patients with HCV infection who are at risk for lichen planus.

Survey of Medical Referral by Japanese Dentists for Patients With Hepatitis B, Hepatitis C, and Lichen Planus.

OBJECTIVES: This study aimed to investigate the referral rates of oral lichen planus (OLP) and untreated hepatitis virus-infected patients by dentists to hepatologists. MATERIALS AND METHODS: The study was conducted at three dental clinics in the Oita prefecture between November 2021 and June 2023. Two distinct groups of patients who visited the dentist for dental treatment were included: those with liver disease and concurrent hepatitis C virus (HCV) or hepatitis B virus (HBV) infection and those diagnosed with OLP. The rate of medical referrals to a hepatologist was investigated. Data on the number of patients, gender, age, diagnosis of liver disease, and referral practices were collected from the records submitted by each dental clinic. Information about the HCV and HBV infection status was collected through interviews with the dentists. RESULTS: A total of 1,665 patients were included, of which 10 were HCV-infected, five were HBV-infected, and six were diagnosed with OLP. None of the 15 patients with liver disease were referred to a hepatologist by their dentists. Nine out of the 10 HCV-infected patients had achieved sustained virological response (SVR) after antiviral treatment. Of the six patients with OLP, one had a history of HBV infection, one had severe fatty liver, and the remaining four had normal livers; five of the OLP patients were referred to a hepatologist (83.3%). CONCLUSION: A high referral rate from dentists to hepatologists was observed among the OLP patients. However, the study highlighted the difficulties in identifying hepatitis patients and establishing appropriate medical coordination in dental institutions.

Hepatitis B and C infections among Japanese dental health workers: Insights from vaccination rates and screening results in the Oita prefecture.

OBJECTIVE: This study examined the hepatitis B virus (HBV) and hepatitis C virus (HCV) infection rates and vaccination rates for hepatitis B (HB) among dental healthcare workers (DHCWs) in the Oita prefecture, Japan. METHODS: Hepatitis virus testing was conducted on 1920 participants (486 dentists and 1434 dental staff). Anonymous data on age, gender, occupation, hepatitis B surface antigen (HBsAg), antibodies to hepatitis B surface antigen (anti-HBs), antibodies to HCV (anti-HCV), history of HB vaccination, and antiviral treatment for individuals with positive anti-HCV were collected. RESULTS: The positivity rates for HBsAg, anti-HBs, and anti-HCV were 0.5%, 39.7%, and 0.6%, respectively. Dentists had significantly higher rates of anti-HBs positivity (53.9% vs. 34.9%; p < .0001) and anti-HCV positivity (1.4% vs. 0.3%; p = .0080) compared to dental staff. The vaccination and non-vaccination rates among 1395 with a known HB vaccination history were 59.1% and 40.9%, respectively. Dentists had a significantly higher HB vaccine vaccination rate than the dental staff (73.6% vs. 54.0%; p < .0001). Those in the vaccination group were younger (p < .0001), had a higher proportion of males (p = .0022) and dentists (p < .0001), a lower HBsAg positivity rate (p < .0097), and a higher anti-HBs positivity rate (p < .0001) compared to those in the non-vaccination group. The positivity rate of HBsAg and anti-HBs in the unvaccinated group increased with age, with HBsAg positivity reaching 3.8% in the 70s and anti-HBs positivity reaching 40.4% in the 70s and 66.7% in the 80s. CONCLUSIONS: This study highlights the need to raise awareness about hepatitis prevention vaccination, particularly among dental staff, due to differences in HB vaccination rates across occupations. In particular, they indicated that elderly DHCWs may be more vulnerable to HBV infection. Regular monitoring of the vaccination rate and infection risk is crucial.

Independent factors associated with altered plasma active ghrelin levels in HCV-infected patients.

