[in Japanese]

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This paper forms the fourth of a five-part series on the attitudes of first-year medical/healthcare university students toward sexual minorities. We summarize the outcomes and inferences emerging from the questionnaire survey conducted in 2019. Similar to the three previous surveys, the respondents completed an online survey via smartphones. The results indicate that the homophobic attitudes of adolescents toward close friends or family have become less common. Moreover, they have become more motivated to gain an in-depth understanding of human sexuality and gender identity. The majority of the respondents feel uncomfortable with gender roles, norms, and stereotypes. Lastly, their empathetic understanding of sexual minorities has been strengthened substantially. In addition, their view of these groups has become increasingly positive. Notably, the majority of respondents （84％; n ＝ 522） expressed the desire to be enlightened regarding the issues related to sexual orientation and gender identity. On the basis of these insights, we conclude that schools should create an environment in which learners can develop high levels of knowledge about sexual and gender minorities. Furthermore, teachers should be encouraged to foster a symbiotic society that culturally accepts and intellectually respects differences.

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Many bacteria inhabit the human intestine and form the gut microbiota. Recently, the relationship between changes in the gut microbiota and various diseases has been reported. This study aimed to investigate the distribution of gut microbiota in children with lower urethral disorders and functional constipation. We sampled intestinal bacteria in 10 children with lower urethral disorders and functional constipation （8 boys, 2 girls; average age, 8.1 years） and 10 healthy children （10 boys; average age, 7.1 years）. We cultured these intestinal bacterial samples and identified four bacteria. Our results revealed that, Clostridium and Lactobacillus were significantly increased in children with lower urinary urethral disorders and functional constipation （p＜0.05）. No significant differences were found in other bacterial species and total bacterial count. Changes in the gut microbiota may affect urination and defecation. Probiotics may improve underlying disease and lower urinary tract abnormalities.

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Although the number of people who commit suicide in Japan has continued to decline since 2009, it is still relatively high from a global perspective. Recently, suicides related to unemployment caused by coronavirus disease 2019 have increased. With increases in karoshi and industrial accidents, ensuring supportive measures for workers’ mental health has become a pressing issue. We previously examined whether screening for mood disorders, which are strongly associated with suicide-related behaviors, helps prevent suicide in small- and medium-sized enterprise employees, where mental health support is insufficient. This study builds on the findings of a previous study that mental illness screening helps identify mood disorders and may be used as a primary prevention method for suicides. A total of 1,411 consenting workers were surveyed using the Mini International Neuropsychiatric Interview. A representative module of each disease item was extracted and analyzed. The Depression, Bipolar Spectrum Diagnostic Scale, Liebowitz Social Anxiety Scale, and Sheehan Disability Scale approved by the Center for Epidemiological Studies were used for secondary assessments. Individuals with depression, bipolar disorder, dysthymia, and mood disorders were compared with a control group, and multivariate analyses were performed to investigate items that identified individuals with depression, mood dysregulation, bipolar disorder, or all-inclusive mood disorders. The adjusted odds ratios in the anxiety disorder groups were 3.2, 2.6, 2.1, and 1.8 for panic disorder, social anxiety disorder, agoraphobia, and generalized anxiety disorder, respectively, and 2.1 and 2.8 for obsessive–compulsive disorders and bulimia nervosa groups, respectively. The adjusted odds ratio in the drug-use disorder groups was 2.0 for bipolar disorder, and in the mood disorder group, it was 3.3 for anorexia nervosa, showing a significant correlation although the results were not reflected in the mood disorder group. However, the bipolar disorder and mood disorder groups may be screened individually. We found that bipolar disorder is a mental illness that cannot be overlooked; the results of the mood disorder group were comparable. These results were significantly correlated with mental illnesses that are referred to as neuroses in a conventional diagnosis. In conclusion, screening for anxiety, obsessive–compulsive, and eating disorders helps prevent mood disorders among workers. We hope that our findings will indirectly contribute to the prevention of suicide among workers.

