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Purpose: The aim of this study was to determine a standard deviation (SD) that most reduces the radiation dose without sacrificing the diagnostic accuracy of thin-section computed tomography (CT) for clinical use.Materials and Methods: A total of 120 patients were examined by multidetector CT. They were assigned to one of four SD groups: 8, 9, 11, and 12. Each SD group consisted of 30 patients. The CT images of the same patients with SD10 that had formerly been examined were used for comparison. Two radiologists independently evaluated the degrees of image noise and diagnostic acceptability of the pulmonary diseases using a point score grading system. We compared the scores between each SD and the SD10 group.Results: Generally, image noise was significantly more prominent in the higher-SD groups. The mean score of diagnostic acceptability was significantly lower in the SD12 group (4.2 ± 1.6) than in the SD10 group (4.6 ± 1.1) group (P < 0.001), whereas no difference was present between the SD8 (4.9 ± 0.7), SD9 (4.8 ± 1.0), and SD11 (4.4 ± 1.5) groups and the SD10 group (4.7 ± 1.1, 4.6 ± 1.4, 4.6 ± 1.1, respectively).Conclusion: Thin-section CT with SD12 is not acceptable. SD11 seems to be the setting with the lowest radiation dose while providing acceptable imaging quality for pulmonary thin-section CT. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate thinsection computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET) findings of localized pulmonary mucinous bronchioloalveolar carcinomas (BACs).Methods and Materials: From February 2000 to February 2009, there were seven patients with pulmonary localized mucinous BACs that were pathologically confirmed in the surgical specimens. Their CT findings were assessed regarding location, extent (percent) of groundglass opacity (GGO), margin characteristics, and the presence of air-containing spaces and contractive changes. We evaluated the presence of the "angiogram sign" in the patients who underwent enhanced CT. The maximum standardized uptake value (SUVmax) on FDG-PET was measured in four cases.Results: All tumors were located in the lower lobes. The percentages of GGOs ranged from 0% to 70% (average 20%). The tumor margins were well defined in five cases and ill-defined in two cases. Air-containing spaces were seen in all cases. Evidence of contractive change was seen in two of the seven cases. The angiogram sign was identified in one of five patients who underwent enhanced CT. The SUVmax on FDG-PET ranged from 0.93 to 1.97 (mean 1.53).Conclusion: The imaging features of localized mucinous BACs include solid or partly solid attenuation, the presence of air-containing spaces, lack of contractive changes, and lower lobe predominance. Additionally, the SUVmax is markedly low on FDG-PET. [ABSTRACT FROM AUTHOR]

Abstract Background As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated. Methods Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of α/β ratios (1–10 Gy). Receiver operating characteristics analysis was used to define the most appropriate α/β ratio. Results Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy. Conclusions Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients.

Abstract Background Chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT), appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer Materials and methods A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated. Results Rib fracture was identified on follow-up CT in 41 patients (23.2%). Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4 -58 months). Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%), of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms. Conclusion Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present.

Nasopalatine duct cysts are difficult to detect on panoramic radiographs due to obstructive shadows and are often overlooked. Therefore, sensitive detection using panoramic radiography is clinically important. This study aimed to create a trained model to detect nasopalatine duct cysts from panoramic radiographs in a graphical user interface-based environment. This study was conducted on panoramic radiographs and CT images of 115 patients with nasopalatine duct cysts. As controls, 230 age- and sex-matched patients without cysts were selected from the same database. The 345 pre-processed panoramic radiographs were divided into 216 training data sets, 54 validation data sets, and 75 test data sets. Deep learning was performed for 400 epochs using pretrained-LeNet and pretrained-VGG16 as the convolutional neural networks to classify the cysts. The deep learning system's accuracy, sensitivity, and specificity using LeNet and VGG16 were calculated. LeNet and VGG16 showed an accuracy rate of 85.3% and 88.0%, respectively. A simple deep learning method using a graphical user interface-based Windows machine was able to create a trained model to detect nasopalatine duct cysts from panoramic radiographs, and may be used to prevent such cysts being overlooked during imaging., (© 2024. The Author(s).)

Objectives: Despite the difficulty in distinguishing between squamous cell carcinoma (SCC) and medication-related osteonecrosis of the jaw (MRONJ) on the basis of medical imaging examinations, the two conditions have completely different treatment methods and prognoses. Therefore, differentiation of SCC from MRONJ on imaging examinations is very important. This study aimed to distinguish SCC from MRONJ by performing texture analysis using magnetic resonance imaging (MRI) short-tau inversion recovery images., Methods: This retrospective case-control study included 14 patients with SCC of the lower gingiva and 35 with MRONJ of the mandible who underwent MRI and computed tomography (CT) for suspected SCC or MRONJ. SCC was identified by histopathological examination of tissues excised during surgery. The radiomics features of SCC and MRONJ were analyzed using the open-access software MaZda version 3.3 (Technical University of Lodz, Institute of Electronics, Poland). CT was used to evaluate the presence or absence of qualitative findings (sclerosis, sequestrum, osteolysis, periosteal reaction, and cellulitis) of SCC and MRONJ., Results: Among the 19 texture features selected using MaZda feature-reduction methods, SCC of the gingiva and MRONJ of the mandible revealed differences in two histogram features, one absolute gradient feature, and 16 Gy level co-occurrence matrix features. In particular, the percentile, angular second moment, entropy, and difference entropy exhibited excellent diagnostic performance., Conclusion: Non-contrast-enhanced MRI texture analysis revealed differences in texture parameters between mandibular SCC and mandibular MRONJ. MRI texture analysis can be a new noninvasive quantitative method for distinguishing between SCC and MRONJ., (© 2023. The Author(s) under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology.)