BACKGROUND & AIMS: Metabolic disorders are frequently seen in hepatitis C virus (HCV)-infected patients. Ghrelin, a gut hormone, regulates hepatic metabolisms, and must be activated to exert its biological effects. The aims of this study were to investigate changes in plasma active ghrelin levels and identify independent factors associated with plasma active ghrelin levels in HCV-infected patients. METHODS: We enrolled patients with HCV infection (n = 96), hepatitis B virus (HBV) infection (n = 49), non-alcoholic fatty liver disease (NAFLD; n = 20) and healthy subjects (CON; n = 16). Plasma active ghrelin levels were measured using ELISA. Factors associated with plasma active ghrelin levels were assessed by multivariate and Spearman's correlation analyses. RESULTS: Plasma active ghrelin levels were significantly lower in relation to the severity of liver disease in both the HBV and HCV groups. Furthermore, HCV infection was identified as an independent factor associated with decreased plasma active ghrelin levels in the multivariate analysis (OR -3.05; 95% CI -0.93 to -19.51; P = 0.0192). Plasma active ghrelin levels were significantly correlated with serum albumin levels in the HCV group (ρ = 0.497, P < 0.0001). CONCLUSIONS: We demonstrated that liver cirrhosis and HCV infection were independent factors associated plasma active ghrelin levels. Moreover, plasma active ghrelin levels were positively correlated with serum albumin levels among HCV-infected patients. Therefore, active ghrelin levels may be regulated by both progression of liver disease and HCV infection and could be involved in the regulation of serum albumin levels in HCV-infected patients.

Onset of Oral Lichen Planus Led to Direct-Acting Antiviral Therapy in a Patient with Long-Term Hepatitis C: The Role of a Dentist as Gatekeeper.

Oral lichen planus (OLP), a chronic inflammatory mucocutaneous disease, is an extrahepatic manifestation of a hepatitis C virus infection. In recent years, direct-acting antivirals (DAAs) have made great strides in the treatment of hepatitis C. However, there might be a lack of information about the treatment strategies available among those with this condition. Herein, we report a case of an 85-year-old female patient who was diagnosed with hepatitis C at the age of 55 but had not received antiviral treatment over the past 30 years. She underwent DAA treatment following a recommendation from her oral surgeon after the onset of OLP. The patient had declined interferon therapy in the past, owing to concerns about its side effects. She was unaware of the benefits of DAA treatment, probably due to communication difficulties caused by senile hearing loss. Consultation with an oral surgeon for an erosive form of OLP led her to receive antiviral therapy for hepatitis C. She achieved a sustained virologic response (SVR) following the DAA treatment, along with improvements in the signs and symptoms of OLP. Oral surgeons play an important role as gatekeepers in guiding untreated hepatitis patients toward appropriate treatment.

Feline infectious peritonitis virus with a large deletion in the 5'-terminal region of the spike gene retains its virulence for cats.

In this study, the Japanese strain of type I feline infectious peritonitis virus (FIPV), C3663, was found to have a large deletion of 735 bp within the gene encoding the spike (S) protein, with a deduced loss of 245 aa of the N-terminal region of the S protein. This deletion is similar to that observed in porcine respiratory coronavirus (PRCoV) when compared to transmissible gastroenteritis virus, which correlates with reduced virulence. By analogy to PRCoV, we expected that the pathogenicity of C3663 may be attenuated in cats. However, two of four cats inoculated with C3663 died of FIP, and a third C3663-inoculated cat showed FIP lesions at 91 days after challenge. These results indicate that the 5'-terminal region of the S gene is not essential for the development of FIP.

Effect of branched-chain amino acid-enriched nutritional supplementation on interferon therapy in Japanese patients with chronic hepatitis C virus infection: a retrospective study.