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IgA vasculitis is a systemic, small vessel vasculitis that most commonly affects children. The classic presentation of IgA vasculitis includes palpable purpura, joint pain, gastrointestinal complaints, and renal involvement. Purpura occurs in all patients with IgA vasculitis, whereas joint pains occur in 〜 74％, abdominal symptoms in 〜 51％, and renal involvement in 〜 54％. Nonsteroidal antiinflammatory drugs （NSAIDs）, steroids, and factor ⅩⅢ are often administered to treat abdominal symptoms of IgA vasculitis. However, these treatments occasionally fail. We herein report a case of treatment-refractory abdominal symptoms of IgA vasculitis in a 4-year-old girl who responded well to dapsone. Her abdominal pain secondary to recurrent IgA vasculitis did not improve despite oral NSAIDs, along with intravenous administration of steroids and factor ⅩⅢ. Hence, dapsone （1.5mg/kg/day） treatment was initiated on the 20th day of the illness, and the symptoms rapidly improved. Including our case, there have been 22 reports on the use of dapsone for abdominal symptoms of IgA vasculitis in children. Dapsone was effective in all patients, but adverse effects were observed in five patients （methemoglobinemia in two, dapsone hypersensitivity syndrome in one, hemolytic anemia in one, and pancytopenia in one）. All adverse effects improved with discontinuation or reduction. Consequently, we believe that dapsone is a viable treatment option for pediatric patients with steroid-refractory severe IgA vasculitis abdominal pain.

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In recent years, there has been a rise in orthodontic treatments among adults. In such patients, however, treatments are complicated by oral conditions such as nonvital teeth, missing teeth, periodontal diseases, and the presence of prostheses. The treatments are also frequently associated with various risks, including root resorption and ankylosis, and are often lengthy. Herein, we report a case of severe maxillary protrusion in an adult, which was corrected by orthognathic （Wassmund and Wunderer method） and orthodontic treatments.
A 25-year-old woman visited the Koishikawa Orthodontic Dental Clinic with the chief complaints of maxillary protrusion and a gummy smile. The patient was diagnosed with skeletal maxillary protrusion, and in addition, the right central incisor was found to be nonvital, which necessitated prosthetic treatment. The preorthodontic surgical treatment, involving the anterior maxillary osteotomy, was conducted over a period of 1 year and 6 months. After the surgery, the postorthodontic treatment lasted for 1 year and 6 months.
The treatments improved the A point–nasion–B point angle, upper and lower central incisor tooth axis, E-line to upper and lower lip posture, and occlusion without excessive root resorption. The patient expressed satisfaction with the changes in her facial appearance and stable occlusion.
This case shows that the combination of orthodontic and surgical treatments can effectively improve facial configuration.

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The extraction of the first premolar is performed for addressing the chief complaint in many orthodontic treatment cases associated with crowding of the anterior teeth. However, depending on the status of the individual teeth and periodontal tissue, cortical bone condition, occlusal condition, and prosthesis condition, extraction of teeth other than the first premolars is often considered. Herein, we report the skeletal and occlusion changes observed before and after treatment in a 28-year-and-one-month old female patient whose chief complaints were severe crowding and mandibular prognathism when she first presented at our hospital. The patient was undergoing dentition enlargement with a removable orthodontic appliance at another clinic but had discontinued the orthodontic treatment due to the interruption of her visits to the clinic. We decided to perform surgical orthodontic treatment with bilateral maxillary canine extraction following orthodontic examination and diagnosis, which revealed marked gingival recession and thinning of the cortical bone in the right maxillary canine according to CBCT findings. No significant changes, such as gingival recession, were observed in the bilateral maxillary canine region on removing the orthodontic appliance compared to the initial examination. Surgical orthodontic treatment improved the morphological inconsistency at the origin of the patient’s chief complaint, resulting in functional occlusion.

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We report the case of a pregnant woman who underwent cesarean section after being in close contact with a person with coronavirus disease 2019 （COVID-19）. The patient was a 33-year-old pregnant Japanese woman （gravida 1, para 0） with no abnormalities during pregnancy. A COVID-19 cluster occurred at her husband’s workplace; the husband had a fever and was found to be positive on polymerase chain reaction （PCR） testing, so the pregnant woman was a close contact. The husband was urgently hospitalized to isolate him from the patient, who remained on standby at home. After the hospital staff conducted a pre-meeting and simulation in the operating room, a planned cesarean section was performed. Although a PCR test performed the day before the cesarean section was negative, transmission of the virus was still possible during this period. In the operating room, the staff wore personal protective equipment （plastic gowns, eye guards, surgical masks, gloves, caps）, and the infant was resuscitated at a distance of 6 feet from the mother. The infant was in a good condition after resuscitation, and the first visit was performed with the infant inside an incubator. The infant underwent a PCR test within 24 hours of birth, which was negative. The baby and mother were isolated in separate rooms to prevent infection, and breast milk was extracted to feed the infant during the isolation period. Neither mother nor infant developed any COVID-19 symptoms, and they were discharged on the 9^th day postpartum without any complications. Additionally, no infection was found in the healthcare workers. When determining perinatal management for patients suspected of being infected with COVID-19, sufficient pre-planning, consideration of the isolation period, and performance of simulation by the staff are useful.

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