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Japanese patients with very high‐risk cutaneous squamous cell carcinomas (cSCCs), based on the National Comprehensive Cancer Network guidelines, have been reported to display a higher cumulative incidence of relapse and disease‐specific death (DSD) than those with high‐risk cSCC. Therefore, prognosis prediction is crucial for Japanese patients with very high‐risk cSCCs. Herein, we aimed to evaluate the prognostic prediction ability of our novel Japanese Risk Factor Scoring Systems (JARF scoring) in a Japanese cohort of cSSC patients. Data of 424 Japanese patients with resectable very high‐risk cSCCs were analysed. We compared the prognostic ability of the following three staging systems: Brigham and Women's Hospital (BWH) tumour staging, number of NCCN very high‐risk factors, and JARF scoring, including recurrent tumour, high‐risk histological features, deep tumour invasion and lymphatic or vascular involvement as risk factors. The prognostic ability of these staging systems was evaluated according to the cumulative incidence of local recurrence (LR), regional lymph node metastasis (RLNM), DSD, and overall survival (OS). When BWH staging was used, high T stage led to significantly poor outcomes only in the cumulative incidence of RLNM (p = 0.01). The presence of very high‐risk NCCN factors led to significantly poor outcomes in terms of RLNM (p = 0.03) and OS (p = 0.02). Meanwhile, a high number of risk factors in the JARF scoring system clearly led to poor outcomes in terms of LR (p = 0.01), RLNM (p < 0.01), DSD (p = 0.03), and OS (p < 0.01). The JARF scoring system may accurately predict the risk of recurrence and death in very high‐risk cSCC patients in Japan. [ABSTRACT FROM AUTHOR]

Background: Holoprosencephaly (HPE) is a congenital malformation with an estimated prevalence of 0.10–6.06 per 10 000 births but with no nationwide data specific to Japan. Methods: This nationwide retrospective questionnaire survey was conducted from 2011 to 2013. All 467 training hospitals for perinatal and neonatal care certified by the Japan Society of Perinatal and Neonatal Medicine were contacted. The birth prevalence rate (BPR) was assessed from the primary survey and clinical characteristics from the secondary survey. Results: We received valid responses from 253 hospitals in the primary survey (54.6%). Of 390 342 live births, 60 were diagnosed with HPE (23 males and 37 females), resulting in an actual BPR of 1.54 per 10 000 live births. The point estimate for HPE cases was 100 (95% confidence interval [CI]: 80.7–120), and the estimated BPR of HPE was calculated to be 0.32 per 10 000 live births (95% CI: 0.26–0.38) based on 3 117 853 live births according to Japanese national statistics during the study period. In the secondary survey, we obtained data for 49 cases (19 males and 30 females). Of these, 20 were alobar (40.8%), 20 were semilobar (40.8%), five were lobar (10.4%), and four were of unknown type. Genetic examination was performed in 37 of the 49 HPE patients and revealed that chromosomes 13, 18, and 7 were affected in eight, six, and four patients, respectively. Conclusions: This is the most extensive survey on holoprosencephaly to date in Japan. The estimated BPR was consistent with that reported in previous research. [ABSTRACT FROM AUTHOR]

Background A nationwide, multicenter and observational study was retrospectively conducted to evaluate the clinical utility of Cepharanthin ( CEP) for pediatric patients with chronic immune thrombocytopenia ( ITP). Methods Clinical and laboratory data for 46 Japanese patients aged <16 years who were diagnosed as having chronic ITP in 14 hospitals during 2001-2011, and were treated with CEP for >12 months, were analyzed. Results Median daily CEP dose was 1 mg/kg (range, 0.12-2 mg/kg). Median platelet count prior to CEP was 20.5 × 109/L ( IQR, 8.3-53.0 × 109/L), and then significantly increased to 58.5 × 109/L ( IQR, 22.8-115.0 × 109/L) and 69.0 × 109/L ( IQR, 23.0-134.0 × 109/L) at 12 and 24 months of treatment, respectively. No life-threatening bleeds or moderate-severe adverse events were reported. Of 38 patients who received both corticosteroids ( CS) and CEP, 17 patients (45%) were weaned from CS, and 15 patients (39%) attained the reduced dose of CS. The duration from the start of CEP to the stopping of CS was a median of 413 days (range, 49-1734 days) in patients who were weaned from CS. Conclusions CEP alone or combined with CS was useful for the management of pediatric chronic ITPs. [ABSTRACT FROM AUTHOR]