Objective: This study assessed the diagnostic efficacy of apparent diffusion coefficient (ADC), texture features, and their combination for the differential diagnosis of odontogenic cysts and tumors with cyst-like features., Study Design: In total, 14 dentigerous cysts (DCs), 12 odontogenic keratocysts (OKCs), and 6 unicystic ameloblastomas (UABs) were used as predictor variables in 32 outpatients who underwent magnetic resonance imaging. The outcome variables were ADC, texture features, and their combination for each lesion. Texture features including histogram and gray-level co-occurrence matrix (GLCM) were measured on ADC maps. Ten features were selected by using the Fisher coefficient method. The Kruskal-Wallis test and post hoc Mann-Whitney test with Bonferroni adjustment were used to analyze trivariate statistics. Statistical significance was established at P < .05. Receiver operating characteristic analysis was used to evaluate the diagnostic effect of ADC, texture features, and their combination in distinguishing the lesions from each other., Results: Apparent diffusion coefficient, 1 histogram feature, 9 GLCM features, and their combination demonstrated significant differences between DC, OKC, and UAB (P ≤ .01). Receiver operating characteristic analysis revealed a high area under the curve of .95 to 1.00 for ADC, 10 texture features, and their combination. Sensitivity, specificity, and accuracy ranged from .86 to 1.00., Conclusions: Apparent diffusion coefficient and texture features, alone or in combination, can be clinically important in facilitating the distinction between these odontogenic lesions., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can cause loss or alteration of taste and smell as early symptoms or sequelae, but the detailed mechanism behind this phenomenon remains unclear. Here, we investigated whether the SARS-CoV-2 spike protein induces taste cell apoptosis and expression of the apoptosis-related cytokine TNF-α in male Sprague-Dawley rats. Terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP)-fluorescein nick end labeling (TUNEL) assay results revealed a significantly higher apoptosis index for taste cells in the SARS-CoV-2 group than for those in the control group. An immunohistochemistry analysis indicated significantly more TNF-α-positive cells in the SARS-CoV-2 group compared with the control group. These data suggest that the SARS-CoV-2 spike protein promotes taste cell apoptosis and the release of apoptosis-related cytokine TNF-α, implicating its contribution to the taste malfunction caused by coronavirus disease 2019 (COVID-19)., Competing Interests: The authors have no conflicts of interest relevant to this article., (© 2022 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.)

Objectives: This study aimed to quantitatively assess maxillary central incisor roots using pre-orthodontics computed tomography (CT) texture analysis as part of a radiomics quantitative analysis., Methods: This retrospective case-control study included 16 patients with external apical root resorption (EARR) and 16 age- and sex-matched patients without EARR, after orthodontic treatment who underwent pre-orthodontics CT for jaw deformities. All patients were treated with a fixed orthodontic appliance before and after surgical orthodontic treatment. EARR was defined as root resorption ≥ 2 mm of the left and right maxillary central incisors on CT images more than 2 years after the start of orthodontic treatment. Texture features of the maxillary central incisor with and without EARR after orthodontic treatment were analyzed using the open-access software, MaZda Ver. 3.3. Ten texture features were selected using the Fisher method in MaZda from 279 original parameters, which were calculated for each of the maxillary central incisors with and without EARR. The results were tested using the Student's t test, Welch's t test, or Mann-Whitney U test., Results: Four gray-level run length matrix features and six gray-level co-occurrence matrix features displayed significant differences between both the groups (p < 0.01)., Conclusions: CT texture analysis was able to quantitatively assess maxillary central incisor roots and distinguish between maxillary central incisor roots with and without EARR. CT texture analysis may be a useful method for predicting EARR after orthodontic treatment., (© 2022. The Author(s) under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology.)

Purpose: Several landmark trials have reported that direct oral anticoagulants (DOACs) are more effective in preventing stroke and systemic embolism than vitamin K antagonists. However, nonadherence to DOACs worsens prognosis in patients with nonvalvular atrial fibrillation (NVAF) despite the effectiveness of the drugs. The purpose of this study was to evaluate the effects of a pharmacist-led educational interventional program involving motivational interviewing on medication adherence, as assessed by electronic monitoring, in patients receiving DOACs for the treatment of NVAF., Methods: This prospective, randomized, interventional study was conducted at outpatient cardiology clinics at general hospitals and pharmacies in Japan. Patients with NVAF who were treated with a once-daily DOAC (edoxaban) or a twice-daily DOAC (apixaban) were randomized to receive either: (1) an educational interventional program involving motivational interviewing regarding adherence to anticoagulants; or (2) standard medication counseling. The primary end point was the change in the medication adherence rate, calculated as the number of days that patients appropriately took the drug, as assessed by an electronic monitoring device, divided by the total number of days that the drug was prescribed, from a 12-week observation period to a 12-week intervention period. The secondary end points were tolerability outcomes. The effect of the educational interventional program on the primary end point was analyzed in subgroups stratified by gender and type of DOAC received., Findings: A total of 268 patients completed the observation period and were randomly assigned to one of the two study groups. The difference in the primary end point between the educational interventional program group and the standard medication counseling group was not significant (mean [SD], 2.9% [7.5%] vs 3.4% [8.3%]). On multiple linear regression analysis, the difference in DOAC adherence between the two groups was not significant, but that adherence to apixaban was significantly improved among men in the educational interventional program (β = 0.219; P = 0.012). Two patients died of causes considered unrelated to treatment; no stroke/systemic embolism or major bleeding events were observed., Implications: In this randomized, controlled study of the effects of a pharmacist-led educational interventional program using motivational interviewing on adherence to DOACs among patients with NVAF, adherence to DOACs, as assessed using an electronic monitoring device, was not improved with the educational interventional program compared to standard medication counseling . However, adherence to twice-daily apixaban was improved among men, but not among women, in the educational interventional program group. In this study, the selection of DOACs was not randomized, and the lack of assessment of the association between adherence to DOACs and clinical outcomes was a limitation. Japan Registry of Clinical Trials (jRCT) indentifier: jRCTs031180142., Competing Interests: Declaration of Interest T.S. and N.H. have received lecturer's fees from Daiichi Sankyo and Bristol-Myers Squibb. Y.A. has received lecturer's fees from Daiichi Sankyo. N.H. has received research funding from Daiichi Sankyo. The authors have indicated that they have no conflicts of interest with regard to the content of this article., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to quantitatively assess the mandibular condyle in patients with diabetes mellitus (DM) using the apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DWI)., Study Design: 102 patients with DM and temporomandibular joint (TMJ) pain who underwent magnetic resonance imaging (MRI) examination of the TMJs at our hospital between August 2006 and March 2020 were included in this study. 112 patients with temporomandibular disorders (TMD) who underwent MRI examination at our hospital between April 2019 and March 2020 were included as controls. The MRI findings were compared between the two groups., Results: The mean ADC values of the mandibular condyle in patients with DM were significantly greater than the controls (P < 0.01). Receiver operating characteristic (ROC) curve analysis revealed a cutoff of 0.98 for the ADC values of the mandibular condyle in patients with DM., Conclusion: This study found that the ADC on DWI could be used for the quantitative assessment of the mandibular condyle in patients with DM. DWI might serve as a new and noninvasive method to assess the presence of DM., (© 2022. The Author(s) under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology.)

