Showa University Head and Neck Oncology Center was established in October 2014 for the total management of head-and neck-cancer patients. The Department of Oral Rehabilitation Medicine （DORM） cooperated with this center from the time of its establishment. In this study, we investigated the number of patients who received interventions by the DORM, primary sites, treatment procedures, starting dates, and methods of intervention of the DORM. The number of days between surgery and oral intake, period of hospitalization after surgery, and correlation between these periods were also investigated in the T1 and T2 surgical cases. These investigations were performed for patients in the first one year （2014） and those in the latest one year （2019）. A total of 38 and 98 patients received interventions from the DORM in 2014 and in 2019. The starting dates of interventions by the DORM were during the pre-treatment of cancer in 30 （2014） and 97 patients （2019）; these processes involved the post-treatment of cancer in 8 （2014） and 1 patient （2019）. The methods of intervention of the DORM were dysphagia training （30 cases） and oral appliance （8 cases） in 2014 and dysphagia training （96 cases）, oral appliance （76 cases）, and oral prophylaxis （97 cases） in 2019 （several methods showed overlap）. The number of days between surgery and oral intake in 2019 T2 cases was significantly shorter than that in 2014 T2 cases. The period of hospitalization after surgery in 2019 T2 cases was significantly shorter than that in 2014 T2 cases. Extremely strong positive correlations of the number of days between surgery and oral intake with the period of hospitalization after surgery were observed in T1 and T2 surgery cases.

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Allergic rhinitis （AR） is a well-recognized chronic inflammatory disease of the nasal mucosa, being mainly mediated by antigen （Ag）-specific IgE and Th2-type T cell cytokines. The optimal activation of Ag-specific helper T cells is also well known to require the interaction of T cell receptors with Ag in the context of major histocompatibility complex （MHC） and also the involvement of appropriate co-stimulatory molecules. Moreover, although the interaction of CD28 and its ligands, CD80 and CD86, is known to play essential roles in the induction phase of AR as co-stimulatory pathways, the influence of such pathways on the development of the effector/ongoing phase of AR is still not fully understood. In the present study, the role of co-stimulatory pathways on the effector/ongoing phase of AR was studied using a murine model of AR. Intranasal administration of ovalbumin （OVA） elicited a strong Th2 immune responses. Following repeated nasal OVA challenge, the systemically presensitized BALB/c female mice developed significant Ag-induced nasal symptoms, nasal eosinophilia, serum levels of OVA-specific IgE and Th2-associated cytokines. Nasal administration of anti-CD86 antibody, but not anti-CD80 antibody, inhibited nasal symptoms, serum levels of OVA-specific IgE and IL-4 contents in nasal lavage fluids. In contrast, decrease in nasal eosinophilia and IL-5 levels in nasal lavage fluids were only observed in AR model mice, when they were treated with topical administration of both antibodies. These results demonstrated the importance of co-stimulatory pathways through the engagement of CD28 and CD86 in the development of the effector/ongoing phase of nasal inflammatory responses, especially AR.

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To clarify skin tumor incidence and to estimate the proper diagnosis rate, we analyzed the results of skin lesions excised at Showa University Fujigaoka Hospital. A total of 2,504 lesions were obtained from 2,449 patients （1,171 men and 1,278 women; age 11 months to 99 years; mean 56.5 years old） from January 2008 to December 2017; 2,504 and 1,837 （73.4％） were benign tumors, 590 （23.6％） were malignant tumors, and 77 （3.1％） were non-neoplastic lesions. Among the 1,837 benign lesions, epidermal cysts （455 and 24.8％） were the most common, followed by nevus cell nevi （379, 20.6％） and seborrheic keratoses （225, 11.9％）. Among the 590 malignant tumors, basal cell carcinoma （163, 27.6％） was the most frequent, followed by actinic keratosis （132, 22.4％） and Bowen disease （91, 15.4％）. In determining the incidence of malignant tumors by age group, the incidence rate was below 10％ in those less than 50 years old, compared with the 13.9％, 22.5％, 43.0％, and 66.1％ in for those in their 50s, 60s, 70s, and over 80 years old, respectively. The concordance rate between clinical and histopathological diagnosis was 93.3％ （1,762/1,889） for benign tumors and 87.1％ （527/605） for malignant tumors. Of those clinically diagnosed as benign tumors or non-neoplastic lesions, 62 were diagnosed as malignant tumors histopathologically. These included 10 cases of squamous cell carcinoma, 10 malignant melanomas, and 9 basal cell carcinomas. Our data suggest that such discrepancies occur by the following lesions: early-stage tumors, nodes with hemorrhage, pigmented patches on fingers and toes, and tumors arising from uncommon sites, in which clinical diagnosis requires particular close attention to improve the diagnostic accuracy.

