Pneumonia is a frequent complication in patients with acute and subacute stroke. Hence, pneumonia prevention is a prominent issue. Although previous reports have demonstrated the efficacy of various swallowing therapies in preventing pneumonia, details of their efficacy profiles have not been fully elucidated. This study aimed to compare the effectiveness of behavior interventions （BI）, metoclopramide （MCP）, prophylactic antibiotics （PA）, and pharyngeal electrical stimulation （PES） in preventing pneumonia between patients with acute to subacute stroke and a control group （N）. A network meta-analysis of randomized controlled trials was conducted. The primary endpoint was the frequency of pneumonia. Integrated estimates were expressed as odds ratios （ORs） and 95％ credible intervals （CIs）. Five studies （n＝1,179） were included in the analysis. The frequency of pneumonia was significantly lower in group MCP than in groups BI, PA, and N （OR ［95％ CI］ of MCP vs. BI, PA vs. MCP, and MCP vs. N: 0.127 ［0.018 to 0.450］, 24.15 ［3.653 to 84.50］, and 0.081 ［0.013 to 0.273］, respectively）. There was no significant difference in the frequency of pneumonia between each treatment pair among the BI, PA, PES, and N groups. MCP showed good pneumonia prophylaxis in patients with acute to subacute stroke compared to BI or PA. Further clinical studies to verify the efficacy and safety profile of MCP in preventing pneumonia are warranted.

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Many medical institutions have recently conducted studies on the relationship between patients with hematopoietic neoplasms and oral cavity. Statistical analysis of the bacterial populations was performed in this study to identify how oral microflora and health conditions （e.g., dental caries and periodontal diseases） affect the prognosis of patients with hematopoietic neoplasms. Patients undergoing inpatient treatment from January to December 2020 at the Department of Hematology at Showa University, Japan, who required perioperative oral management were included in the study. The oral health of the patients was examined at the initial dental visit, and oral bacterial samples were collected from the tongue, buccal mucosa, and palate of 47 patients who consented to participate after receiving an explanation about the study. Statistical analyses performed after dividing the subjects into two groups following the treatment course showed that Stenotrophomonas maltophilia and Gemella sanguinis were significantly more common in the poor-course group. However, no significant difference in bacterial examination results was noted among the four groups （myeloid neoplasm chemotherapy, myeloid neoplasm hematopoietic stem cell transplantation （HSCT）, lymphoid neoplasm chemotherapy, and lymphoid neoplasm HSCT groups） classified based on disease and treatment method. The detection rate of bacteria potentially causing infectious diseases at the initial dental examination tended to be higher in this study in the poor-course group. The findings of the current study suggest that early detection of pathogenic bacteria after commencing hematology treatment could predict the poor-course that may lead to mortality or severe infections.

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The programmed death ligand 1 immunohistochemistry 22C3 pharm DX assay （PD-L1/22C3） is commonly used for assessing PD-L1 expression in non-small-cell lung cancer. Although various sample types have been used for the PD-L1 assay, the feasibility of the PD-L1/22C3 assay in clinical practice remains undefined. At Showa University Hospital, 270 patients diagnosed with primary lung cancer and 271 pathological specimens were assessed. The overall failure rate of the PD-L1/22C3 assay, tumor proportion score （TPS） distribution, and clinical characteristics were retrospectively reviewed. Efficacy, including objective response rate, progression-free-survival, and overall survival, following pembrolizumab monotherapy for patients with high PD-L1 expression and anti-PD-1/PD-L1 treatment for previously treated patients were also retrospectively analyzed. The overall failure rate for the PD-L1/22C3 assay was 3.0%. PD-L1 expression classified by TPS＜1%, 1-49%, and≥50% was 31%, 33%, and 33%, respectively. Thirty-one patients with high PD-L1 expression （TPS≥50%） received first-line pembrolizumab monotherapy, which exhibited high efficacy and outcome, irrespective of the diagnostic procedure. In 65 patients, anti-PD-1/PD-L1 monotherapy used as second- or further-line treatment showed moderate efficacy, irrespective of the diagnostic procedure and the period between tumor acquisition and PD-L1 assay. However, PD-L1 positivity did not affect clinical outcome. The PD-L1/22C3 assay is feasible in a clinical setting because of its low failure rate and it is a good predictor of pembrolizumab efficacy. For previously treated patients, prediction of the effectiveness of anti-PD-1/PD-L1 treatment based on PD-L1 expression should be considered.

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Most personal identification techniques using dental forensics involve a direct comparison of analog images of the oral cavity with preexisting dental charts. Nevertheless, for the forensic identification of individuals, more efficient and faster methods are required. The progression in digital technology in dentistry has been remarkable, and oral scanning and digital X-ray imaging devices are now used routinely in dental practice. We report a new personal identification technique using intraoral Standard Triangled Language （STL） data, which were obtained using a digital intraoral scanner. We compared the STL data from two virtual corpses with those from a larger population of dental clinic patients to investigate whether the corpses could be identified based solely on the dental impression data. We applied the following two methods: analysis of the area of the three virtual planes connecting the cusp tip of the three adjacent molars （method A） and analysis of the area of the virtual three planes connecting the bulge of each of the three molars （method B）. No virtual corpse could be identified with either of the methods with a margin of error of 0mm². Method A was able to perform the screening without omitting the individual within a margin error of ≥±4mm² to obtain a positive result from the screening. In method B, the error range had to be increased to ≥±5mm². Method A was able to search more accurately than method B, possibly because of the large standard deviation of the measured values across the two teeth. Method B might require multiple measurements to obtain accurate search results. In conclusion, we suggest that our new method could improve the efficiency of personal identification.