Purpose: It is challenging for radiologists to distinguish between venous malformations (VMs) and lymphatic malformations (LMs) using magnetic resonance imaging (MRI). Thus, this study aimed to differentiate VMs from LMs using non-contrast-enhanced MRI texture analysis., Material and Methods: This retrospective case-control study included 12 LM patients (6 men and 6 women; mean age 43.58, range 7-85 years) and 29 VM patients (7 men and 22 women; mean age 53.10, range 19-76 years) who underwent MRI for suspected vascular malformations. LM and VM patients were identified by histopathological examination of tissues excised during surgery. The texture features of VM and LM were analysed using the open-access software MaZda version 3.3. Seventeen texture features were selected using the Fisher and probability of error and average correlation coefficient methods in MaZda from 279 original parameters calculated for VM and LM., Results: Among 17 selected texture features, the patients with LM and VM revealed significant differences in 1 histogram feature, 8 grey-level co-occurrence matrix (GLCM) features, and 1 grey-level run-length matrix feature. At the cut-off values of the histogram feature [skewness ≤ -0.131], and the GLCM features [S(0, 2) correlation ≥ 0.667, S(0, 3) correlation ≥ 0.451, S(0, 4) correlation ≥ 0.276, S(0, 5) correlation ≥ 0.389, S(1, 1) correlation ≥ 0.739, S(2, 2) correlation ≥ 0.446, S(2, -2) correlation ≥ 0.299, S(3, -3) correlation ≥ 0.091] had area under the curves of 0.724, 0.764, 0.773, 0.747, 0.733, 0.759, 0.730, 0.744 and 0.727, respectively., Conclusions: Non-contrast-enhanced MRI texture analysis allows us to differentiate between LMs and VMs., Competing Interests: The authors report no conflict of interest., (© Pol J Radiol 2022.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections cause loss or alteration of taste and smell as early symptoms and sequelae, but the detailed mechanism remains unclear. This study investigated whether coronavirus disease 2019-induced taste disorders are caused by direct effects on taste bud cells. SARS-CoV-2 recombinant spike and nucleocapsid proteins were applied to circumvallate papillae of male Sprague-Dawley rats. Immunohistochemistry and image analysis were used to compare the number of taste buds, and taste bud cells and area, together with confirmation of angiotensin-converting enzyme 2 (ACE2) expression. Immunohistochemical analysis revealed ACE2 expression in the taste buds of rat circumvallate papillae. Decreases in the number of taste buds, taste bud cells, and their area were observed at 12 days after application of SARS-CoV-2 recombinant spike and nucleocapsid proteins. These data suggest that SARS-CoV-2 proteins induce degeneration of taste buds., Competing Interests: The authors have no conflicts of interest relevant to this article., (© 2022 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.)

Objective: We aimed to quantitatively assess the parotid gland by using computed tomography (CT) texture analysis to detect parotid sialadenitis (PS)., Study Design: This retrospective case-control study included 43 patients with PS who underwent CT and magnetic resonance imaging (MRI). Parotid glands with an abnormal signal (STIR: High) on MRI were identified as showing PS. Patients with parotid gland tumors, bilateral PS, marked fatty degeneration, and severe artifacts on CT were excluded. The texture features of parotid glands with PS and the contralateral normal parotid glands were analyzed using the open-access software LIFEx. The regions of interest were manually placed by tracing contours of both parotid glands on CT images. The results were tested with the paired t-test (or Wilcoxon rank-sum test when appropriate). Receiver operating characteristic (ROC) curve analysis was performed to assess the ability of texture features to predict PS., Results: Six gray level run length matrix features, 2 neighborhood gray level difference matrix features, and 5 gray level zone length matrix features displayed significant differences between PS and normal glands (P ≤ .047). ROC curve analysis showed acceptable accuracy in 4 texture features., Conclusions: CT texture analysis allowed quantitative assessment of parotid glands and may have the potential to detect PS., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: This study aimed to evaluate whether lacunar infarcts can be predicted from occlusal support and periodontal stage on images., Methods: Seventy patients with lacunar infarcts and 300 participants without lacunar infarcts who underwent cerebral checkups at our university hospital were retrospectively reviewed. Lacunar infarcts were assessed using magnetic resonance images by a neuroradiologist. The number of teeth, occlusal support, and severity of radiographic bone loss (RBL) were evaluated using computed tomography. Occlusal support was classified according to the Eichner classification. Additionally, patient characteristics were investigated using medical charts and blood test reports. Records of clinical periodontal parameters, such as clinical attachment loss and bleeding on probing, were also evaluated., Results: The severity of RBL and Eichner classification in patients with lacunar infarcts was significantly higher than that in individuals without lacunar infarcts (P<.01). Receiver operating characteristic analysis revealed that the cut-off values for predicting lacunar infarct were ≥ III in the severity of RBL and ≥B1 in the Eichner classification. The corresponding areas under the curve were 0.75 and 0.70, respectively. In multivariate analysis, the factors affecting the severity of RBL (≥ III) (odds ratio [OR], 8.1; 95% confidence interval [CI], 4.1-16.3; P<.001), and Eichner classification (≥B1) (OR, 1.9; 95% CI, 0.86-4.1; P<.05) were significantly associated with the occurrence of lacunar infarcts., Conclusion: The severity of RBL and the Eichner classification may be helpful in predicting lacunar infarcts. Therefore, proper periodontal treatment and prosthodontic rehabilitation of missing teeth may prevent lacunar infarcts.