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In this study, we measured the psoas major/paraspinal muscle mass and intramuscular fat mass in subjects based on sex and age （≥65 or ＜65 years） and made statistical comparisons to obtain basic data on exercise therapy. A total of 45 subjects including men and women were recruited in the study, and those who suffered from diseases that interfere with the activities of daily living were excluded. Using an image analysis software, three-dimensional models of the psoas major and paraspinal muscle were created for each subject from their continuous computerized tomography （CT） images. These models were then used to measure the muscle volume, intramuscular fat mass, and intramuscular fat ratio. The data were compared using statistical analyses. Given the age, the results revealed that subjects ≥ 65 years had significantly low psoas major volume and significantly high paraspinal muscle fat volume and fat ratio. Based on sex, men showed significantly higher volumes of psoas major and paraspinal muscle than by women. Based on sex and age, men and women in the elderly group, that is, those ≥65 years of age, had significantly low psoas major volume and significantly high paraspinal muscle fat volume. In terms of body mass index （BMI）, for the≥65 years group with a BMI ＜25, the psoas major volume was significantly low, whereas the paraspinal muscle fat volume and fat ratio was significantly higher than those in the＜65-year group. The above results suggest that aging induces quantitative changes in the psoas major muscle and qualitative changes in the paraspinal muscles. The psoas major and paraspinal muscles have evident differences in muscle properties and age-related changes.

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Determining the ideal educational method for the initial treatment of patients by analyzing the behavior of nurses at a critical care center using video images and by comparing the behaviors of “experienced” and “novice” nurses. Eight nurses （experienced: four; novice: four） who were responsible for cardiopulmonary arrest （CPA） cases on arrival at the critical care center of a University Hospital and who provided consent for the study. Surveillance camera images were used to monitor nursing activity. Once the nurses entered the patient’s room, images were taken for 30min and analyzed. There were 120 tabulations of the nurses’ location and work activities taken at 15-s intervals for 30min. The nurses’ behaviors during this time period were analyzed at 10-min intervals, and a comparison between experienced and novice nurses was made. Tabulations included the most frequent locations of nurses and the most frequent work activities. The most frequent locations observed were near the bed and the place where electronic medical records. The most frequent work activities were, in the order of priority, medical assistance/patient support and nursing records. Over time, there was a significant difference between experienced and novice nurses. The experienced nurses were significantly more engaged in mental care and preparation for the family, whereas the novice nurses focused more on nursing records. Although the behavior of nurses in CPA cases centered on medical assistance and patient support, their behavior was based on goals that change over time. Novice nurses spent substantial time on nursing records, whereas experienced nurses took actions that predicted subsequent actions based on empirical learning. For initial treatment, there is a need for education that could introduce a system, such as a clinical pathway to nursing records. Moreover, education is required to teach behaviors that predict subsequent actions. Video images reflected nursing behaviors, noting that the clinical judgment process is shared among nurses.

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Social anxiety is a major co-occurring condition in individuals with autism spectrum disorder （ASD）; however, its neuroanatomical basis remains understudied. We examined the neuroanatomical correlates of social anxiety in adults with ASD and compared them in adults with neurotypical control （NC）. The subjects were 40 men with a Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision diagnosis of ASD who were recruited from among the outpatients at Showa University Karasuyama Hospital and 43 neurotypical men without any mental disorders. The subjects’ sociodemographic and clinical characteristics were collected, and the Liebowitz Social Anxiety Scale （LSAS-J）, Autism Spectrum Quotient, and Wechsler Adult Intelligence Scale （Third Edition） were administered to assess the severity of social anxiety, ASD symptoms, and intellectual profiles, respectively. Whole brain 1.5 T magnetic resonance imaging scans were performed. Voxel-based morphometry analysis was used to examine the neuroanatomical correlates of the LSAS-J scores. While the LSAS-J scores were negatively and positively correlated with the gray matter density （GMD） in the sensorimotor cortex and the left superior temporal gyrus in the ASD group, respectively, it had a negative and positive correlation with GMD in the left putamen and bilateral frontal pole, respectively, in the NC group. Adults with ASD have distinctive neuroanatomical correlates of social anxiety compared with their neurotypical counterparts, possibly because of different compensatory mechanisms for heightened social anxiety. These findings shed light on the unique nature of social anxiety in ASD; however, further studies with larger samples that perform a direct comparison between subjects with ASD and NC are warranted.

