Successful rechallenge with cetuximab after progression with nivolumab for recurrent cervical lymph node metastasis from carcinoma of the tongue.

We can infer that the immunostimulatory effect of nivolumab and reactivation of cetuximab enhance the antitumor effect of the therapy

Expressions of ezrin, ERK, STAT3, and AKT in tongue cancer and association with tumor characteristics and patient survival.

Ezrin, ERK, STAT3, and AKT are proteins that are overexpressed in various types of cancer, although their expressions in tongue cancer has received less focus. This study aimed to address associations between the expression levels of these proteins and with characteristics of the tumor and patient survival. We performed immunohistochemical staining of ezrin, ERK, STAT3, and AKT in tumors from patients with tongue carcinoma in situ (CIS, n = 17) and tongue squamous cell carcinoma (SCC, n = 46). Statistical differences between the SCC versus the CIS cohorts were estimated by calculations of bivariate odds ratios of low versus high expression of the proteins. Fisher\u27s exact tests were used to appraise interassociations between the proteins, as well as expression levels versus patient and tumor characteristics. Survival based on Kaplan-Meier statistics in combination log-rank tests were used to address potential effects of the patient and tumor characteristics versus 5-year survival rate. The relative high: low expression of all four proteins in the two cohorts differed, and particularly ERK was markedly overexpressed in the SCC versus the CIS cohort (odds ratio = 45.3, p < .01). The relative high: low expression each protein versus patient and tumor characteristics; showed associations between AKT expression and T stage (p = .002) plus node metastases (p = .12), and between ERK expression and drinking (p = .01) and smoking history (p = .01). There was no significant difference observed between ERK and the three other molecules, nor any significant difference between the degree of expression of each protein and the 5-year disease-specific survival rate. Ezrin, ERK, STAT3, and AKT appear to be involved in the progress from carcinoma in situ in the tongue into squamous cell carcinoma. ERK in particular is overexpressed, suggesting that ERK may be a novel therapeutic target for preventing tongue cancer

当科が報告したインシデントレポートの分析

当院では 2010年7月からコンピューターを用いたインシデント報告システムを導入し,職員が匿名でインシデントを報告できる体制となっている.本体制運用開始後10年間に当科で報告されたインシデントレポート55件を患者影響レベルに従って8段階に分類した.レベル0は6件(10.9%),レベル1は14件 (25.5%),レベル2は13件(23.6%),レベル 3a は10件(18.2%),レベル3bは8件(14.5%),レベル4aは0件(0%),レベ4bは3件(5.4%),レベ5は1 件(1.8%)であった.当科におけるレベル別報告件数の比率は，重大なアクシデントと中等度のエラーと300のヒヤリ・ハットの比率が1：29：300であるというハインリッヒの法則に則っていなかった.しかし当科では2010年から2020年にかけてヒヤリ・ハット報告数は増加しているため,インシデントを報告する習慣が身につきつつあると考えられた.今後,より積極的に報告を行うように，職員へのさらなる啓蒙活動が医療事故の防止のために重要であると考えられた.In July 2010,we introduced a computerized incident reporting system, which allows staff to report incidents anonymously. The 55 incidents reported in our department during the first 10 years of operation of this system were classified into 8 levels according to the patient impact level. Level 0 was 6 incidents (10.9%),level 1 was 14 incidents (25.5%),level 2 was 13 incidents (23.6%),level 3a was 10 incidents (18.2%),level 3b was 8 incidents (14.5%),level 4a was 0 incidents (0%),level 4b was 3 incidents (5.4%),and level 5 was 1 incident (1.8%).The ratio of the number of reports by level in our department did not follow Heinrich\u27s law, which states that the ratio of serious incidents to moderate errors and 300 near-misses is 1:29:300.However,the number of Hiyari-Hatto reports increased from 2010 to 2020 in our department, suggesting that the habit of reporting incidents is becoming more common. In the future, it will be important to educate the staff to report more actively in order to prevent medical accidents

Differences in the Knowledge and Experience of Physicians and Dentists About Medication-Related Osteonecrosis of the Jaw in Osteoporotic Patients.