Purpose: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication of treatment with bisphosphonates or antiangiogenic inhibitors. MRONJ has four stages (0-3); however, stage 0 MRONJ is difficult to detect using computed tomography (CT). This study aimed to quantitatively assess the mandibular bone marrow using texture analysis to detect stage 0 MRONJ from CT images., Methods: This retrospective study included 25 patients with stage 0 MRONJ who had a history of treatment with bisphosphonates and underwent CT and magnetic resonance imaging (MRI). The mandibular bone marrow with abnormal signals (T1-weighted imaging: low, T2-weighted imaging: low or high, short-tau inversion recovery: high) on MRI, and no qualitative characteristic CT and oral findings indicative of osteonecrosis (exposed bone, sequestrum, periosteal reaction, and osteolysis) was identified as 0 MRONJ. Texture features of the bone marrow of the mandible with MRONJ and the contralateral, normal mandibular bone marrow were extracted using an open-access software, namely, LIFEx. The volumes of interest (VOIs) were manually placed on CT images by tracing the bilateral mandibular bone marrow regions, excluding the teeth, mandibular canal, and cortical bone. Thirty-seven texture features were extracted from each VOI., Results: Six gray-level run length matrix features and four gray-level zone length matrix features exhibited significant differences between mandibular bone marrow with and without MRONJ., Conclusions: CT was able to quantitatively assess texture features of normal mandibular bone marrow and that with MRONJ. Texture analysis may be useful as a new method for detecting stage 0 MRONJ using CT., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: Diabetes mellitus (DM) is associated with a broad range of complications, such as retinopathy, nephropathy, neuropathy, and cardiovascular disease. Therefore, predicting DM from head and neck images is a challenge for clinicians. The purpose of this study was to assess the mandibular condylar bone marrow in DM patients using computed tomography (CT) texture analysis., Methods: This retrospective study included 16 DM and age and sex matched 16 control patients (11 men, 5 women; mean age, 56.8 ± 14.4 years; range 31-78 years). Patients with Type I DM, prior history of taking bisphosphonates, osteoarthritis of the temporomandibular joint, and CT images with metal artifacts were excluded from this study. Bilateral mandibular condylar bone marrow was manually contoured on axial CT images. The presence or absence of DM is the primary predictor variable. Texture features of the region of interest was the outcome variable, that were analyzed using an open-access software, MaZda Ver.3.3. For each group, 20 features out of 279 parameters were selected with Fisher, probability of error and average correlation coefficient methods in MaZda. Bivariate statistics were computed with the Mann-Whitney U test and the P value was set at .05., Results: One histogram feature, 15 Gy level co-occurrence matrix features, and four gray level run length matrix features showed differences between the DM patients and non-DM patients (P < 0.05)., Conclusions: Several texture features of the condyle demonstrated differences between the DM and non-DM patients. CT texture analysis may potentially detect DM from the condylar bone marrow., (© 2021. The Author(s), under exclusive licence to Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd.)

Objective: The purpose of this study was to quantitatively assess normal submandibular glands and submandibular sialadenitis (SS) using computed tomography (CT) texture analysis as part of radiomics quantitative analysis., Study Design: In total, 31 patients with unilateral SS who underwent head and neck magnetic resonance imaging (MRI) and CT and were retrospectively reviewed. Submandibular glands with abnormal signals (STIR: high, T2-weighted image: high, T1-weighted image: low) on MRI were identified as SS. The radiomics features of the contralateral normal submandibular glands and SS were analyzed using an open-access software, MaZda Version 3.3. Sixteen radiomics features were selected with Fisher and probability of error and average correlation coefficient methods in MaZda from 279 original parameters calculated for each of the normal and SS glands. The results were statistically analyzed with the Wilcoxon rank sum test., Results: One gray-level co-occurrence matrix feature and 9 gray-level run length matrix features displayed significant differences between normal submandibular glands and glands with SS (P < .05)., Conclusions: CT texture analysis was able to quantitatively distinguish between normal and diseased submandibular glands. It therefore may have the potential to detect SS., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Nonadherence diminishes the efficacy of direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation (NVAF). This report presents the baseline survey results regarding medication adherence among NVAF patients who were treated with once-daily edoxaban or twice-daily apixaban from a randomized control trial of the effect of an educational intervention on DOAC adherence., Methods: We prospectively studied 301 NVAF patients who were treated with edoxaban (n = 175) or apixaban (n = 126) during the 12-week observation period. Adherence was measured with an electronic monitoring system and is expressed as the percentage of days with the correct doses in the measurement period (days). Adherence to DOAC therapy was defined based on the standard threshold (≥80%) or a strict threshold (≥90%)., Results: Of the 301 patients, 33 had incomplete data or protocol deviations, leaving 268 patients (edoxaban 158 and apixaban 110) for the per-protocol baseline analysis. There was no difference in adherence (threshold ≥80%) between the groups (edoxaban 95% vs apixaban 91%, P  = .2), but there was a lower proportion of patients with strict adherence (threshold ≥90%) among apixaban users than among edoxaban users (edoxaban 87% vs apixaban 76%, P  = .02). Multivariate analysis showed a negative relationship between apixaban use and an adherence rate ≥90% (odds ratio 0.49, 95% confidence interval [CI]: 0.25-0.94)., Conclusions: Our study showed that the proportion of DOAC users with adherence (≥80%) did not differ between the groups, but the proportion of patients with strict adherence (≥90%) was lower among those using apixaban than among those using edoxaban., Competing Interests: T Shiga and N Hagiwara received lecture fees from Daiichi Sankyo and Bristol‐Myers Squibb. N Hagiwara received research funding from Daiichi Sankyo. The other authors declare that they have no competing interests., (© 2021 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.)

