AIM:Self-sampling human papillomavirus (HPV) testing has been introduced for cervical cancer screening worldwide. In Japan, there are two types (brush and sponge) of HPV self-sampling devices. However, the recommended type for cervical cancer screening remains unclear. This study aimed to evaluate the feasibility of the HPV self-sampling device-sponge type (HSD-ST). Additionally, we aimed to examine the positive rate (sensitivity) for cervical intraepithelial neoplasia (CIN) 2 or worse using the HSD-ST. Finally, we aimed to perform a questionnaire survey regarding the usability of the HSD-ST.METHODS:We included 165 women who underwent HPV testing at one of three gynecologic clinics. First, the women used the HSD-ST and completed a questionnaire regarding its usability. Subsequently, they underwent physician-sampling HPV testing and cytology. We examined the agreement rate of HPV positivity between self- and physician-sampling HPV testing.RESULTS:The HPV-positive rates of self- and physician-collected samples were 59.4% and 62.4%, respectively, with an overall concordance rate of 88.5% and a calculated kappa coefficient of 0.76, indicating high concordance. Moreover, the positive (sensitivity) rates for CIN2 or worse were 81.4% and 89.8% in the self- and physician-collected samples, respectively.CONCLUSIONS:Our findings demonstrated the feasibility and usability of the HSD-ST.

日本は子宮頸がん検診の受診率が約40％で、HPVワクチン接種率は約1％であり、若年者の子宮頸癌が増加傾向にある。未受診者対策としての自己採取HPV検査の精度について検討した。2012年の自己採取器具Delphi（wet法）によるPCR法HPV検査での検討では、CIN2＋（20例）のHPV検査陽性率（感度）は自己採取90％（18/20）、医師採取85％（17/20）であった。2013年の自己採取器具Evalyn brush（dry法）によるPCR法HPV検査での検討では、CIN2＋（20例）のHPV検査陽性率は自己採取90％（18/20）、医師採取90％（18/20）であった。2014年の自己採取器具Flocked Swabs（dry法）によるPCR法HPV検査では、CIN2＋（21例）のHPV検査陽性率は、自己採取100％（21/21）、医師採取95％（20/21）であった。2016～2017年のEvalyn brushによるHC2法HPV検査では、CIN2＋（170例）のHPV検査陽性率は自己採取77.6％（132/170）、医師採取91.8％（156/170）であった。2020年の自己採取器具ホームスミアキット（wet法）とPCR法HPV検査では、CIN2＋の10例のHPV検査陽性率は自己採取80％（8/10）、医師採取90％（9/10）であった。

In Japan, government support for human papillomavirus (HPV) vaccination began in November 2010. However, the mass media repeatedly reported on severe adverse events. The Japanese Ministry of Health, Labor and Welfare suspended proactive recommendations for HPV vaccines in June 2013. Japan's HPV vaccination rate dropped from 70% to less than 1% in 2017.We examined cervical cancer screening results in terms of abnormal cytology, histology, and HPV vaccination status among 11,903 women aged 20 to 25 y in the fiscal year 2015. The overall rate of HPV vaccination was 26.1% (3,112/11,903). Regarding cytology, the rate of atypical squamous cells of undetermined significance (ASC-US) or worse was 3.3% (103/3,112) in women who received HPV vaccination (vaccine (+) women) and 5.6% (496/8,791) in women who did not (vaccine (-) women). The rate of high-grade squamous intraepithelial lesion (HSIL) or worse was 0.26% (8/3,112) in vaccine (+) women and 0.81% (72/8,791) in vaccine (-) women. Regarding histology, the rate of cervical intraepithelial neoplasia 1 or worse (CIN1+) was 1.4% (42/3,112) in vaccine (+) women and 2.1% (178/8,791) in vaccine (-) women. The rates of CIN2+ and CIN3+ were similar regardless of vaccination. We found a significantly lower incidence of CIN in vaccine (+) women. These results suggest that the resumption of recommending HPV vaccination as primary prevention for cervical cancer is needed in Japan.