BACKGROUND: The aims of this study were to evaluate the effects of nutritional supplementation with branched-chain amino acids (BCAA) with zinc component (Aminofeel®) on adherence to and outcome of therapy in patients treated with interferon (IFN) for chronic hepatitis C and cirrhosis and to determine whether to recommend the supplement. METHODS: In this retrospective study, 51 patients who received IFN therapy were investigated among 203 consecutive patients who visited our hospital and were advised regarding the potential benefit of taking Aminofeel®. Each patient was free to choose whether to purchase and take Aminofeel®. RESULTS: Twenty four patients (group 1-A) took Aminofeel® during standard IFN therapy and 13 (group 1-B) did not. Low-dose, long-term IFN (maintenance) therapy, mainly peglated (Peg)-IFN alpha 2a, was administered to 14 patients who were difficult to treat, because of no effect or harmful side effects with standard IFN therapy, and who had advanced liver fibrosis. Among the 14, 11 patients (group 2-A) took Aminofeel® and 3 (group 2-B) did not. The prevalence of obesity was significantly higher (P=0.04) in group 1-A than in group 1-B. The rate of adherence to IFN therapy was higher in group 1-A (83.3%) than in group 1-B (53.8%, P=0.05). There were no significant differences between the two groups in the rates of sustained virological response (SVR) to IFN therapy. According to multivariate analysis, two factors, SVR and intake of Aminofeel®, were associated with successful adherence to IFN therapy. The adjusted odds ratios for these two factors were 13.25 and 12.59, respectively, and each was statistically significant. The SVR rate of maintenance IFN therapy was in 18.2% group 2-A and 0% in group 2-B. CONCLUSION: Our data show that BCAA intake is useful for adherence to and effect of IFN therapy for patients with chronic hepatitis C. Nutritional supplementation with BCAA seems to be useful for HCV-infected patients receiving IFN therapy because it is impossible to introduce standard treatment for all patients among Japan's aging population.

A retrospective case-control study of hepatitis C virus infection and oral lichen planus in Japan: association study with mutations in the core and NS5A region of hepatitis C virus.

BACKGROUND: The aims of this study were to assess the prevalence of hepatitis C virus (HCV) infection in Japanese patients with oral lichen planus and identify the impact of amino acid (aa) substitutions in the HCV core region and IFN-sensitivity-determining region (ISDR) of nonstructural protein 5A (NS5A) associated with lichen planus. METHODS: In this retrospective study, 59 patients (group 1-A) with oral lichen planus among 226 consecutive patients who visited our hospital and 85 individuals (group 1-B, controls) with normal oral mucosa were investigated for the presence of liver disease and HCV infection. Risk factors for the presence of oral lichen planus were assessed by logistic regression analysis. We compared aa substitutions in the HCV core region (70 and/or 91) and ISDR of NS5A of 12 patients with oral lichen planus (group 2-A) and 7 patients who did not have oral lichen planus (group 2-B) among patients (high viral loads, genotype 1b) who received interferon (IFN) therapy in group1-A. RESULTS: The prevalence of anti-HCV and HCV RNA was 67.80% (40/59) and 59.32% (35/59), respectively, in group 1-A and 31.76% (27/85) and 16.47% (14/85), respectively, in group 1-B. The prevalence of anti-HCV (P < 0.0001) and HCV RNA (P < 0.0001) in group 1-A was significantly higher than those in group 1-B. According to multivariate analysis, three factors - positivity for HCV RNA, low albumin level (< 4.0 g/dL), and history of smoking - were associated with the development of oral lichen planus. The adjusted odds ratios for these three factors were 6.58, 3.53 and 2.58, respectively, and each was statistically significant. No significant differences in viral factors, such as aa substitutions in the core region and ISDR of NS5A, were detected between the two groups (groups 2-A and -B). CONCLUSION: We observed a high prevalence of HCV infection in patients with oral lichen planus. Longstanding HCV infection, hypoalbuminemia, and smoking were significant risk factors for the presence of oral lichen planus in patients. It is advisable for Japanese patients with lichen planus to be tested for HCV infection during medical examination.

Candidiasis and other oral mucosal lesions during and after interferon therapy for HCV-related chronic liver diseases.

BACKGROUND: Oral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection. METHODS: Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 ± 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out. RESULTS: Cultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94). CONCLUSION: We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.

Effects and outcomes of interferon treatment in Japanese hepatitis C patients.