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The purpose of this study was to develop a method for visualizing the position of station±0 on translabial ultrasonography and to investigate its relationship with delivery outcomes. By using 501 pelvic sagittal section radiography images of Japanese pregnant women with a singleton fetus in the normal cephalic position at 35–39 weeks, the straight line connecting the projected ischial spine and inferior margin of the pubis was used as the plane of station±0, and the angle between this line and the long axis of the pubis was defined as the 0-angle. The intra- and inter-examiner errors of 0-angle were calculated, and the relationship between the 0-angle and maternal background factors （age, height, body mass index, and weeks of imaging） and the prognosis of delivery （cesarean section, frequency of instrumental delivery, and time required for delivery） was examined. The mean±standard deviation of the 0-angle was 118.9°±5.9°, with a normal distribution, and the intraclass correlation coefficients of the intra- and inter-examiner errors were 0.973 （95％ confidence interval ［CI］：0.950-0.986） and 0.967 （95％ CI：0.938-0.982）, respectively. None of the maternal background factors correlated with the 0-angle. The 0-angle in the cesarean section group was significantly smaller than that in the vaginal delivery group （119.1°±6.0° vs. 116.9°±5.1°）, especially in the cesarean section group （119.1°±6.0° vs. 115.9°±4.5°）. The 0-angle is a highly reproducible and versatile index that is independent of maternal body size. The 0-angle was significantly smaller in the group with delivery arrest, indicating that a shallow pelvic inlet surface tends to cause poor infant head descent. In addition, we visualized station±0 using 0-angle translabial ultrasonography, which can objectively evaluate the degree of infant head descent.

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There is no clear established intervention guideline for the timing of rehabilitation intervention for patients undergoing cancer rehabilitation. A requirement for continuing chemotherapy is the ability to maintain a performance status （PS） score, which is an index of activity, between 0 and 2. At present, when a rehabilitation prescription is issued, various adverse events due to cancer that affect physical function are expected. In many cases, significant improvement in physical function cannot be expected. We believe that an early rehabilitation intervention that requires the subject to be more active than the current rehabilitation prescription may lead to PS maintenance. In this study, we divided the patients with advanced colorectal cancer who received chemotherapy into those in the pre-cachexia stage and those in the terminal stage （one month before death） at the time of diagnosis. We conducted a muscle mass survey of the psoas major muscle, which is related to the ability to perform activities of daily living such as walking. At the planning stage of the study, the psoas major muscle strength was expected to decrease toward the end of life. However, in reality, it decreased significantly from the time of diagnosis to the time of pre-cachexia. Even in the terminal stage of rehabilitation intervention, the number of cases of decreased psoas major muscle mass was lower than that of non-intervention cases. The present study suggests that rehabilitation intervention should be performed as soon as possible.

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To identify neurodevelopmental disorders in adults with mood disorders, self-report assessment scales for attention deficit hyperactivity disorder （ADHD） or autism spectrum disorder （ASD） symptoms, such as Conners’ Adult ADHD Rating Scale （CAARS） and the Autism Spectrum Quotient （AQ）, are often used. In the present study, we assessed CAARS and AQ scoring tendencies in adults with mood disorders without ADHD or ASD. Between April 2017 and March 2019, 33 and 31 in-patients with Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, diagnoses of depression and bipolar disorder, respectively, who were admitted to the psychiatry emergency wards of Showa University Karasuyama Hospital were included. Forty-eight adults without mental disorders were recruited as healthy controls. We compared the CAARS and AQ scores among the three groups （depression, bipolar disorder, and healthy control groups） using analysis of variance and multiple comparisons with Bonferroni correction. Sociodemographic data and the estimated intelligence quotient based on the Japanese Adult Reading Test-25 were also compared among the groups. The sociodemographic characteristics did not show any between-group differences; however, the AQ and CAARS subscale scores （except those for impulsivity） were elevated in the depression and bipolar disorder groups compared with those in the healthy control group. In multiple comparisons, the depression group showed significantly higher scores than the healthy control group for the AQ and CAARS items, except hyperactivity. The bipolar disorder group showed significantly higher scores than the healthy control group for all CAARS items. The symptomatic characteristics of mood disorders may increase the AQ and CAARS scores because of symptom overlap between neurodevelopmental and mood disorders. The AQ and CAARS scores in patients with mood disorders require careful evaluation.