OBJECTIVE:Liquid-based cytology has replaced conventional cytology in cervical cancer screening in many countries. However, a detailed comparison of liquid-based cytology with conventional cytology has not been reported in Japan. Therefore, the aim of the study is to evaluate efficacy of liquid-based cytology in Japan.METHODS:We first evaluated the prevalence of use of liquid-based cytology and then examined the efficacy of liquid-based cytology and conventional cytology for detecting CIN and the rate of unsatisfactory specimens using data from cancer screening collected by the Japanese Cancer Society from FY2011 to FY2014. A Poisson regression model with random effects analyses was used to classify histological outcomes and unsatisfactory specimens using liquid-based cytology compared to conventional cytology.RESULTS:A total of 3 815 131 women were analyzed in the study. The rate of liquid-based cytology increased from approximately 8% in FY2011 to 37% in FY2014. Compared to conventional cytology, the detection rates with liquid-based cytology were significantly higher (1.42 times) for CIN1+ [detection rate ratio (DRR) = 1.42, 95% confidence interval (CI) 1.35-1.48, P < 0.001] and CIN2+ (DRR = 1.16, 95% CI 1.08-1.25, P < 0.001). Positive predictive value ratios of CIN1+ and CIN2+ were also significantly higher for liquid-based cytology than for conventional cytology. However, there was no significant difference between liquid-based cytology and conventional cytology for detection rates and positive predictive values of CIN3+ and cancer. The rate of unsatisfactory specimens was significantly lower with liquid-based cytology compared to conventional cytology (DRR = 0.07, 95% CI 0.05-0.09, P < 0.001).CONCLUSIONS:In order to avoid the unsatisfactory specimens in cervical cancer screening, the results of this study did indicate that liquid-based cytology was more useful than conventional cytology in practical standpoints.

目的 : わが国の子宮頸がんの一次スクリーニングの細胞診に HPV 検査を加えた際の有効性を検討する.

The Japanese national immunization programme for Human Papillomavirus (HPV) started in 2010. Vaccination rates increased up to 70% in women in the 1996-1999 birth. However, the proactive recommendation for HPV vaccine was suspended in 2013, following repeated media reports of adverse events. Vaccination rates plumped to less than 1% in women born since 2002. In this study, incidence of abnormal cytology and histology was examined in terms of HPV vaccination among 5,924 women aged 20 to 24 years in the fiscal year (FY) 2014 and 2015. The total rate of vaccination was 16.9% (1,002/5,924). In case of FY 2015, the rates of vaccination were 59.26%, 49.68%, 11.97%, 9.08%, and 4.58% in those aged 20, 21, 22, 23, and 24 years old, respectively. The rates of high-grade squamous intraepithelial lesion (HSIL) or worse were 0.20% (2/1,002) in women with HPV vaccination and 1.14% (56/4,922) in those without HPV vaccination, indicating a significant reduction of 82.46% with vaccination (P < 0.0001). The rates of cervical intraepithelial neoplasia (CIN) 1+ were 0.80% (8/1,002) in women with vaccination and 2.28% (112/4,922) in those without vaccination. The reduction rate of CIN1+ was 64.91% (P = 0.0025). The rates of CIN2+ were 0.10% (1/1,002) with vaccination and 0.69% (34/4,922) without vaccination. The reduction rate of CIN2+ was 85.51% (P = 0.0261). Our data are the first to demonstrate a significant reduction of CIN2+ cases in an Asian population. Scientific discussion is needed to restart the proactive recommendation for HPV vaccine in Japan.

Prevention of cervical cancer has been unsuccessful in Japan because of low rates of cancer screening and vaccination. The Vaccine Adverse Review Committee of the Japanese Government investigated 2,475 adverse events and reported 617 (6.9/100,000) severe cases and 176 (2.0/100,000) cases with chronic pain. The proactive recommendation for human papillomavirus (HPV) vaccination has been suspended since June 2013. In this study, we examined vaccination rate and incidence of abnormal cervical cytology in women aged 20 to 24 years attending cancer screening in Miyagi. Among the 3,272 women who underwent a health check in the fiscal year 2014 (April 2014-March 2015), 332 (10.2%) received a HPV vaccination. The HPV vaccination rates were 42.3%, 10%, 17.5%, 3.8% and 4.0% in women aged 20, 21, 22, 23 and 24 years, respectively. The rates of atypical squamous cells of undetermined significance (ASC-US) or worse were 2.41% (8/332) in women with HPV vaccination and 5.03% (148/2,940) in those without HPV vaccination, indicating a significant decrease in vaccinated women (p = 0.03). ASC-US cases were referred to HPV DNA tests. In addition, the rates of high grade squamous intraepithelial lesion (HSIL) or worse were 0.30% (1/332) in women with HPV vaccination and 0.82% (24/2,940) in those without HPV vaccination, showing the marginal decrease in women who were vaccinated (p = 0.3). Thus, this study indicates that HPV vaccination is associated with a reduction in the incidence of cervical abnormalities, suggesting a need for scientific discussion of reinstatement of proactive recommendation for HPV vaccine in Japan.