Purpose: Myalgia of the masticatory muscles is difficult to evaluate quantitatively. The purpose of the present study was to quantitatively assess myalgia of the masticatory muscles in patients with temporomandibular disorders (TMDs) using the apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (MRI)., Patients and Methods: Patients who had undergone MRI with clinically diagnosed TMDs according to the criteria of the American Academy of Orofacial Pain and unilateral temporomandibular joint pain from March 2015 to January 2017 were prospectively enrolled. The MRI techniques used included axial diffusion-weighted imaging (DWI) and short T1 inversion recovery imaging through the neck to the skull base. The regions of interest were drawn to completely include the right and left lateral pterygoid muscles, medial pterygoid muscles, and masseter muscles on a slice demonstrating the largest area of each muscle on the ADC map. We compared each masticatory muscle of the pain side with those of the contralateral side without pain., Results: A total of 106 patients with TMD had met the inclusion criteria (18 males, 88 females; mean age, 48.7 years; range, 16 to 80). The mean ADC values of the masticatory muscles of the pain side were significantly greater than those of the no-pain sides (P < .01), as were those for the lateral pterygoid muscles (1.35 ± 0.79 × 10 -3  mm 2 /second vs 1.13 ± 0.77 × 10 -3  mm 2 /second), medial pterygoid muscles (1.28 ± 0.46 × 10 -3  mm 2 /second vs 1.05 ± 0.69 × 10 -3  mm 2 /second), masseter muscles (1.33 ± 0.78 × 10 -3  mm 2 /second vs 1.09 ± 0.64 × 10 -3  mm 2 /second)., Conclusions: The ADC values of the masticatory muscles on the pain side were significantly greater than those of the contralateral side without pain. Our results suggest that DWI could be used to assess myalgia of the masticatory muscles quantitatively., (Copyright © 2019 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The effect of a prior defect on secondary liver atrophy is unknown. We describe a case of sigmoid volvulus that was facilitated by progressive atrophy in a deformed liver. A 75-year-old man with abdominal pain and fullness was referred to our hospital. Computed tomography (CT) revealed reduced left hepatic lobe volume and a whirl sign, characteristic of sigmoid volvulus. The sigmoid volvulus was successfully detorted with endoscopy. Retrospective evaluation of liver morphology on CT and magnetic resonance imaging showed that the portal vein at the liver hilum was denuded due to a parenchymal defect of the medial segment, with compression by the crossing artery. As pulse Doppler ultrasonography demonstrated reduced portal blood flow in the region where liver atrophy developed, compression of the denuded portal vein presumably facilitated secondary atrophy and contributed to sigmoid volvulus. The present case shows that a deformed liver itself can be a cause of secondary atrophy. Therefore, continued monitoring of liver morphology and evaluation of portal blood flow to predict liver atrophy may be required, when an individual with a partial liver defect is encountered.

Background: Choto-san is a traditional medicine used for hypertension and headaches in Japan and China. Some studies have shown its effectiveness in the treatment of dementia. The present review aimed to assess the effectiveness and acceptability of Choto-san in the treatment of adults with cognitive impairment., Methods: We included randomized controlled trials comparing Choto-san with placebo for patients with dementia or mild cognitive impairment., Results: Three randomized controlled trials evaluating 219 participants were included. Two were studies on vascular dementia, and the other was on Alzheimer's dementia. There was no difference between Choto-san and placebo in terms of short-term dichotomous judgement of improvement, but Choto-san was more effective than placebo in terms of short-term improvement of cognitive function as measured by continuous outcomes. Also, dropouts judged it to be acceptable. However, the results were imprecise and/or heterogeneous. The number of participants included in the analysis was small (n = 199 in the primary analysis) and sometimes inconsistent, as indicated by the large I 2 (72% in the primary analysis)., Conclusion: Low-quality evidence was suggestive of Choto-san's efficacy for vascular dementia, but the present results may be overestimated. Studies with a larger sample size and conducted over longer periods should be performed. Regardless, Choto-san can be one of the choices for the treatment of vascular dementia as it is well tolerated., (© 2017 Japanese Psychogeriatric Society.)