BACKGROUND: No study has compared the long-term prognoses of hepatitis C patients with hepatitis C virus (HCV) antibody-negative individuals and investigated the effects of interferon (IFN) treatment. To clarify the long-term prognosis of HCV-positive residents of an isolated Japanese island and prospectively investigate the effects of IFN treatment in comparison with the HCV-negative general population. METHODS: HCV antibody was positive in 1,343 (7.6%) of the 17,712 individuals screened. 792 HCV RNA-positive, HBsAg-negative subjects were enrolled. 1,584 HCV antibody-negative, HBsAg-negative general residents were sex- and age-matched to the 792 subjects. A total of 154 <70-year-old patients without liver cirrhosis (LC) or hepatocellular carcinoma (HCC) underwent IFN treatment. The survival rate with all-cause death as the endpoint was determined and causes of death were compared. RESULTS: The 10- and 20-year survival rates of the hepatitis C and general resident groups were 65.4% and 87.8%, and 40.8% and 62.5%, respectively (p < 0.001; hazard risk ratio, 0.444; 95% confidence interval (CI): 0.389-0.507). There were 167 liver disease-related deaths and 223 deaths from other causes in the hepatitis C group, and 7 and 451, respectively, in the general resident group. Liver disease-related death accounted for 43.8% and 1.5% of deaths in the hepatitis C and general resident groups (p < 0.0001). The cumulative survival rate of the hepatitis C patients without IFN (n = 328) was significantly lower than the gender- and age-matched general resident group (n = 656) (p < 0.0001) but there was no significant difference between the IFN-treated (n = 154) and general resident groups (n = 308). CONCLUSIONS: In the hepatitis C group, the proportion of liver disease-related death was markedly higher, and the survival rate lower, than the general resident group. Introduction of IFN treatment in <70-year-old patients with hepatitis C without LC or HCC improved the survival rate to a level comparable to that of the general residents.

Education and Awareness Activities Regarding Hepatitis B and C Among Japanese Dental Health Workers in the Oita Prefecture.

OBJECTIVES: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are known to pose a major threat for dental health workers (DHWs). Previously, we reported that the HBV and HCV infection rates among DHWs in the Oita Prefecture in Japan were higher than those among the general population. The aim of this study was to disseminate knowledge about hepatitis and its prevention among the DHWs. MATERIALS AND METHODS: Educational booklets were mailed to 2,197 DHWs working in 487 dental clinics. After anonymously responding to online questions about their experience with HBV and HCV testing, Hepatitis B vaccination, and percutaneous injury, the subjects were required to respond to additional questions about their understanding of hepatitis. RESULTS: A total of 521 DHWs (205 males and 316 females) responded to the questionnaires. Among them, 61.6% had experienced percutaneous injuries, but only 19.4% were fully aware of how to deal with them before reading the booklet, and also 10.6% had sufficient knowledge about hepatitis. The past Hepatitis B vaccination, past HBV testing rate, and past HCV testing rate were 62.4%, 71.8%, and 43.2%, respectively. The DHWs who are not dentists (n = 293) had significantly lower rates of past testing for their own hepatitis virus, knowledge about treatment of percutaneous injuries, and awareness of hepatitis as compared to dentists (n = 228). After reading the booklet, 99.5% of subjects found the booklet useful and 87.3% said it would influence their future hepatitis testing. CONCLUSION: The educational booklet was effective way to increase DHWs' knowledge about Hepatitis B and C and how to manage percutaneous injuries.

Effect of oral care gel on the quality of life for oral lichen planus in patients with chronic HCV infection.