Purpose: To assess the incidence of monozygotic twinning (MZT) among cases undergoing assisted reproductive technology (ART) treatment. Methods: We performed a retrospective observational study and analyzed the data of patients who were registered in the national ART registry system of Japan from January to December 2010; only the data of patients with single embryo transfer (ET) were included. Results: Of 30,405 pregnancies, 425 resulted in MZT following fresh and frozenthawed ET. The MZT incidence among women undergoing ART was 1.4 %. Multiple logistic regression analysis indicated that cases undergoing fresh and frozen-thawed ET, blastocyst transfer had a significantly increased MZT rate ( P < 0.01). Assisted hatching (AH) and frozen-thawed ET and maternal age did not significantly affect the MZT incidence. Of 8510 fresh ET pregnancies, 104 resulted in MZT. Multiple logistic regression analysis indicated that blastocyst transfer significantly increased the MZT rate in cases undergoing fresh ET. Ovarian stimulation, intracytoplasmic sperm injection, AH, and maternal age did not significantly affect the MZT incidence. Conclusions: Blastocyst transfer was associated with an increased MZT incidence. We have to be aware of the potential risk of MZT caused by blastocyst transfer. However, further studies are required to assess the correlation among specific AH types, embryo culture conditions, and MZT incidence. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to assess the efficacy of assisted hatching ( AH) in assisted reproductive technology ( ART) treatment. Material and Methods In this retrospective observational study, the data of patients who were registered in the National ART Registry System of Japan between January and December 2010 were analyzed. The descriptive statistics and validity of AH in fresh embryo transfer ( ET) and frozen-thawed ET were assessed by using multiple logistic regression analyses. Results From a total of 105 450 single ET, 46 029 (43.7%) cycles underwent AH. A total of 9737 (21.3%) and 36 292 (60.9%) cycles underwent AH from 45 818 fresh single ET and 59 632 frozen-thawed single ET, respectively. In the fresh ET patients that underwent AH, the clinical pregnancy and live birth rate were significantly decreased in patients of all ages compared with that of the non- AH group. In the frozen-thawed ET patients, there was no significant difference in pregnancy and live birth rate between the AH group and the non- AH group. Conclusion AH treatment was more frequently performed in frozen-thawed ET patients than in fresh ET patients, and in the blastocyst stage than in the early cleavage stage. A significantly decreased pregnancy and live birth rate was observed in the fresh ET patients who underwent AH. In the frozen-thawed ET patients who underwent AH, improvement in the clinical pregnancy and live birth rate was not observed. Further studies on the indication and application of AH in ART treatment are required. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the implications of assisted reproductive technologies (ART) on neonatal birth weight. Design: A retrospective study using analysis of covariance and multiple logistic regression analysis of the Japanese ART registry. Setting: Japanese institutions providing ART treatment. Patient(s): A total of 25,777 singleton neonates reaching term gestation following ART during the years 2007–2008, with 11,374 achieved through fresh embryo transfers (fresh ET) and 14,403 achieved through frozen-thawed embryo transfers (FET). Intervention(s): None. Main Outcome Measure(s): Birth weight. Result(s): The mean birth weight after FET was significantly higher compared with fresh ET and all Japanese births (3,100.7 ± 387.2 g, 3,009.8 ± 376.8 g, and 3,059.6 ± 369.6 g, respectively). The risk for low birth weight in FET was significantly lower compared with fresh ET. In fresh ET, ovarian stimulations were associated with about twofold risk of low birth weight compared with natural cycle. Regarding to the duration of embryonic culture, the risks resulting from a shorter culturing time were significantly higher compared with a longer culturing time in fresh ET. Conclusion(s): The best method of embryo transfer for fetal growth was FET after extended culturing until blastocyst stage. However, further investigations should be performed to understand the safety of ART treatment. [ABSTRACT FROM AUTHOR]

