Treatment outcomes of real-time intraoral sonography-guided implantation technique of 198Au grain brachytherapy for T1 and T2 tongue cancer.

It is often challenging to determine the accurate size and shape of oral lesions through computed tomography (CT) or magnetic resonance imaging (MRI) when they are very small or obscured by metallic artifacts, such as dental prostheses. Intraoral ultrasonography (IUS) has been shown to be beneficial in obtaining precise information about total tumor extension, as well as the exact location and guiding the insertion of catheters during interstitial brachytherapy. We evaluated the role of IUS in assessing the clinical outcomes of interstitial brachytherapy with 198Au grains in tongue cancer through a retrospective medical chart review. The data from 45 patients with T1 (n = 21) and T2 (n = 24) tongue cancer, who were mainly treated with 198Au grain implants between January 2005 and April 2019, were included in this study. 198Au grain implantations were carried out, and positioning of the implants was confirmed by IUS, to ensure that 198Au grains were appropriately placed for the deep border of the tongue lesion. The five-year local control rates of T1 and T2 tongue cancers were 95.2% and 95.5%, respectively. We propose that the use of IUS to identify the extent of lesions and the position of implanted grains is effective when performing brachytherapy with 198Au grains.

Intraoral Ultrasonographic Features of Tongue Cancer and the Incidence of Cervical Lymph Node Metastasis.

PURPOSE: The purpose of this study was to investigate the relationship between the visual characteristics of tongue lesion images obtained through intraoral ultrasonographic examination and the occurrence of late cervical lymph node metastasis in patients with tongue cancer. PATIENTS AND METHODS: This study investigated patients with primary tongue cancer who were examined using intraoral ultrasonography at Hiroshima University Hospital between January 2014 and December 2017. The inclusion criteria were squamous cell carcinoma, curative treatment administration, lateral side of tongue, surgery or brachytherapy alone, no cervical lymph node or distant metastasis as primary treatment, and treatment in our hospital. The exclusion criteria were carcinoma in situ, palliative treatment, dorsum of tongue, and multiple primary cancers. The follow-up period was more than 1 year. The primary endpoint was the occurrence of late cervical lymph node metastasis, and the primary predictor variables were age, gender, longest diameter, thickness, margin or border shapes of the lesion, and treatment methods. The relationship between the occurrence of late cervical lymph node metastasis and the longest diameter, thickness, margin types, and border types as evaluated through intraoral ultrasonography were assessed. The data were collected through a retrospective chart review. RESULTS: Fifty-four patients were included in this study. The analysis indicated that irregular lesion margins were significantly associated with the occurrence of late cervical lymph node metastasis (P < .0001). The cutoff value for late cervical lymph node metastasis was 21.2 mm for the longest diameter and 3.9 mm for the thickness. CONCLUSIONS: The results of this study indicates that the irregular lesion margin assessed using intraoral ultrasonography may serve as an effective predictor of late cervical lymph node metastasis in N0 cases.

An investigation of tooth loss factors in elderly patients using panoramic radiographs.

OBJECTIVES: The aim of this study was to observe the dental condition in a group of elderly patients over a period of 10 years in order to clarify important risk factors. MATERIALS AND METHODS: Participants were elderly patients (in their eighties) who took panoramic radiographs between 2015 and 2016, and for whom panoramic radiographs taken around 10 year earlier were also available. The number of remaining and lost teeth, the Eichner Index, the presence or absence of molar occlusion, the respective condition of dental pulp, dental crowns, alveolar bone resorption, as well as periapical lesions were investigated through the analysis of panoramic radiographs. Additionally, other important variables were collected from patients' medical records. From the obtained panoramic radiograph sets, the patients' dental condition was investigated, and a systematic comparison was conducted. RESULTS: The analysis of the panoramic radiographs showed that the number of remaining teeth decreased from an average of 20.8-15.5, and the percentage of patients with 20 or more teeth decreased from 69.2 to 26.9%. A factor analysis investigating tooth loss risk suggested that tooth loss was associated with the bridge, P2 or greater resorption of the alveolar bone, and apical lesions, and gender (with males having a higher risk compared to females). CONCLUSIONS: Teeth showing P2 or greater alveolar bone resorption, bridge, and apical lesions on panoramic radiographs are most likely to be lost in an elderly patient's near future. Consequently, this group should be encouraged to visit their dental clinics regularly and receive comprehensive instruction on individual self-care methods.

Computer-aided diagnosis system for osteoporosis based on quantitative evaluation of mandibular lower border porosity using panoramic radiographs.

OBJECTIVES: A new computer-aided screening system for osteoporosis using panoramic radiographs was developed. The conventional system could detect porotic changes within the lower border of the mandible, but its severity could not be evaluated. Our aim was to enable the system to measure severity by implementing a linear bone resorption severity index (BRSI) based on the cortical bone shape. METHODS: The participants were 68 females (>50 years) who underwent panoramic radiography and lumbar spine bone density measurements. The new system was designed to extract the lower border of the mandible as region of interests and convert them into morphological skeleton line images. The total perimeter length of the skeleton lines was defined as the BRSI. 40 images were visually evaluated for the presence of cortical bone porosity. The correlation between visual evaluation and BRSI of the participants, and the optimal threshold value of BRSI for new system were investigated through a receiver operator characteristic analysis. The diagnostic performance of the new system was evaluated by comparing the results from new system and lumbar bone density tests using 28 participants. RESULTS: BRSI and lumbar bone density showed a strong negative correlation (p < 0.01). BRSI showed a strong correlation with visual evaluation. The new system showed high diagnostic efficacy with sensitivity of 90.9%, specificity of 64.7%, and accuracy of 75.0%. CONCLUSIONS: The new screening system is able to quantitatively evaluate mandibular cortical porosity. This allows for preventive screening for osteoporosis thereby enhancing clinical prospects.