BACKGROUND: Oral lichen planus (OLP) decreases the quality of life because it can cause spontaneous pain during eating and tooth-brushing and an uncomfortable feeling in the mouth. In addition, OLP may be associated with HCV-related liver disease.We investigated the visual analogue scale (VAS) and effects of oral care gel, REFRECARE-H®, on patients with OLP associated with HCV infection. RESULTS: Nine OLP patients (mean age 67.9 ± 7.6 years) with HCV-related liver diseases were recruited and their VAS score determined along with a biochemical examination of the blood. Types of OLP included erosive (6 patients) and reticular (3). REFRECARE-H®, an oral care gel (therapeutic dentifrice) containing hinokitiol, was applied by each patient as a thin layer on the oral membrane, after each meal and at bedtime for 30 days. Application of REFRECARE-H® improved the quality of life in all terms of dry mouth, breath odor, oral freshness, oral pain during rest, oral pain at a mealtimes, taste disorder, loss of appetite, sleep disorder, depressive mood and jitteriness. VAS scores of dry mouth, breath odor, oral freshness, and sleep disorder were significantly increased 30 days after application of REFRECARE-H® (P = 0.01, P = 0.05, P = 0.03, P = 0.04). VAS scores of oral pain at a mealtimes and taste disorder were increased 30 days after application of REFRECARE-H® (P = 0.06). There was an absence of side effects. CONCLUSIONS: REFRECARE-H® improved the quality of life for OLP. It is necessary for the hepatologist to educate patients regarding oral hygiene, as well as provide treatment of liver disease.

The role of dentists in controlling hepatocellular carcinoma in Japan (Review).

In Japan, the method of treatment for hepatitis is well established due to the high rates of hepatitis C. However, the identification of patients with hepatitis who do not receive appropriate treatment poses a major problem. Some patients with this disease may need to consult with a dentist due to the development of extrahepatic manifestations, such as lichen planus, in the oral cavity. Alternatively, the dentist might discover patients with untreated hepatitis C and hepatitis B during routine dental examination. In such cases, the patient should be referred to a hepatologist for further examinations and treatment. Thus, dentists are required to act as 'gatekeepers of hepatitis'. Furthermore, Japanese dentists need to increase hepatitis B vaccine coverage for infection control. By acting as a 'care coordinator of hepatitis', the dentist will be able to contribute to the eradication of liver cancer in Japan, thereby eliminating the discrimination and prejudice against patients with hepatitis. Dentists need to have a deep understanding of liver disease from the viewpoints of both nosocomial infection control and treatment of oral diseases.

Effects of Hepatitis C Virus Elimination by Direct-Acting Antiviral Agents on the Occurrence of Oral Lichen Planus and Periodontal Pathogen Load: A Preliminary Report.

OBJECTIVE: The association between hepatitis C virus (HCV) and oral lichen planus (OLP) is well known, but the association with periodontal disease has been reported less often. The purpose of this study was to investigate the effects of periodontal bacteria and OLP lesions before and after HCV elimination. Subjects and Methods. The subjects were four OLP patients (mean age 72.5 years) with HCV infection. Six types of periodontal bacteria (Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Fusobacterium nucleatum) were quantified in saliva, and changes in OLP were examined before and after elimination of HCV by antiviral therapy. Biochemical blood tests also were performed. RESULTS: The total number of periodontal bacteria, the numbers of P. gingivalis, T. forsythia, T. denticola, and F. nucleatum, and the risk of presenting with the red-complex bacteria (P. gingivalis, T. forsythia, and T.denticola), leading to periodontal disease progression, decreased after HCV elimination. OLP disappeared in three of the four patients and decreased in the other after sustained virological responses (SVRs). CONCLUSION: HCV elimination not only improved OLP lesions but also reduced the number of periodontal pathogens and the amount of red-complex periodontal pathogens.

Analysis of hepatitis B and C virus infections amongst members of the Dental National Health Insurance Society in the Oita Prefecture.