• Predictors of the invasion level of basal cell carcinomas (BCCs) are unclear. • Tumor thickness showed a significant correlation with tumor diameter. • Invasion level was significantly correlated with anatomical region and tumor diameter. • Our results can help optimize the adequate deep surgical margins in facial BCCs. Basal cell carcinoma (BCC) is the most common skin cancer. While Mohs micrographic surgery is commonly accepted for BCC treatment, surgical excision with free margins is widely considered the best treatment modality for BCCs in Japan. However, little is known about the predictors of the invasion levels of BCCs. To investigate the optimization of deep surgical margins by identifying factors significantly influencing the invasion levels of facial BCCs. The tumor invasion level was defined as the deepest part of a tumor. Tumor thickness was measured from the top of the granular layer to the deepest extension of the tumor or from the ulcer base overlying the deepest point of invasion in ulcerated lesions. Factors independently associated with tumor thickness and invasion level were identified by multivariate analysis. Six variables were tested: age, sex, anatomical region (nose, orbit, others), histologic pattern (aggressive, non-aggressive), presence of pigmentation, and diameter. We included 718 cases of facial BCCs involving 705 Japanese patients. The most frequent anatomical region and histologic pattern were the nose and nodular pattern, respectively. Only tumor diameter showed a correlation with tumor thickness (β = 0.377, P < 0.001). Tumor diameter (AOR = 71.189, 95 % CI: 11.420–430.931, P = 0.01) and the following anatomical regions showed correlations with the invasion level: nose/others: AOR=2.769, 95 % CI: 1.235–6.493, P = 0.01; orbit/others: AOR=6.369, 95 % CI: 2.728–15.429, P < 0.001; orbit/nose: AOR=2.300, 95 % CI: 1.056–4.984, P = 0.04. This study serves as a guide for optimizing deep surgical margins and planning surgery for facial BCCs considering independently associated factors. [ABSTRACT FROM AUTHOR]

Background and Aims: Although single-balloon enteroscopy (SBE)-assisted or short-type SBE (short SBE)-assisted ERCP has been reported as useful in patients with surgically altered anatomy, most studies had small sample sizes or single-center designs. This study aimed to evaluate the efficacy and factors affecting the procedure results of short SBE-assisted ERCP in patients with surgically altered anatomy., Methods: This multicenter, retrospective study was conducted at 8 tertiary referral care centers in Japan. The data of patients who underwent ERCP-related procedures using short SBE between September 2011 and August 2019 at each facility were analyzed., Results: Overall, 1318 patients were included in this analysis. The enteroscopy (reaching the target site), cannulation, and total procedural success rates were 87.9% (95% confidence interval [CI], 86.1%-89.6%), 87.0% (95% CI, 84.9%-88.8%), and 74.9% (95% CI, 72.5%-77.2%), respectively. Adverse events occurred in 7.7% of patients (95% CI, 6.4%-9.3%). Multiple logistic regression analysis indicated that age (≥75 years), Roux-en-Y reconstruction, pancreatic indication, and malignancy were factors affecting the total procedural failure., Conclusions: This large-scale study proved that short SBE-assisted ERCP in patients with surgically altered anatomy was effective. Moreover, it clarified factors affecting procedure results. Proficiency with alternative treatment techniques is required in difficult cases. (Clinical trial registration number: UMIN00004045.)., (Copyright © 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.)

