Introduction: Relieving cancer pain in children poses significant challenges, especially when pharmacological therapies become ineffective or difficult to administer. This case report describes a pediatric patient with renal cancer who experienced severe lumbago and was successfully treated with implanted epidural analgesia. Case: An 11-year-old boy had been diagnosed with left renal cell carcinoma 1 year prior. After a left nephrectomy and postoperative chemotherapy, the patient experienced a local recurrence a few months later. The patient was referred to the palliative care team because of discomfort in the lumbar region. Detailed imaging and medical history strongly suggested cancer-related pain. Opioid therapy was initiated; however, the patient developed increasing difficulties with oral intake due to headache and nausea associated with escalating pain levels. Epidural analgesia was administered, which resulted in pain relief and improved oral intake. Considering the child’s prognosis, a subcutaneous implantable epidural port was placed to facilitate the continuation of treatment. Subsequently, the patient’s quality of life improved, allowing for activities such as outings. Conclusion: When facing the limitations of pharmacological therapies, a nerve block such as an epidural analgesic can be an effective therapeutic option in pediatric cancer treatment.

PURPOSE: . The aim of this study was to introduce rating criteria to evaluate student performance in a newly developed, digital wax-up preclinical program for computer-aided design (CAD) of full-coverage crowns and preliminarily investigate the reliability and internal consistency of the rating system. MATERIALS AND METHODS: . This study, conducted in 2017, enrolled 47 fifth-year dental students of Okayama University Dental School. Digital wax-up training included a fundamental practice using computer graphics (CG), multipurpose CAD software programs, and an advanced practice to execute a digital waxup of the right mandibular second molar (#47). Each student’s digital wax-up work (stereolithography data) was evaluated by two instructors using seven qualitative criteria. The total qualitative score (0-90) of the criteria was calculated.The total volumetric discrepancy between each student’s digital wax-up work and a reference prepared by an instructor was automatically measured by the CAD software. The inter-rater reliability of each criterion was analyzed using a weighted kappa index. The relationship between the total volume discrepancy and the total qualitative score was analyzed using Spearman’s correlation. RESULTS: . The weighted kappa values for the seven qualitative criteria ranged from 0.62 - 0.93. The total qualitative score and the total volumetric discrepancy were negatively correlated (ρ = -0.27, P = .09, respectively); however, this was not statistically significant. CONCLUSION . The established qualitative criteria to evaluate students’ work showed sufficiently high inter-rater reliability; however, the digitally measured volumetric discrepancy could not sufficiently predict the total qualitative score.

Data from the first trial of the computer-based nationwide common achievement test in medicine, carried out from February through July in 2002, were analyzed to evaluate the applicability of the item-response theory. The trial test was designed to cover 6 areas of the core curriculum and included a total of 2791 items. For each area, 3 to 40 items were chosen randomly and administered to 5693 students in the fourth to sixth years; the responses of 5676 of these students were analyzed with specifically designed computer systems. Each student was presented with 100 items. The itemresponse patterns were analyzed with a 3-parameter logistic model (item discrimination, item difficulty, and guessing parameter). The main findings were: 1) Item difficulty and the percentage of correct answers were strongly correlated (r=-0.969to-0.982). 2) Item discrimination and the point-biserial correlation were moderately strongly correlated (r=0.304 to 0.511). 3) The estimated abilities and the percentage of correct answers were strongly correlated (r=0.810 to 0.945). 4) The mean ability increased with school year. 5) The correlation coefficients among the 6 curriculum area ability scores were less than 0.6. Because the nationwide common achievement test was designed to randomly present items to each student, the item-response theory can be used to adjust the differences among test sets. The first trial test was designed without considering the item-response theory, but the second trial test was administered with a design better suited for comparison. Results of an analysis of the second trial will be reported soon.