Aim:Prevention of medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis requires the cooperation of physicians and dentists. We investigated the knowledge, experience, and behaviour related to medical and dental cooperation for MRONJ prevention in patients with osteoporosis between physicians and dentists practising in the Shiga prefecture.Materials and methods:We conducted a cross-sectional study to investigate the cooperation between practising physicians and dentists for preventing osteonecrosis of the jaw (ONJ) in patients with osteoporosis using 2 separate questionnaires from July 28, 2018, to February 3, 2019, in Shiga prefecture, Japan.Results:Of 461 dentists who were sent the questionnaires at their dental clinics, 307 (67%) responded via fax. Of 846 physicians who were sent the questionnaire at their clinics, 378 (45%) responded via fax. Of these, 268 (32%) were finally analysed because 110 (13%) physicians had never treated patients with osteoporosis; 50% dentists and 24% physicians were familiar with the MRONJ position paper in Japan, and 39% dentists and 9% physicians had encountered MRONJ in their clinical practice. A total of 30% physicians had requested oral health care by a dentist before administering bone-modifying agents (BMA) therapy. The knowledge and experience of MRONJ differed between doctors and dentists.Conclusion:The behaviour of doctors and dentists was insufficient to enable medical and dental cooperation for the prevention of MRONJ in patients with osteoporosis. The lack of cooperation between physicians and dentists during osteoporosis treatment in the Shiga prefecture in Japan is documented in this study

シセイ カンセンショウ ガ ゲンイン ト ウタガワレタ ガンメン タンドク ノ イチレイ

【緒言】丹毒は，発熱とともに皮膚に出現する浮腫性紅斑を主症状とする真皮の化膿性炎症性疾患であるが，歯性感染症が原因と考えられる顔面丹毒の報告は少ない． 今回われわれは，右側上顎前歯の根尖性歯周炎が原因と疑われた顔面丹毒の1例を経験したので報告する．【症例】患者は67歳の女性. 右側顔面の腫脹を主訴に当科を紹介され受診した．初診時所見として, 右側眼窩下部から右側頬部, 右側顎下部にかけて境界明瞭な紅斑と腫脹を認め，右側上顎3番に根尖性歯周炎を認めた．当初, 右側上顎3番の根尖性歯周炎に起因する頬部蜂窩織炎と診断し, 切開排膿術を施行したが, 排膿を認めなかったことから, 鑑別疾患として丹毒を疑い, 皮膚科対診を行ったところ, 顔面丹毒との臨床診断を得た. 抗菌薬投与後も右側頬部の腫脹および右側上顎3番部の違和感が消失しなかったため, 右側上顎3番の根管開放を行ったところ, 消炎を認め, 第11病日に右側顔面の紅斑は消失した. 約2ヵ月経過した現在, 再発なく経過は良好である．Erysipelas is a pyogenic inflammatory disease of the dermis characterized by erythema with edema appearing on the skin with fever. However, there have been few reports of facial erysipelas caused by dental infection. In this report, we describe a case of erysipelas of the face that was suspected to have been caused by periodontitis of the right maxillary canine tooth.The patient was a 67-year-old woman. She was referred to our department because of right-sided facial swelling. At the time of initial examination, erythema and swelling with well-defined borders were observed from the lower right orbit to the right cheek and lower right side of the jaw. We initially diagnosed her disease as buccal cellulitis caused by periodontitis of the right maxillary canine tooth and therefore performed incisional drainage. However, because there was no drainage of pus, we suspected erysipelas as a differential diagnosis. After consultation with a dermatologist, the patient was diagnosed with facial erysipelas. The swelling in the right cheek area and discomfort in the right maxillary canine tooth persisted after administration of antibacterial drugs; therefore, we created a root canal opening in the right maxillary canine tooth. Eleven days after symptom onset, the erythema on the right side of the face disappeared. After about 2 months, the patient was doing well without any recurrence