Improvement of region of interest extraction and scanning method of computer-aided diagnosis system for osteoporosis using panoramic radiographs.

OBJECTIVES: Patients undergoing osteoporosis treatment benefit greatly from early detection. We previously developed a computer-aided diagnosis (CAD) system to identify osteoporosis using panoramic radiographs. However, the region of interest (ROI) was relatively small, and the method to select suitable ROIs was labor-intensive. This study aimed to expand the ROI and perform semi-automatized extraction of ROIs. The diagnostic performance and operating time were also assessed. METHODS: We used panoramic radiographs and skeletal bone mineral density data of 200 postmenopausal women. Using the reference point that we defined by averaging 100 panoramic images as the lower mandibular border under the mental foramen, a 400 × 100-pixel ROI was automatically extracted and divided into four 100 × 100-pixel blocks. Valid blocks were analyzed using program 1, which examined each block separately, and program 2, which divided the blocks into smaller segments and performed scans/analyses across blocks. Diagnostic performance was evaluated using another set of 100 panoramic images. RESULTS: Most ROIs (97.0%) were correctly extracted. The operation time decreased to 51.4% for program 1 and to 69.3% for program 2. The sensitivity, specificity, and accuracy for identifying osteoporosis were 84.0, 68.0, and 72.0% for program 1 and 92.0, 62.7, and 70.0% for program 2, respectively. Compared with the previous conventional system, program 2 recorded a slightly higher sensitivity, although it occasionally also elicited false positives. CONCLUSIONS: Patients at risk for osteoporosis can be identified more rapidly using this new CAD system, which may contribute to earlier detection and intervention and improved medical care.

The effectiveness of mouthwashes in alleviating radiation-induced oral mucositis in head and neck cancer patients: a systematic review.

OBJECTIVE: The aim of the study was to perform a systematic literature search and meta-analysis to reveal the most effective mouthwash for head and neck cancer patients who are experiencing radiation therapy-induced mucositis. METHODS: Using two electronic databases, a literature search and data interpretation were systematically performed as follows: (i) problem specification, (ii) devising of a literature search plan, (iii) literature search and retrieval of publications, and (iv) meta-analysis and data interpretation. The main problem was specified as follows: what mouthwash is effective in alleviating oral mucositis for head and neck cancer patients who are undergoing radiotherapy? RESULTS: The literature search yielded 354 titles and abstracts. After reviewing the extracted literature, 25 publications met the inclusion criteria for this study and 17 of 25 were eventually evaluated in the meta-analysis. CONCLUSION: The results of the meta-analysis indicated that the use of a mouthwash that includes anti-inflammatory properties contributes the most to alleviating oral mucositis in patients who are undergoing radiotherapy to treat head and neck cancer.

The proximate phonological unit of Chinese-English bilinguals: proficiency matters.

An essential step to create phonology according to the language production model by Levelt, Roelofs and Meyer is to assemble phonemes into a metrical frame. However, recently, it has been proposed that different languages may rely on different grain sizes of phonological units to construct phonology. For instance, it has been proposed that, instead of phonemes, Mandarin Chinese uses syllables and Japanese uses moras to fill the metrical frame. In this study, we used a masked priming-naming task to investigate how bilinguals assemble their phonology for each language when the two languages differ in grain size. Highly proficient Mandarin Chinese-English bilinguals showed a significant masked onset priming effect in English (L2), and a significant masked syllabic priming effect in Mandarin Chinese (L1). These results suggest that their proximate unit is phonemic in L2 (English), and that bilinguals may use different phonological units depending on the language that is being processed. Additionally, under some conditions, a significant sub-syllabic priming effect was observed even in Mandarin Chinese, which indicates that L2 phonology exerts influences on L1 target processing as a consequence of having a good command of English.

The multiple pronunciations of Japanese kanji: a masked priming investigation.

English words with an inconsistent grapheme-to-phoneme conversion or with more than one pronunciation ("homographic heterophones"; e.g., "lead"-/lεd/, /lid/) are read aloud more slowly than matched controls, presumably due to competition processes. In Japanese kanji, the majority of the characters have multiple readings for the same orthographic unit: the native Japanese reading (KUN) and the derived Chinese reading (ON). This leads to the question of whether reading these characters also shows processing costs. Studies examining this issue have provided mixed evidence. The current study addressed the question of whether processing of these kanji characters leads to the simultaneous activation of their KUN and ON reading, This was measured in a direct way in a masked priming paradigm. In addition, we assessed whether the relative frequencies of the KUN and ON pronunciations ("dominance ratio", measured in compound words) affect the amount of priming. The results of two experiments showed that: (a) a single kanji, presented as a masked prime, facilitates the reading of the (katakana transcriptions of) their KUN and ON pronunciations; however, (b) this was most consistently found when the dominance ratio was around 50% (no strong dominance towards either pronunciation) and when the dominance was towards the ON reading (high-ON group). When the dominance was towards the KUN reading (high-KUN group), no significant priming for the ON reading was observed. Implications for models of kanji processing are discussed.