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Hereditary hemorrhagic telangiectasia （HHT）, also known as Rendu-Osler-Weber disease, is a rare autosomal dominant disease characterized by fibrovascular tissue in the skin or respiratory or gastrointestinal mucosa. The common symptoms are anemia and recurrent hemorrhages. Here, we report a case of HHT with manifestations on the oral mucosa. A 75-year-old woman visited Shin-yamanote Hospital because of abnormal red spots on her tongue, hard palate, lips, and oral mucosa. She had been receiving an injection of iron supplementation for anemia due to recurrent epistaxis. Her mother and daughter had recurrent epistaxis, and the latter had palmer erythema. A biopsy specimen from the tongue revealed dilated capillaries which was stained by CD31, factor Ⅷ, and smooth muscular antigen. The pathological diagnosis was dilated capillaries lined by flat endothelial cells. The clinical and histologic findings were consistent with the diagnosis of HHT.

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We encountered a nine-year-old boy case presenting with headache and who was suspected and diagnosed with pheochromocytoma due to hypertension and the family history on the side of his father. Blood pressure was successfully controlled before surgery, and a retroperitoneal tumor resection was performed at another facility. After the surgery, the blood pressure was normalized, and the patient was followed up without recurrence nor metastasis. Including children, a headache is important as an initial complaint to assess and monitor blood pressure and to conduct a medical interview, including family history, to make a correct diagnosis of pheochromocytoma, which is a rare cause of headache and hypertension in children.

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Cementoblastomas are rare, benign, odontogenic tumors that are intimately associated with tooth roots. Since incomplete removal often leads to recurrence, radical surgeries, such as segmental resection, are often used for the treatment of large cementoblastomas that extend to the inferior border of the mandible. Herein, we describe a case of a giant mandibular cementoblastoma treated conservatively using excision and curettage. An 18-year-old Japanese man with a radiopaque lesion apparent on a panoramic X-ray was referred to our hospital by a nearby dental clinic. Initial examination revealed a bone-like hard mass continuous with the mandibular bone under the mucosa of the floor of the mouth. Panoramic X-ray and computed tomography examination showed a radiopaque circular mass measuring 32×30×28mm associated with the root of the right mandibular first molar. A clinical diagnosis of cementoblastoma was made and removal and curettage of the tumor and placement of an iliac cancellous bone graft was performed under general anesthesia. Histopathological examination showed calcified cementum-like tissue deposited in thick trabeculae on the intact root, and these were rimmed by cementoblasts present in the fibrovascular stroma. Thus, a final diagnosis of cementoblastoma was made. No evidence of recurrence was seen two years after the operation. As these tumors frequently affect young people, treatment strategies should aim to prevent recurrence and also preserve the morphology of the mandible to maintain the quality of life of the patient. Careful follow-up will be continued in consideration of the risk of recurrence in this case.

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The total number of overtime hours recorded after night shifts in the entire target ward was 416h from June 2016 to May 2017. Monthly overtime peaked at 54.8h in October and hit bottom at 18.3h in May, with the monthly average of 35h. All three night-shift nurses customarily worked overtime for about 1h. This study aimed to clarify the effect of the schedule table and the worksheet based on it, which were used to reduce overtime hours after night shifts. We compared the total overtime hours before and after using two tools for 22 nurses taking night shifts in the hospital’s target ward, starting in June 2017. As a result, overtime hours after night shifts decreased to 90h per year from the previous record of 416h. Overtime spiked at 16h in June, when the two tools kicked off, and dropped to the bottom at 5h in May. The monthly average was 7.5h. Using the schedule table and the worksheet is likely to expedite the transfer of work between shifts. This condition probably enables nurses to share information quickly, leading to a reduction in overtime. Indications are inefficient works leading to overtime perpetuation. Thus, work efficiency should be improved by utilizing the two tools to reduce overtime work.

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