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This study aimed to evaluate the morphological characteristics of the infrazygomatic crest with various jaw morphologies, occlusal forces, and maxillary first molar position in three dimensions to explore various factors that affect the morphology of the infrazygomatic crest, and to obtain knowledge regarding the ideal maxillary first molar position. Seventy-three Japanese subjects （32males with a mean age of 22.50±6.23 years and 41 females with a mean age of 25.17±6.78 years） had their occlusal force measured and underwent cone-beam CT for orthodontic treatment. The subjects were categorized into the following three groups based on the mandibular plane angle （Mp）: hypodivergent group （Mp＜23°）, normodivergent group （Mp 23°‒30°）, and hyperdivergent group （Mp≥30°）. Subjects were also divided into two groups based on the maxillary first molar positions: mesial and distal. The thickness of the infrazygomatic crest was evaluated using cross-sectional cone-beam CT images obtained in the coronal and axial planes. The thickness of the infrazygomatic crest in the coronal plane significantly differed among the hypodivergent, normodivergent, and hyperdivergent groups and between the mesial and distal groups. The thickness of the infrazygomatic crest in the axial plane significantly differed among the hypodivergent, normodivergent, and hyperdivergent groups. In conclusion, differences in the maxillary first molar position and the vertical skeletal pattern may affect the morphology of the infrazygomatic crest.

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This study investigated the effects of rose essential oil aromatherapy with a 15-minute neck and shoulder massage as the treatment intervention. Forty-two female nurses were assigned to the aromatherapy group （n＝20）, which was treated with 1% rose essential oil in grapeseed oil, or the control group （n＝22）, which was treated with grapeseed oil only. The participants’ saliva samples were analyzed for chromogranin A and biological antioxidant potential levels. Their scores on the State-Trait Anxiety Inventory-Form JYZ, the Japanese Pittsburgh Sleep Quality Index, and a modified visual analog scale were evaluated. Biological antioxidant potentials after treatment and modified visual analog scale scores in the aromatherapy group were higher than those in the control group. The sleep disturbance factors of the Japanese Pittsburgh Sleep Quality Index after treatment decreased in the aromatherapy group compared with the control group. Aromatherapy with rose essential oil not only improved anxiety and sleep difficulty but also exhibited antioxidant effects. Our findings suggest that use of rose essential oil in neck and shoulder massage effectively alleviates stress.

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Although identifying antemortem pathological thrombi in autopsies is vital in assessing the cause of death, distinguishing them from simple blood clot masses only based on macroscopic appearance is sometimes challenging. This study examined the utility of increased methemoglobin concentrations in identifying antemortem pathological thrombi. From 49 autopsy cases, 98 blood clot samples were collected from the arterial （aorta） or venous （vena cava and proximal pulmonary artery） circulation. The samples were divided into a pathological thrombus group and a simple coagulation group based on macroscopic appearances. Methemoglobin concentrations （MetHb） were determined using a spectrophotometer, while the cutoff value was calculated by plotting the receiver operating characteristic curve. MetHb levels were significantly higher in the pathological thrombus group than in the simple coagulation group in arterial and venous samples （arterial: 15.1％ vs. 6.3％, venous: 15.2％ vs. 5.9％, respectively; p＜0.05）. The cutoff value was 11.1％ （area under the curve ［AUC］ 0.85） in arterial samples and 16.7％ （AUC 0.75） in venous samples. We also analyzed corrected values by subtracting MetHb values of the reference blood. This corrected value was also significantly higher in the thrombus group than the simple coagulation group in both arterial and venous samples （arterial: 10.1％ vs. 1.5％, venous: 10.1％ vs. 1.3％, respectively; p＜0.05）. The cutoff values were 4.6％ （AUC 0.87） in arterial samples and 3.7％ （AUC 0.73） in venous samples. The MetHb concentration in blood clot masses of autopsied bodies can help differentiate between antemortem pathological thrombi and simple postmortem coagulation masses.

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In an orthodontic treatment during the permanent dentition period of patients with skeletal class Ⅲ malocclusion, it is sometimes difficult to decide which orthodontic treatment, with or without orthognathic surgery, is better. For patients with cleft lip and palate, we consider not only skeletal discrepancy between maxillary and mandibular morphology but also other factors including the number of congenitally missing teeth, abnormal morphology in permanent teeth, and soft tissue morphology. A 23-year-old female patient with bilateral cleft lip and palate had anterior crossbite and open bite malocclusion. The lateral cephalometric analysis found skeletal class Ⅲ （ANB, 0.3°; Wits appraisal, −4.5mm）. After the treatment plans were thoroughly discussed with the patient, orthodontic treatment without orthognathic surgery was started, including the maxillary left lateral incisor and mandibular bilateral first premolars and third molars extraction using a standard edgewise system. The active orthodontic treatment lasted approximately 3 years, and the patient obtained proper overjet, overbite, and interdigitation. However, a slightly concave profile remained. Although camouflage orthodontic treatment is possible to prevent invasive surgery and improve malocclusion in patients, orthodontists should share with the patient the camouflage orthodontic treatment advantages and limitations relative to orthodontic-orthognathic treatment before starting treatment.

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