【目的】子宮頸がんは発生原因が、ヒトパピローマウイルス（HPV）であることが解明された。さらにこの前がん病変を発見するには、子宮頸がん検診の受診率向上と細胞診検査の精度を上げることが重要である。近年婦人科細胞診領域に、液状法が導入されはじめている。そこで、従来の塗抹細胞診と液状細胞診、ハイリスクHPV検査結果の比較検討をしたので報告する。【対象】当施設の平成23年1月から12月までの、子宮頸部細胞診を施行した18,956例を対象とした。【方法】子宮頸部よりブラシを用いて擦過採取した従来法18,956例と、同意を得られたスプリットサンプル標本1,227例は液状法（TACASバイアル少量法）、とハイリスクHPV検査を行った。 ハイリスクHPVはBML（ハイブリットキャプチャー法）へ依頼した。【結果】従来法の不適正率は0.2％（44/18,956）で液状法では0％（0/1,227）であった。 液状法の判定は従来法と比較し、95.2％（1,168/1,227）の一致率であった。 ASC-US以上の判定については、液状法が従来法よりも感度が高かった。 高リスクHPV検査の陽性率は6.9％（85/1,227）であった。 従来法及び液状法ともに陰性（NILM）であった1,137例中27例、2.4％（27/1,137）が高リスクHPV陽性であった。さらに追跡調査でCIN1又はLSILが48％（13/1,227）認められた。液状法の方が従来法よりも、細胞が均一に塗抹され、さらに血液の影響が少なく異型細胞の検出が容易であった。【結論】液状法は、不適正標本を減らし、さらに異型細胞の検出感度を向上させる可能性が示唆された。また、HPV併用液状法によって、ASC-US管理と検診感度の向上が期待できると考えられる。

日本では、毎年約15,000人が子宮頸癌（上皮内癌含む）と診断され、約3,500が死亡している。そのうち、44歳までに約400人が死亡している。20代30代の女性に限ればもっとも罹患率が多い癌は子宮頸癌であり、増加傾向が続いている。 日本の現状の問題点は(1)検診受診率が低い(2)従来法細胞診での診断が続いている(3)HPV予防ワクチンの接種の遅れである。日本産婦人科医会は子宮頸がんの撲滅をめざして、(1)ベセスダシステム（TBS）の導入(2)液状化検体細胞診（LBC）の導入(3)HPV併用検診の導入(4)HPV予防ワクチンの積極的な勧奨の再開（WHOやFIGOは再度安全宣言を出している）(5)受診率の向上を目指している。今回はTBS、LBC、HPV併用検診とワクチンに関するトピックスについて解説する。

Purpose Postoperative chylous ascites is an unusual complication following retroperitoneal surgery. A search of the English literature showed only 44 cases of chylous ascites following gynecological cancer surgery. The treatment is primarily conservative, but surgical treatment is considered in resistant cases. We developed a novel non-surgical therapeutic strategy for postoperative chylous ascites. Methods We report a case of severe chylous ascites following pelvic lymph node dissection for gynecological cancer. Results Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, and systematic pelvic lymph node dissection were performed for a stage II G1 endometrioid adenocarcinoma (FIGO 2009). Forty-one days after surgery, the patient was readmitted due to massive ascites. Repeated paracentesis and a low-fat diet were only partially effective. Fifty-one days after surgery, we started paracentesis with a continuous low-pressure drainage system. Nine days later, there was no further fluid drainage. The patient was asymptomatic and without recurrent disease at follow-up 3 months later. Conclusions Pelvic lymph node dissection may cause postoperative chylous ascites. Paracentesis with a continuous low-pressure drainage system can be an effective conservative treatment for postoperative chylous ascites.

平成 21 年度から「ベセスダシステム 2001 準拠子宮頸部細胞診報告様式」が導入された. 新様式導入に関連する治療選択上の注意点をアメリカと日本の主要なガイドラインを参考に検討した. 運用にあたっては以下の点に留意する必要がある.1. 検体の適正な評価はベセスダシステムの根幹をなすものであり, そのためには採取器具の選択が重要である. 産婦人科診療ガイドラインでは「子宮頸部の細胞採取はヘラもしくはブラシで行う」とされている.2. ベセスダシステムでは腺系病変への視点が取り入れられている. 特に異型腺細胞 (atypical glandular cells : AGC) は新しい概念であり, 注意する必要がある.3. CIN2 の管理・治療方針は, 治療かフォローか, アメリカと日本のガイドラインでは見解が分かれる. 産婦人科診療ガイドラインでは, CIN2 の管理方針に関し, 厳重なフォローをする, としている. ただし, フォローが困難な症例などでは選択的に治療することができることも記載されている.