Among the several types of cells composing the airway epithelium, the ciliary cells are responsible for one of the most important defense mechanisms of the airway epithelium: the transport of inhaled particles back up into the throat by coordinated ciliary movement. Changes in the cytoplasmic Ca(2+) concentration ([Ca(2+)]i) are the main driving force controlling the ciliary activity. In mouse ciliary cells, membrane hyperpolarization from -20 to -60 mV under whole-cell voltage-clamp induced a slow but significant [Ca(2+)]i rise in a reversible manner. This rise was completely inhibited by the removal of Ca(2+) from the extracellular solution. Application of diazoxide, an ATP-dependent K(+) channel opener, dose-dependently induced a membrane hyperpolarization (EC50 = 2.3 μM), which was prevented by the addition of 5 μM glibenclamide. An inwardly rectifying current was elicited by the application of 10 μM diazoxide and suppressed by subsequent addition of 5 μM glibenclamide. Moreover, the application of 10 μM diazoxide induced a significant [Ca(2+)]i rise and facilitated ciliary movement. Multi-cell reverse-transcription polymerase chain reaction analyses and immunocytochemical staining suggested that the subunit combination of Kir6.2/SUR2B and possibly also Kir6.1/SUR2B is expressed in ciliary cells. The confocal Ca(2+) imaging analyses suggested that the [Ca(2+)]i rise induced by diazoxide occurred preferentially in the apical submembrane region. In conclusion, the application of a KATP channel opener to airway ciliary cells induces membrane hyperpolarization and thereby induces a [Ca(2+)]i rise via the facilitation of Ca(2+) influx through the non-voltage-dependent Ca(2+) permeable channels. Therefore, a KATP opener may be beneficial in facilitating ciliary movement.

Purpose: To investigate prognostic and risk factors for recurrence after stereotactic body radiation therapy (SBRT) in patients with stage I non-small cell lung carcinoma (NSCLC), focusing on dual time point [18]F-fluorodeoxyglucose positron emission tomography (FDG PET)., Materials and Methods: We prospectively evaluated 57 patients with stage I NSCLC (45 T1N0M0 and 12 T2N0M0) who had undergone pretreatment FDG-PET/CT and were subsequently treated with SBRT. All patients received a whole-body PET/CT scan at 60 min and a whole-lung at 120 min after the injection. The maximum standardized uptake value (SUV) and retention index (RI) of the lesions were calculated. Local recurrence, regional lymph node metastasis, distant metastasis, and the recurrence pattern were evaluated. Cox proportional hazard regression analyses were performed to evaluate prognostic factors or risk factors of recurrence., Results: During the median follow-up period of 27 months, local recurrence, regional lymph node metastasis, and distant metastasis were seen in 17 (30%), 12 (21%), and 17 (30%) of the 57 patients, respectively. The 3-year overall survival rate was 63.4%. SUVmax did not affect any recurrence, DFS, OS, or CSS. RI significantly predicted higher distant metastasis (HR 47.546, p=0.026). In contrast, RI tended to predict lower local recurrence (HR 0.175, p=0.246) and regional lymph node metastasis (HR 0.109, p=0.115)., Conclusions: SUVmax at staging FDG-PET does not predict any recurrence, DFS, OS or CSS. In contrast, higher RI predicts higher distant metastasis and tended to predict lower local or regional lymph node metastasis., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Although the mechanism(s) involved in the ceramide deficiency in the stratum corneum (SC) of atopic dermatitis (AD) skin is unknown, Th2 type cytokines have been reported to down-regulate ceramide levels in the epidermis. However, almost all research to date has focused on ceramide levels in the whole epidermis, not just in the SC layers alone, which are predominantly responsible for the skin barrier function., Objective: We highlighted the effects of Th1/Th2 cytokines on ceramide levels in the SC., Methods: We developed a modified system of human epidermal equivalents in which epidermis without a SC is cultured for 1 week to generate complete SC layers after which ceramides are extracted from the separated SC layers and are then quantified as per SC protein., Results: The addition of Th2 cytokines (IL-4/IL-6) at a concentration of 10nM resulted in a marked decrease in SC ceramide levels. The reduced ceramide content in the SC was accompanied by the down-regulated expression of the genes encoding serine-palmitoyl transferase-2, acid sphingomyelinase and β-glucocerebrosidase in the epidermis. In contrast, the addition of Th1 cytokines (GM-CSF/IFN-γ/TNF-α) at concentrations of 2.5 or 10nM resulted in a slight increase in SC ceramide levels, which were accompanied by no change or an increase in the expression of those genes encoding sphingolipid metabolic enzymes in the epidermis., Conclusion: These findings suggest that the Th2 type of inflammation evoked in AD skin is one of the essential factors involved in down-regulating the levels of ceramide in the SC., (Copyright © 2012 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.)

To examine factors that regulate ceramide production during keratinization of the human stratum corneum (SC), we developed a reconstructed human epidermal keratinization model in which a fresh layer of SC is newly formed within 1 week. Addition of the UDP-glucose: ceramide glucosyltransferase inhibitor 1-phenyl-2-decanoylamino-3-morpholino-1-propanol significantly diminished SC ceramide levels (expressed as µg/mg protein) with decreased glucosylceramide levels. Desipramine hydrochloride, an inhibitor of sphingomyelinase, also significantly reduced SC ceramide levels. Similarly, conduritol B epoxide, an inhibitor of β-glucocerebrosidase, significantly down-regulated SC ceramide levels and significantly increased glucosylceramide levels. These results indicate the reliability of this model to elucidate ceramide synthesis regulating factors. Using this model, we assessed the effects of the inflammatory cytokine interleukin-1α (IL-1α), several bioactive sphingolipids and all-trans retinoic acid (RA) on ceramide levels in the SC. Whereas treatment with IL-1α (at 10 nM) significantly down-regulated ceramide levels, treatment with sphingosylphosphorylcholine (at 50 µM) or sphingosine-1-phosphate (at 10 or 20 µM) distinctly up-regulated ceramide levels. Interestingly, RA (at low as 10 nM) significantly up-regulated ceramide levels without affecting the formation of the SC or levels of keratinization-related proteins in the epidermis. The increased levels of ceramide were accompanied by a significantly increased secretion of granulocyte-macrophage colony-stimulating factor as well as by a significantly down-regulated expression of acid-ceramidase at both the gene and protein levels. Taken together, our results underscore the superiority of this reconstructed human epidermal keratinization model to analyze factors that regulate ceramide synthesis, especially in human SC.