In Japan, ~3 million individuals are estimated to be infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). The rates of hepatitis virus infection amongst dentists is higher than that amongst other healthcare workers due to increased exposure to both saliva and blood. However, an efficient method for the testing of hepatitis virus infections amongst dentists remains to be established. The aim of the present study was to examine the rate of hepatitis virus infection amongst dental healthcare workers (DHWs) by introducing a health checkup that included screening for HBV and HCV infections. A total of 1,834 members of the Dental National Health Insurance Society in the Oita Prefecture, consisting of dentists and other employees, were tested for hepatitis B surface antigen (HBsAg), antibodies to HBsAg (anti-HBs) and antibodies to HCV (anti-HCV) during routine medical checkups. Anonymized data, including the age, sex, occupation (dentist or employee), and presence of a hepatitis virus marker, was collected and analyzed. The positive rates of HBsAg, anti-HBs and anti-HCV in the study sample were 0.6, 44.1 and 0.5%, respectively; the positive rates were higher amongst dentists than the employees. Furthermore, the positive rates of HBsAg and anti-HCV increased with age and were higher in subjects aged 50-79 (1.7-2.2%). The positive rate of presence of anti-HBs was significantly higher in the dentists compared with employees (56.4 vs. 39.6%; respectively; P<0.0001). The three factors associated with anti-HB positivity were HBsAg negativity, occupation (dentist) and age (20-29 years) with adjusted odds ratios of 8.29, 2.27 and 1.59, respectively (P<0.05). These results suggest that introducing a hepatitis virus examination during routine health checkups of DHWs may prove useful in identifying infected individuals.

Effect of Oral Care in a Patient with Depression and Burning Mouth Syndrome during the COVID-19 Pandemic.

Burning mouth syndrome (BMS) is a burning sensation that occurs in the mouth without any underlying cause. There is no satisfactory treatment for BMS, so far. Herein, we report the case of a 74-year-old female with untreated depression who presented with BMS. Despite taking antidepressants, she developed suicidal thoughts, particularly due to the increasing number of coronavirus disease 2019 (COVID-19) cases and suicides in Japan. The symptoms of BMS and the oral discomfort were eliminated using a multifaceted approach, which included the following: continuous application of the oral care gel "REFRECARE-H®" to the mucous membranes, regular dental visits, collaboration with medical and dental professionals, and administration of zinc preparations. Her suicidal thoughts had disappeared, and her quality of life, assessed using the visual analogue scale, was improved following the treatment. Dentists should strive to provide oral care, while providing treatment in collaboration with specialists, for the early detection of depression and zinc deficiency in patients with BMS.

Serum albumin and mortality risk in a hyperendemic area of HCV infection in Japan.

BACKGROUND: Hypoalbuminemia has been shown to be associated with increased mortality. We reported a mass screening in 1990 of X town in Japan, which demonstrated a high prevalence of hepatitis C virus (HCV) infection. This follow-up study determined, through a period of 12 years, whether serum albumin levels impact on the life prognosis of the residents of X town. RESULTS: Of the 509 subjects, 69 had died and 55 had moved to other regions by 2002. Therefore, we analyzed 454 people for whom we could confirm life and death between 1990 and 2002. Albumin levels were assigned to two groups, low (<4.0 g/L, group A) and normal (≥4.0 g/L, group B). Of the 454 subjects analyzed, 25 were in group A and 429 in group B and the mortality was 68.0% (17/25 cases, P < 0.00001 vs. group B) and 12.1% (52/429), respectively. Mortality from hepatocellular carcinoma (HCC) was 66.7% in group A (6/9 cases, P = 0.01 vs. group B) and 15.8% (3/19) in group B. According to multivariate analysis, five factors--50 years or older, low albumin level (<4.0 g/L), abnormal AST level, history of smoking, and absence of alcohol consumption--were associated with death. The adjusted odds ratios for these five factors were 20.65, 10.79, 2.58, 2.24 and 2.08, respectively, and each was statistically significant. CONCLUSIONS: We show that the serum albumin level is an independent risk factor for mortality from all causes in the residents of X town and an important prognostic indicator. Improvement of hypoalbuminaemia should be considered for improvement of prognosis.

Dental problems delaying the initiation of interferon therapy for HCV-infected patients.