AIM:The oral management of dementia patients is critical to prevent aspiration pneumonia and maintain patients' quality of life. However, the oral health status of these patients has not been adequately elucidated thus far, and it is not well understood how oral care is managed for mild dementia patients. To provide effective oral management for mild dementia patients, we investigated their oral health status and how their oral care was managed.METHODS:We enrolled 10 outpatients aged 66 to 85 years old who regularly visited our neurology clinic. All of the patients had mild dementia. We conducted 2 questionnaire studies regarding oral hygiene and dentures and performed an oral examination to evaluate the changes in oral hygiene status over time. The questionnaire was designed to explore the understanding of oral hygiene methods. Oral care instructions were given to the patients and their caregivers. Three surveys of 2 questionnaires each were performed. The survey was conducted at the initial visit, and 3 months and 6 months later.RESULTS:Although oral care instructions were given to the patients and their caregivers, neither their plaque index nor gingival index showed major improvement over time. Based on the results of these questionnaires, patient awareness of oral hygiene did not change over time.CONCLUSION:It is difficult for patients with mild dementia to perform oral care by themselves. It is important to make oral hygiene habits second nature in middle-aged patients, to introduce oral management to be performed by the caregivers and to promote early dental intervention to improve and maintain oral hygiene status in mild dementia patients.

OBJECTIVES:Current diagnostic imaging modalities for resin-based composites (RBC) do not possess sufficient resolution and cross-sectional tomographic imaging to detect defects of RBC restorations in real-time. The purpose of this in vivo study was to investigate swept-source optical coherence tomography (SS-OCT) as a new tool to evaluate defects of RBC restorations.METHODS:We evaluated for the failure of RBC restorations in 52 patients (11 male, 41 female) at the Division of Oral and Dental Surgery, National Centre for Geriatrics and Gerontology, Japan. SS-OCT images of the 132 RBC restorations were obtained in order to investigate their marginal adaptation, porosity and internal integrity.RESULTS:Rates of defective restorations in terms of marginal adaptation, large porosity and gap formation were 65.2 percent, 27.3 percent, and 15.2 percent, respectively. Only 18.9 percent of the RBC restorations had no defects.CONCLUSIONS:SS-OCT has the potential to provide higher-resolution information related to the structure of RBC restorations currently unavailable with any diagnostic or imaging method.

AIM:The purpose of this study was to ascertain the current statuses and problems of dental home care patients by surveying the oral care status and needs of patients in the home medical care support ward at the National Center for Geriatrics and Gerontology. Patients that required continuous oral management even after discharge from the hospital were referred to local dental clinics to receive home dental care. We investigated the suitability and problems associated with such care, and identified the dental care needs of home patients and the status of local care coordination, including those in hospitals.METHODS:The subjects were 82 patients. We ascertained their general condition and oral status, and also investigated the problems associated with patients judged to need specialized oral care by a dentist during oral treatment. Patients who required continuous specialized oral care after discharge from hospital were referred to dental clinics that could provide regular care, and the problems at the time of referral were identified.RESULTS:Dry mouth was reported by many patients. A large number of patients also needed specialized dental treatment such as the removal of dental calculus or tooth extraction. Problems were seen in oral function, with 38 of the patients (46%) unable to gargle and 23 (28%) unable to hold their mouths open. About half of the patients also had dementia, and communication with these patients was difficult. Of the 43 patients who were judged to need continuing oral care after discharge from hospital, their referral to a dental clinic for regular care was successful for 22 (51%) patients and unsuccessful for 21 (49%) patients. The reasons for unsuccessful referrals included the fact that the family, patient, nurse, or caregiver did not understand the need for specialized oral care.CONCLUSION:The present results suggest the need for specialized oral treatment in home medical care. These findings also suggest that coordinating seamless dental care among primary physicians, intermediates, and transferring care after hospital discharge to regular dentists is difficult.

The porosity of denture base resins continues to be one of the undesirable characteristics of acrylic resins. It is commonly accepted that porosity of the denture not only often leads to denture fractures, but also may function as a reservoir of potential pathogens. The purpose of this study was to present the first OCT images of finished dentures using a new advanced-type OCT scanner we have developed, and to discuss the application of our new OCT system for nondestructive inspection of dentures. Ten newly fabricated full dentures of outpatient of the National Center for Geriatrics and Gerontology in Japan were selected for this study. Two types of denture base resins were used for inspection by OCT, which provided clear images of all the dentures examined. Internal structures, not visually detectable, inspection, can be observed using this OCT system. It is concluded that OCT can detect nonvisible internal structures in dentures, a finding not reported to date. OCT may, therefore, be an appropriate method for detecting interior defects in dentures nondestructively.