Background: Chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT), appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer, Materials and Methods: A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated., Results: Rib fracture was identified on follow-up CT in 41 patients (23.2%). Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4-58 months). Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%), of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms., Conclusion: Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present.

The degenerating muscle (dmu) mouse harbors a loss-of-function mutation in the Scn8a gene, which encodes the alpha subunit of the voltage-gated sodium channel (VGSC) Na(V)1.6. The distribution of c-Fos and c-Jun was examined in spinal and cranial motoneurons of the dmu mouse. In the cervical spinal cord, trigeminal motor nucleus (Vm), facial nucleus (VII), dorsal motor nucleus of the vagus (X), and hypoglossal nucleus (XII) of wild-type mice, motoneurons expressed c-Fos and c-Jun-immunoreactivity. The immunoreactivity in wild-type mice was mostly weak and localized to the nucleus of these neurons whereas in the spinal cord and brain stem of dmu mice motoneurons showed intense c-Fos and c-Jun-immunoreactivity. The number of c-Fos-immunoreactive motoneurons was dramatically elevated in the cervical spinal cord (wild type, 4.8 +/- 1.0; dmu, 17.3 +/- 1.6), Vm (wild type, 76.2 +/- 21.6; dmu, 216.9 +/- 30.9), VII (wild type, 162.4 +/- 43.3; dmu, 533.3 +/- 41.2), and XII (wild type, 58.2 +/- 43.3; dmu, 150.9 +/- 25.7). The mutation also increased the number of c-Jun-immunoreactive motoneurons in the cervical spinal cord (wild type, 1.6 +/- 0.8; dmu, 12.1 +/- 2.1), Vm (wild type, 41.4 +/- 18.0; dmu, 123.1 +/- 11.7), and X (wild type, 39.1 +/- 10.7; dmu, 92.8 +/- 17.8). The increase of these transcription factors may be associated with the uncoordinated and excessive movement of forelimbs and degeneration of cardiac muscles in dmu mice.

The rise of Ca(2+) concentration ([Ca(2+)](i)) by reducing external Na(+) in urinary bladder smooth muscle cells (UBSMCs) from transgenic mice overexpressing Na(+)/Ca(2+) exchanger type-1.3 (NCX1.3(tg/tg)) was about 4 times as large as that in the wild-type (WT). NCX1 protein expression in UB increased about 4-fold in NCX1.3(tg/tg). The Ca(2+) release by caffeine in UBSMCs was comparable between NCX1.3(tg/tg) and WT, but [Ca(2+)](i) decay was faster in NCX1.3(tg/tg). Contractions induced by acetylcholine, 60 mM K(+), or electrical stimulation were significantly smaller in UB segments of NCX1.3(tg/tg). NCX worked in Ca(2+)-extrusion mode during these contractions in UBSMCs of both WT and NCX1.3(tg/tg).

We study the ecological distribution of a unique syntrophic bacterium, Symbiobacterium thermophilum, and related bacteria. In this study, we found that they were frequently obtained from seashells and several marine samples. Symbiobacterium also grew from sterilized oyster shells incubated undersea for 2 or 3 months on the coast of Shimoda, Shizuoka, Japan. 16S rRNA gene-based phylogeny of the clones obtained from the Symbiobacterium-positive cultures demonstrated the potential diversity of this bacterial group, which constitutes a distinct clade between Actinobacteria and Firmicutes. We successfully isolated two new Symbiobacterium strains from oyster shells. 16S rRNA gene-based phylogeny indicated that one belongs to S. thermophilum, and that the other is affiliated with a different species. We also isolated Ureibacillius spp., which showed activity supporting the growth of S. thermophilum.

A method to measure the GTP cyclohydrolase and biopterin (BP) content at the same time in the sonicate of pheochromocytoma PC12h cells was described. The cells cultured in a 5-cm dish were sonicated with 0.4 to 0.5 ml of 50 mM Tris-HCl, pH 7.8, and a 50 microliters aliquot was used for one assay. After the GTP cyclohydrolase reaction, dihydroneopterin triphosphate, the reaction product, was oxidized and dephosphorylated to form neopterin (NP); and the pterins in the reaction mixture were then analyzed by high-performance liquid chromatography (HPLC). Mainly three peaks of pterins were detected in the eluate from the HPLC column: they were NP, BP, and 2-amino-4-hydroxypteridine (AHP). The amount of NP was a measure of the enzyme activity. On the other hand, a significant part of the biopterin contained in the enzyme sample was converted to AHP during the GTP cyclohydrolase reaction. Therefore, the sum amount of BP plus AHP was a measure of total BP content in the enzyme sample (sonicate of PC12h cells). The method is convenient and useful to study the actions and action mechanisms of various biologically active substances on the BP level of pheochromocytoma cells in culture.