シガ イカ ダイガク イガクブ フゾクビョウイン ノ シュウジュツキ コウクウ キノウ カンリ ノ リンショウテキ トウケイ 2002ネン

滋賀医科大学医学部附属病院歯科口腔外科では2014年より, 周術期患者の口腔機能管理を目的とした「オーラルマネジメントシステム」を稼働した. 2015年には, 患者に快適, 安心, 安全な周術期医療を提供することを目的として, 多職種からなる「周術期チーム」が発足し, 当科はチームの一員として口腔機能管理を担っている. 今回われわれは, 2015年4月１日から2022年3月31日までの７年間の年度毎の全身麻酔手術件数, 周術期口腔機能管理依頼件数の推移と周術期口腔機能管理依頼率(1年間の全身麻酔手術件数に対する周術期口腔機能管理依頼件数の割合), 依頼件数の多かった診療科について臨床的検討を行った. 当院の2021年度の全身麻酔手術件数は4158件, 依頼件数は1931件, 依頼率は46.3%であり, オーラルマネジメントシステムを導入した2015年度より年々増加を認めていた. 診療科毎の依頼件数は消化器外科, 耳鼻咽喉科が多かった. 当科の院内啓蒙活動や周術期口腔機能管理により術後合併症のリスクが低下する報告が増えたことにより, 医科の周術期口腔機能管理の認知が高まり, 依頼件数, 依頼率の増加につながったと考える. 診療科毎の依頼件数に関しては, 歯科口腔領域と関係の深い診療科の依頼が多いと考えられた. 周術期チームが発足してから, 他職種連携は密となり, 依頼件数, 依頼率の増加を認めたが, 周術期口腔機能管理が, 術後合併症の予防を示すエビデンスはまだないため今後の課題と考えている.The Department of Oral Surgery of Shiga University Hospital launched the "Oral Management System" for the purpose of managing oral functions of perioperative patients, in 2014. "Perioperative team" consisting of members from various professions was established in 2015, with the aim of providing comfortable, safe, and secure perioperative care to patients. Our department is responsible for the management of oral functions. In this study, we conducted a clinical review of the number of general anesthesia cases per year, the number of requests for perioperative oral function management, the rate of requests for perioperative oral function management (the ratio of the number of requests for perioperative oral function management to the number of general anesthesia cases per year), and the departments with high number of requests for perioperative oral function management during the seven years from April 1, 2015, to March 31, 2022. The number of general anesthesia surgeries in our hospital in 2021 was 4158, and the number of requests was 1931, for a request rate of 46.3%. The number of requests had been increasing every year since 2015, when the oral management system was introduced. The number of requests per department was higher in the departments of gastroenterological surgery and otorhinolaryngology. The number of requests and the request rate increased. Because we consider that the awareness of perioperative oral functional management in the medical department has increased due to our hospital\u27s educational activities and an increase in the number of reports showing that perioperative oral function management reduced postoperative complications. After the perioperative team was established, the collaboration among other departments became closer, and the number of requests and the request rate increased. However, there is still no evidence that perioperative oral function management prevents postoperative complications, and this is an issue for the future

シガ イカ ダイガク イガクブ フゾク ビョウイン ニオケル オーラル マネージメント システム ノ リンショウテキ ケントウ

当科では2014年から周術期口腔機能管理を目的に「オーラルマネージメントシステム」を稼働させている．2015年には患者に快適，安心，安全な周術期環境を提供することを目的とした，麻酔科医,薬剤師,歯科医師,歯科衛生士,看護師，管理栄養士,言語聴覚士など多職種からなる「周術期管理チーム」が発足し，当科はそのチームの一員として「オーラルマネージメントシステム」を使った口腔機能管理を担っている．今回われわれは，このシステムを利用して全身麻酔手術前の周術期口腔機能管理を実施した患者数の推移および依頼状況を把握するため臨床的検討を行った. 当院における2019年度の周術期口腔機能管理実施件数は1377件と2015年から比較して約1.6倍に増加し,実施率も34.5％と増加を認めた. 院内での啓蒙活動により,多職種における人々の口腔内に関する意識が高まり,周術期口腔機能管理実施件数や実施率の増加に繋がったと考えられた. その一方でマンパワーやチェア台数の不足などの課題も明らかとなった. 今回の調査結果を元に今後もシステムの発展に尽力する予定である.Since 2014, the Department of Oral and Maxillofacial Surgery at the Shiga University of Medical Science Hospital has been running an ‟Oral management system” specialized for oral management in the perioperative period. In 2015, the ‟Perioperative management team” was formed with the aim of providing a safe perioperative environment for patients. The team comprises anesthesiologists, pharmacists, dentists, dental hygienists, nurses, dietitians, speech pathologists, and other professionals, and manages the oral functions of patients. In this study, we report the statuses of requests and rate of adoption of the ‟Oral management system” in every department. In 2019, the number of cases of perioperative oral function management in our hospital was 1,377, an increase of about 1.6 times compared to 2015, and the implementation rate also increased to 34.5%. The educational activities in the hospital increased the awareness of the oral health of people in many professions, and led to an increase in the number and rate of perioperative oral function management. On the other hand, issues such as the lack of manpower and the number of chairs became apparent. Based on the results of this survey, we plan to continue our efforts to develop the system

Factors predicting oral and maxillofacial fractures after falling and factors predicting the duration of treatment

Dental traumatology. 2023 Oct;39(5):418-424.令和5年

Successful rechallenge with cetuximab after progression with nivolumab for recurrent cervical lymph node metastasis from carcinoma of the tongue

Abstract We can infer that the immunostimulatory effect of nivolumab and reactivation of cetuximab enhance the antitumor effect of the therapy

Analysis of micrognathia with obstructive sleep apnea syndrome improved by a combination of Le Fort I with horseshoe osteotomies, mandibular distraction osteogenesis, and genioplasty

Abstract The relationship between microgenia and obstructive sleep apnea syndrome is well known. 27‐year‐old woman. She underwent a combination of Le Fort I with horseshoe osteotomies and mandibular distraction osteogenesis and genioplasty. She was satisfied with the aesthetics of her face, with an AHI of 7.8/h