Objectives: This study aimed to investigate the effects of alcohol consumption (AC) on maxillofacial fractures caused by falls on a level surface (simple falls)., Material and Methods: Patients with maxillofacial fractures caused by falls who visited the Oral and Maxillofacial Surgery Clinic from January 2006 to December 2016 were evaluated. Patients with simple falls were subdivided into those who fell with AC (Falls with AC) and those who fell without AC (Falls without AC)., Results: Of 180 patients with falls with maxillofacial fractures, 155 had simple falls, and 25 patients had falls from a height. Of the simple falls, 52 were Falls with AC, and 102 were Falls without AC. Falls with AC were significantly more frequent in males (p = .0005). The average number of fracture lines in the mandible was significantly higher in Falls with AC (2.13 ± 0.99 [mean ± SD]) than in Falls without AC (1.76 ± 0.91) (p = .011). The average Facial Injury Severity Scale was significantly higher in Falls with AC (3.08 ± 1.43) than in Falls without AC (2.43 ± 1.29) (p = .007)., Conclusions: Falls with AC were associated with more severe maxillofacial fractures than Falls without AC., (© 2020 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background/aims: Loss of consciousness while falling is reported to increase the risk of more severe injury. However, few studies of maxillofacial injuries have been reported. The aim of this study was to investigate the effects of loss of consciousness on maxillofacial fractures in falls on a level surface (simple falls)., Material and Methods: Patients with maxillofacial fractures caused by simple falls were subdivided into two categories: patients who fell without loss of consciousness and patients who fell with loss of consciousness, according to the Guidelines for the Diagnosis and Management of Syncope (version 2009). The severity of the injuries was compared between these two groups., Results: In 413 patients with maxillofacial fractures, 58 cases were falls without loss of consciousness, and 44 cases were falls with loss of consciousness. In falls with loss of consciousness, 54.5% were reflex syncope, followed by syncope due to orthostatic hypotension (15.9%), epilepsy (15.9%), and cardiac syncope (9.1%). The average number of fracture lines in the mandible was significantly lower in falls without loss of consciousness (1.53 ± 0.7) than in falls with loss of consciousness (2.00 ± 1.00) (P = 0.045). The average Facial Injury Severity Scale score was lower in falls without loss of consciousness (2.24 ± 1.20) than in falls with loss of consciousness (2.68 ± 1.39). Fractures of other parts of the body were significantly more common in falls without loss of consciousness (22.2%) than in falls with loss of consciousness (9.1%) (P = 0.0135)., Conclusions: Patients with loss of consciousness and maxillofacial fractures due to simple falls showed a tendency to sustain more severe maxillofacial injuries than those without loss of consciousness., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To evaluate the relationship between frozen-thawed single blastocyst transfer (BT) and maternal and neonatal outcomes of pregnancy., Design: Retrospective analysis., Setting: Japanese nationwide registry of assisted reproductive technology (ART) with mandatory reporting for all ART clinics in Japan., Patient(s): Registered from 2008 through 2010 undergoing single embryo transfer cycles (n = 277,042)., Intervention(s): None., Main Outcome Measure(s): Rates of preterm birth (PTB; <37 weeks' gestation), low birth weight (LBW; <2,500 g), small for gestational age (SGA), large for gestational age (LGA), placenta previa, placenta abruption, placenta accreta, and pregnancy-induced hypertension (PIH) after fresh/frozen-thawed and cleaved-embryo/blastocyst transfers were performed., Result(s): Frozen-thawed embryo transfer (FET) was associated with a significantly reduced occurrence of PTB, LBW, and SGA but increased rate of LGA. FET was also associated with a higher incidence of placenta accreta (odds ratio 3.16) and PIH (odds ratio 1.58). BT was associated with a significantly decreased rate of SGA and increased rate of LGA. There was no significant association between BT and maternal complications., Conclusion(s): Frozen-thawed BT is associated with improved general perinatal outcomes of pregnancy but significantly increased maternal risks of placenta accreta and PIH. This finding requires further investigation to assure maternal safety of patients undergoing ART treatment., (Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Allergic rhinitis and asthma are often comorbid, and allergic rhinitis has been shown to be a risk factor for asthma in adults and children. Recently, the prevalence of allergic rhinitis among bronchial asthma (BA) patients was reported to be 67.3% in Japan. However, seasonal variation in the prevalence of rhinitis in Japan remains unclear., Objectives and Methods: To investigate the seasonal differences in comorbid allergic rhinitis among asthmatic patients, a survey of BA outpatients aged six years and older was conducted at the Allergy Center, Saitama Medical University. In total, 150 patients (mean age, 43.8±21.8 years old) in summer 2012 and 181 patients (mean age, 48.7±18.3 years old) in spring 2013 completed the Self Assessment of Allergic Rhinitis and Asthma (SACRA) questionnaire., Results: The prevalence of allergic rhinitis in BA patients was 50% in the summer of 2012 and 85.6% in the spring of 2013, indicating a significant seasonal variation. Control of asthma was significantly poorer in both seasons in patients with rhinitis compared to those without rhinitis. Furthermore, in patients with moderate/severe-persistent rhinitis, control of asthma was significantly worse than in patients with mild-intermittent rhinitis in spring 2013, but not in summer 2012., Conclusion: Although the comorbidity rate of rhinitis among BA patients was greater in the spring than in the summer, rhinitis is thought to be closely related with asthma control regardless of the season.