Cervical Papanicolaou smears and paraffin sections of biopsy specimens obtained from women attending dysplasia clinics were examined for viral DNA sequences by in situ hybridization technique using 35S-labeled cloned recombinant DNA probes of human papillomavirus (HPV) types 6, 11, and 16. These and one unrelated DNA probe complementary to measles virus RNA were labeled by nick translation using either one or two 35S-labeled nucleotides. The radiolabeled probes were reduced in size with DNase to 60-160 nucleotides. Paraffin sections and cervical smears were collected on pretreated slides, hybridized with the probes under stringent or nonstringent conditions for 50 h, and autoradiographed. Additional cervical specimens from the same women were examined for the presence of genus-specific papillomavirus capsid antigen by the immunoperoxidase technique. Preliminary results may be summarized as follows. The infecting virus could be identified in smears as well as in sections. Viral DNA sequences were detected only when there were condylomatous cells in the specimen and in only a proportion of the condylomatous cells. Even under stringent conditions, some specimens reacted with both HPV-6 and HPV-11. None of the specimens hybridized with HPV-16 or with the unrelated probe. In some instances, the cells did not hybridize with any of the three probes even when duplicate specimens contained frankly condylomatous, capsid antigen-positive cells. In situ hybridization of Papanicolaou smears or of tissue sections is a practical method for diagnosis and follow-up of specific papillomavirus infection using routinely collected material.

Effects of starvation and immobilization on the concentration of pipecolic acid and proline in mouse brain regions, liver, heart, kidney and blood plasma were analyzed. Pipecolic acid concentration in mouse brain and liver was increased after 24 or 48 h starvation, while proline concentration was not affected. Significant increases in levels of pipecolic acid were also observed in the rhombencephalon, liver and heart after 3 h immobilization. Proline in the blood plasma and kidney was decreased, while that in liver was increased, by the immobilization. Thus, the effect of such stress on concentration of pipecolic acid differed from that seen with proline. The possible involvement of pipecolic acid in synaptic mechanisms in the central nervous system and/or in pathogenesis of the diseases related to abnormal pipecolic acid metabolism should be given attention.

Southern transfer analysis for human papillomavirus genomic sequences was conducted on 152 vulvar and vaginal tissue specimens obtained from 86 patients. Histopathologic diagnoses included condyloma acuminatum, intraepithelial neoplasia, and invasive cancer. In six patients, lesions of more than one pathologic type were identified. Vaginal lesions constituted less than 5% of tissues examined. Distribution of lesions was as follows: condyloma, 93 lesions from 57 patients; intraepithelial neoplasia, 47 lesions from 29 patients; and invasive carcinoma, 12 lesions from six patients. Seventy-five percent of the patients were white. The mean age of the patients increased from 25 years for condyloma to 38 years for vulvar intraepithelial neoplasia III to 56 years for invasive cancer. A viral diagnosis was made in 81% of condylomas, 84% of vulvar intraepithelial neoplasia III, and 58% of invasive carcinomas. Distribution of viral types differed markedly for the various histopathologies. Types 6/11 accounted for 77% of condylomas and 0% of vulvar intraepithelial neoplasia III. Type 16 was recovered from 12% of condylomas and 81% of vulvar intraepithelial neoplasia III. Type 18 was identified in a small proportion in both categories; type 31 was seen in a few vulvar intraepithelial neoplasia III lesions. In invasive carcinomas, type 16 was the predominantly identified virus. Papillomavirus type 16 emerges as the dominant oncogenic virus in vulvar neoplasms. Its presence in a large percentage of condylomas raises the issue of an "atypical condyloma" as a precursor of neoplasia.

Warty lesions of the oral cavity were examined for etiologic association with genital tract papillomaviruses HPV-6, HPV-11, and HPV-16. DNAs extracted from ten oral biopsies were screened for HPV genomic sequences by Southern transfer hybridization with 32P-labeled viral DNA probes. Nonstringent hybridization with an HPV-6 probe revealed papillomavirus DNA sequences in four of seven tissues with histologic evidence of papillomatosis, in none of two tissues without histologic evidence of papillomatosis, and in one tissue that was not examined by histology. Stringent hybridization tests with HPV-6 and HPV-16 probes identified the genome in one tissue as being HPV-16, in a second tissue as being HPV-6 subtype a, and in a third tissue as HPV-6 (subtype unidentified); papillomavirus DNA sequences in two tissues are as yet not identified. An additional case of HPV-6 or HPV-11 related oral cavity lesion was diagnosed by in situ hybridization of paraffin sections with a 35S-labeled, mixed HPV-6 + HPV-11 probe. The hybridization in the positive section was extensive and confined to epithelial nuclei. The oral lesions associated with genital tract papillomaviruses were asymptomatic, multiple or single, and were located in different parts of the oral cavity, for example, on the gingivae, on the tongue, on the lip, on the tonsillar pillar, and on the floor of the mouth.

Human papillomavirus infection of the genital tract was identified by the filter in situ hybridization test. Exfoliated cervical cells were tested separately for the prevalence of human papillomavirus 6/11 and 16/18. Human papillomavirus deoxyribonucleic acid (DNA) was identified in 70 and 92% of specimens of U.S. and West German women, respectively, who showed concurrent cytologic and colposcopic abnormalities, and in 50 and 54% of women, respectively, who showed neither cytologic nor colposcopic abnormalities at the time of examination. In the cytologic categories of condyloma, mild to moderate dysplasia (cervical intraepithelial neoplasia I/II), and severe dysplasia-carcinoma in situ (cervical intraepithelial neoplasia III), the overall DNA detection rate of human papillomavirus 6/11 and 16/18 varied between 75 and 83%; but human papillomavirus 16/18 was recovered relatively more frequently from the more severe lesions. Forty-eight West German women were monitored cytologically over a period of three to 24 months; progression to carcinoma in situ (cervical intraepithelial neoplasia III) was correlated with initial isolation of human papillomavirus 16/18. The vagina and vestibule were found to be frequent sites of human papillomavirus infection with the same virus type as in the cervix. In an investigation of male partners of 40 human papillomavirus-positive women, human papillomavirus was identified in exfoliated cells from 26; in 19 instances, the males harbored the same human papillomavirus types as their female partners.