The purpose of this study was to evaluate the effect of continuous oral care on the nutritional status of older people who require care using a 1-year randomized, controlled study. Fifty-three residents of a nursing home in Japan participated in this study. Subjects were randomly divided into two groups, an oral care intervention group and control group. The subjects in the oral care intervention group received professional oral care from a dentist three times a week over the course of 1 year. Body weight, body mass index (BMI), serum albumin, and high-density lipoprotein cholesterol (HDL-C) were measured as objective indicators of nutritional status at baseline and after 1 year, and compared between the groups. In the oral care group, no significant decline was seen in all indicators from the start to the end of the intervention, but in the control group there was a statistically significant decline in all indicators at the end of the year. These results suggest that the intervention of oral care alone can serve to maintain the nutritional status of older people who require care. Implementation of continuous oral care is an important task from the viewpoint of maintaining nutritional status in older people.

OBJECTIVES:In this laboratory study, we examined the use of a swept-source optical coherence tomography (SS-OCT) as a diagnostic tool for occlusal caries. METHODS:One-hundred and eleven investigation sites of occlusal fissures were selected from 62 extracted teeth and examined visually using conventional dental equipment without any magnification. SS-OCT observations were carried out on the same locations as where the conventional examination had been performed. The teeth were then sectioned using a diamond saw and directly viewed under a confocal laser scanning microscope (CLSM). Presence and extent of caries was scored in each observation and the obtained results from SS-OCT and conventional visual inspection were compared with the CLSM. The reproducibility and indices of sensitivity and specificity of SS-OCT were calculated and compared with those of the visual inspection. The results were statistically analyzed using receiver operating characteristic (ROC) curve and Spearman rank correlation test. RESULTS:SS-OCT could clearly detect the presence of enamel demineralization lesion in a tomography image synthesized based on the backscatter signal (sensitivity=0.98). Although the sensitivity for dentine caries of SS-OCT was over that of the visual inspection, the detection level was decreased to 0.60. When the methods were compared to the CLSM, the diagnostic accuracy of SS-OCT was better than that of the conventional visual inspection (Az values of visual inspection and SS-OCT, 0.74 versus 0.86 for enamel demineralization, 0.68 versus 0.80 for dentine caries; Spearman's correlation coefficients to CLSM; visual inspection: 0.665, SS-OCT: 0.824). CONCLUSIONS:The carious demineralization, especially in enamel, can be clearly discriminated as a highlighted area due to scattering of light matches the location of demineralized area at the base of the fissure and the results correlated well with the CLSM.

TS-1は5FUのプロドラッグであるFTに，DPD阻害剤であるCDHPと胃腸毒性を軽減するOxoを配合した新しいフルオロウラシル系経口抗腫瘍剤でこれらの機能によって口腔癌にたいして安全且つ強力な抗腫瘍効果がある。TS-1は癌に対して放射線増感作用がある。われわれは術前TS-1と放射線同時併用療法をおこなった慢性腎不全によって人工透析を受けている患者における進行上顎歯肉癌の症例を報告する。患者は62歳男性で左側後方頬溝の周囲に40×25mm大の腫瘍が存在し,翼口蓋窩に浸潤していた（T4N1M0，Stage IVA）。CDHPが主に腎から排泄されるので腎機能が低下した患者にTS-1を投与すると，より高濃度の血中5FU濃度が維持され，毒性が増強する。本例ではTS-1投与時の5FU濃度の治療薬物血中濃度モニタリング（TDM）を行うことにより，透析を受けている慢性腎不全患者の上顎歯肉癌の治療にとって適したTS-1の投与量を推定し治療投与を行った。このプロトコールにおいて透析直後にTS-1を25mg×1回/日を隔日15回投与した。また放射線治療40Gyを併用した。骨髄抑制などの重篤な副作用なく安全に治療は行われ，PRの治療効果を得た。術前化学放射線同時併用療法が奏功したので根治的切除が可能であった。また切除標本の頭頸部癌取り扱い規約による組織学的効果判定はgrade IIであった。維持透析患者の上顎歯肉癌に対して血中薬物動態評価によるTS-1と放射線治療の併用は安全で有効な治療方法であった。