BACKGROUND: There has been little discussion about the importance of oral management and interferon (IFN) therapy, although management of the side effects of therapy for chronic hepatitis C has been documented. This study determined whether dental problems delayed the initiation of IFN therapy for hepatitis C virus (HCV)-infected patients. RESULTS: We analyzed 570 HCV-infected patients who were admitted to our hospital from December 2003 to June 2010 for treatment consisting of pegylated IFN (Peg-IFN) monotherapy or Peg-IFN/ribavirin combination therapy. The group comprised 274 men and 296 women with a mean age 57.2 years. Of the 570 patients, six could not commence Peg-IFN therapy, despite their admission, because of dental problems such as periodontitis, pupitis, and pericoronitis. The ages of six whose dental problems delayed the initiation of Peg-IFN ranged from 25 to 67 years, with a mean age of 47.3 +/- 15.2 years. IFN therapy was deferred for 61.3 +/- 47.7 days. Among the six subjects for whom IFN treatment was delayed, only one had a salivary flow that was lower than the normal value. CONCLUSIONS: Treatment of dental infections is required before IFN therapy for HCV infection can be started. To increase the depth of understanding of oral health care, it is hoped that dentists and medical specialists in all areas will hold discussions to generate cooperation.

Aminofeel improves the sensitivity to taste in patients with HCV-infected liver disease.

BACKGROUND: Patients with chronic liver diseases have a taste disorder and altered zinc metabolism. We investigated the effects of a supplement enriched with branched-chain amino acids (BCAA) (Aminofeel) on sensitivity to different tastes in patients with hepatitis C virus (HCV) infected liver disease. MATERIAL/METHODS: Nine patients (mean age 63.3+/-9.1 years) with HCV-related liver diseases were identified and examined for sensitivity to different tastes. Eight patients had no awareness of taste disorders, and 3 patients had oral lichen planus. We examined 4 tastes (sweet, salty, sour, and bitter) using a Taste Disk and sensitivity to different tastes was rated on a 6-point scale (I, II, III, IV, V, and VI). Each patient was given one sachet of Aminofeel after breakfast and another at bedtime for 90 days. RESULTS: Only one patient was aware of a taste disorder before administration of Aminofeel, but 4 patients had decreased gustatory sensitivity in the sour taste test, and 2 had it in the bitter taste test. Sensitivity to sour tastes significantly increased after the administration of Aminofeel(R) (P=0.03). Sensitivity to sweet tastes increased after the administration of Aminofeel (P=0.06). Zinc value significantly increased after the administration of Aminofeel (P=0.02). CONCLUSIONS: Patients with HCV-infected liver disease have decreased sensitivity to different tastes and decreased zinc levels. Some patients were unaware that they had a taste disorder. Aminofeel improved sensitivity to different tastes and increased zinc values. Thus, Aminofeel is a useful therapeutic agent for taste disorders.

High incidence of multiple primary carcinomas in HCV-infected patients with oral squamous cell carcinoma.

BACKGROUND: Hepatitis C virus (HCV) infection has been associated with several extrahepatic manifestations. Oral cancer is one of them. We investigated the association among oral squamous cell carcinoma (OSCC), multiple primary cancers (MPCs), insulin resistance and HCV infection. MATERIAL/METHODS: Upper gastrointestinal tract examination and determination of the presence of HCV infection were routinely done for 60 primary OSCC patients. Occurrence of MPCs was evaluated between 1992 and 2008. RESULTS: Of the 60 patients, 21 (35%: 15 males and 6 females; mean age 67.3+/-11.9 years) developed MPCs. Antibodies to HCV were found in 26.7% (16/60) of cases. The incidence of MPCs in HCV-infected OSCC cases was 62.5% (10/16 cases, P<0.01 vs the non-HCV-infected OSCC group); for cases without HCV infection it was 25% (11/44 cases). In HCV-infected cases, 10 MPCs with patients, hepatocellular carcinoma (HCC) was the most common outcome (5 cases), whereas gastric cancer was the most common outcome (6 cases) in non-HCV-infected 11 MPCs. In logistic regression analysis, the adjusted odds ratios on staging IV, anti-HCV positive, and over 70 years old were 15.50, 13.45, and 4.46, respectively, indicating that there were significant differences. Furthermore, the patients with HCV-infected MPCs had hyperinsulinemia. CONCLUSIONS: HCV infection was strongly associated with the occurrence of MPCs as well as primary OSCC. HCV-infected OSCC patients in Japan should receive medical treatment to inhibit development of HCC. In patients with HCV infection, it is important to clinically examine organs other than the liver.