Increasing the rate of continuation is considered important in treating alcoholism. The bottoming-out experience is considered essential for continuing treatment. To the best of our knowledge, no evidence-based study has investigated the bottoming-out experience in Japan. We independently defined the bottoming-out experience in this study based on overseas evidence and determined whether there was a difference in the background of alcoholics and the continuation rate of outpatient treatment depending on the presence or absence of the bottoming-out experience. The study participants were patients who made their first visit to the addiction outpatient clinic of Showa University Karasuyama Hospital between April 1, 2016 and August 31, 2019 and were diagnosed with alcoholism. Using medical records, we retrospectively surveyed sex, age, the presence/absence of coexisting physical or mental illness, the presence/absence of a roommate, employment status at the time of the first visit, the presence/absence of public assistance, address at the time of the first visit, the presence/absence of a group treatment program at our hospital, participation status in a self-help group, hospitalization status after the first visit, the duration of outpatient treatment, and the presence/absence of the bottoming-out experience before the visit. We conducted univariate and multivariate analyses of the survey items. The multivariate analysis was performed using survival analysis and Cox proportional-hazard model using the Kaplan-Meier method and log-rank test to examine the influence on the continuation of outpatient treatment. The results showed that the presence/absence of the bottoming-out experience did not affect the continuation rate of outpatient treatment when various factors were considered （P＝0.10）. This supports our view that early intervention should be proactively provided in treating alcoholism, instead of waiting for the occurrence of the bottoming-out experience.

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With the rapid advancement in medical technology and the vast number of new medical vocabularies being created in recent years, English language education at medical universities is becoming more standardized with English for Specific Purposes （ESP）. This study aims to explore the possibility of applying topic models, one of the text mining methods, as a method for creating vocabulary lists that reflect the changes in specialized vocabulary in medical specialties. A corpus of about 35,000 words was created based on articles published in the latest academic journals, and Latent Dirichlet Allocation （LDA）, one of the most popular topic modeling methods, was applied to this corpus. Results showed the effectiveness of the topic model in creating vocabulary lists for dental specialties and that the number of topics the LDA is supposed to generate can be set to the minimum value among the extreme values of the harmonic mean of the log-likelihood to obtain word groups that satisfy the convenience of learners. We highlighted the advantages of this method of creating vocabulary lists using topic models with respect to learning specialized vocabulary.

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This is the fifth report on the “Internet-based Survey of Students’ Attitudes toward Sexual Minorities,” conducted annually since 2016. This survey was designed to further elucidate the attitude toward and awareness regarding the sexual minorities among individuals aged 18 years to early 20s. Similar to the surveys conducted over the past four years, the 2020 survey reported herein focused included first-year students at A University. The surveys conducted previously had a response rate of approximately 80%-90%, whereas the 2020 survey rate dropped to approximately 30%. One possible reason for this could be the online format that was utilized for the 2020 survey, which was dissimilar to the questionnaires format followed by the previous surveys; they were conducted in person. A list of the primary results, including trends in attitudes toward and awareness regarding sexual minorities, is listed below:
・Simple tabulation revealed that the number of opportunities for contact with sexual minorities was higher in previous surveys; moreover, the percentage of students feeling disgust toward sexual minorities was the lowest during the latest survey, indicating a trend toward more sympathetic behavior.
・The percentage of respondents willing to acquire accurate knowledge about sexual minorities increased.
・In the principal component analysis of the questionnaire responses for the 2017-2020 surveys, the scores for the first （simple homophobia） and second （superficial empathy） components exhibited a decreasing trend.
・The percentage of correct answers to the question “It is possible to change one’s sex in the family register in Japan,” which reflects the knowledge of sexual minorities, showcased a clear downward trend. Responses to another question pertaining to the willingness to acquire correct knowledge about sexual minorities indicated that the gender gap in empathy toward sexual minorities is not narrowing and may be fixed or widening.

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Cone-beam computed tomography （CBCT） is widely used in dentistry, and the CBCT images can be analyzed along with other investigation data to provide useful information. In this study, we evaluated the digital three-dimensional （3D） representations of CBCT images, overlaid with the images of study models using 3D modeling software. We used 30 teeth samples of a phantom with removable jaws to develop the study models of the upper and lower jaws. Then, we captured the CBCT images of the phantom’s jaws and the study models in voxel sizes of 0.40mm×0.40mm×0.40mm and 0.25mm×0.25mm×0.25mm and used the software to make the 3D models. The maximum and minimum values of measurement errors were calculated for each tooth from the mesial, distal, buccal, and lingual surfaces and the areas of tooth cusp tips. We used the t-test to compare the values of errors between the images with the large and small voxel sizes. This study identified that the images with the smaller voxel size had smaller errors at the mesial, buccal, and tooth cusp tip areas than those with the larger voxel size. Because of radiation exposure during the CBCT examination, appropriate imaging parameters must be selected in the software and according to the purpose of CBCT when the digital composition is performed.

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We report two cases of suspected cocaine poisoning patients brought to the hospital. Case 1: A male in his twenties suffering a cardiopulmonary arrest was transported to the hospital. On arrival, he had no pupillary light reflex, and the triage was positive for cocaine. Cardiopulmonary resuscitation was performed; however, normal heart rhythm could not be restored, and he was pronounced dead. Case 2: A male in his twenties was in police custody but was transported to the hospital due to tonic seizures. On arrival, he was not breathing spontaneously. Triage was positive for cocaine and amphetamine. Therefore, he was intubated in the intensive care unit. However, he died on day five of hospitalization due to multiple organ failures. Both cases were of suspected cocaine poisoning. Death due to cocaine poisoning usually occurs 2-3 minutes after intake. However, in these two cases, the involvement of cocaethylene was suspected due to the simultaneous alcohol ingestion.

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Usually, fallopian tube carcinoma is associated with peritoneal dissemination and cancerous ascites. We report the case of a patient with an inguinal hernia and intraepithelial fallopian tube cancer who presented with pleural effusion and cystic metastasis. A 76-years-old woman, G1P1, was referred to our hospital for further investigation and treatment of her pleural effusion. She underwent a hysterectomy for uterine fibroids at the age of 49. Contrast-enhanced computed tomography revealed a right-sided pleural effusion and a cyst in the right femoral inguinal hernia. Pleural fluid cytology revealed the presence of malignant cells. The pathological diagnosis from the pleural biopsy specimen was a serous adenocarcinoma. Pelvic magnetic resonance imaging revealed a diffuse-weighted high signal and contrast-enhancing mural nodule in the right femoral inguinal hernia. Inguinal hernia cystectomy and bilateral adnexectomy were performed under the suspicion of peritoneal carcinoma. The postoperative pathological diagnosis was high-grade serous carcinoma （HGSC） in the peritoneal node and serous tubal intraepithelial carcinoma in the right fallopian tube. Since both conditions have similar immunostaining images, she was diagnosed with stage ⅣA fallopian tube cancer. Approximately 50％ of peritoneal serous carcinomas derived from epithelial carcinoma originate from the fallopian tube. The criteria for determining the primary site of HGSCs have recently been proposed. The diagnosis of a primary peritoneal carcinoma is made after excluding the fallopian tubes and ovaries as the primary sites of carcinogenesis. In this case, the preoperative examination revealed only peritoneal lesions, leading to the suspicion of peritoneal carcinoma. However, because the postoperative pathological examination revealed microscopic lesions in the fallopian tubes, her final diagnosis was intraepithelial fallopian tube carcinoma.

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A 1-month-old male infant with a chief complaint of fever was admitted to our hospital. On physical examination and blood analyses, he had findings that were indicative of leukemia, such as hepatosplenomegaly, leukocytosis, anemia, and thrombopenia. He was diagnosed with syphilis according to an infectious disease examination performed before a blood transfusion. Although the mother had no history of syphilis as per the anamnesis, further investigations revealed that she suffered from syphilis. As a result, the patient was diagnosed with congenital syphilis. Recently, the incidence of syphilis has increased and so have the reports of congenital syphilis. The vertical transmission of syphilis may occur at a rate of 1％-2％, even if the mother received the appropriate treatment. Therefore, detailed medical interviews, including the mother’s past treatment history, are crucial for the diagnosis of congenital syphilis. However, syphilis lacks symptoms; vertical infection may be established without the mother being aware that she is infected, as in this case. Furthermore, patients with congenital syphilis may develop symptoms of acute leukemia. In infants with such symptoms, the differential diagnosis of congenital syphilis is required even if the mother had no history of syphilis. We report and discuss the case of an infant with congenital syphilis born to a mother with undiagnosed syphilis.

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Few studies have reported decreased serum alkaline phosphatase （ALP） levels associated with specific disorders. Here, we report a case of an 8-years-old boy who was referred to our hospital with neck swelling and diagnosed with Kikuchi-Fujimoto disease based on blood tests, contrast-enhanced computed tomography, and fine-needle aspiration biopsy of the cervical lymph nodes. His serum ALP levels exhibited a transient decrease in the acute phase with a subsequent increase in the recovery phase. Therefore, transiently decreased serum ALP levels may be an indicator for the diagnosis of Kikuchi-Fujimoto disease.

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