Background: Dexmedetomidine (DEX) is an α₂-adrenergic agonist widely used for intravenous sedation. Its pharmacological properties suggest autonomic modulatory effects; however, these remain insufficiently characterized during operative procedures. This pilot study compared autonomic responses to surgical stress of DEX and propofol (PPF) during third molar extraction using the Analgesia Nociception Index (ANI), a heart rate variability-derived marker of autonomic balance. Methods Adults aged ≥18 years undergoing extraction of mandibular third molars under intravenous sedation were prospectively enrolled. Sedation was maintained with either DEX or PPF infusion following a small pre-induction dose of midazolam. ANI was continuously recorded using a High-Frequency Variability Index module, with a 240-s moving average considered equivalent to ANI. The primary outcome was the minimum ANI value within each predefined 5-min intraoperative interval; percent change from baseline (%Δ

Background: The COVID-19 pandemic disrupted healthcare delivery worldwide, including dental services. In Japan, the burden and age-specific patterns of dental anesthesia use have not been quantified. We aimed to describe national trends in dental sedation and general anesthesia (GA) in Japan from fiscal year (FY) 2019 (pre-pandemic baseline) through FY 2023 using aggregated claim-level data from the National Database Open Data Japan and interpret these trends in the context of COVID-19-related healthcare constraints. We compared the age distributions of patients who underwent GA in dentistry and medicine. Methods: This analysis used aggregated claim counts from the National Database Open Data (FY 2019–FY 2023). Sedation and GA categories were defined using reimbursement codes: inhalation sedation (K002), intravenous sedation interpreted as conscious or moderate sedation (K003), intravenous anesthesia interpreted as deep sedation (L001–2), and GA (L008). Outcomes were annual claim counts, relative indices standardized to FY 2019 (=100), and age-stratified distributions in 5-year groups (0–4 years to ≥90 years). Age distributions for GA were visualized as mirrored pyramids in dentistry and medicine. No inferential tests were performed. Results: Inhalation sedation increased by approximately 7% in FY 2023. Intravenous sedation increased substantially by 68%. Intravenous anesthesia declined sharply in FY 2020, the first pandemic year, and then plateaued. Dental GA decreased in FY 2020, recovered, and expanded to 110,000 claims by FY 2023 (relative index: 122.3).Dental GA showed a bimodal age distribution (peaking at 5–9 years and 15–29 years), whereas medical GA were concentrated at 70–85 years, indicating distinct modality- and sector-specific demand structures. Conclusion Using claims tabulations spanning the pre-pandemic, pandemic, and “with-COVID” phases, we found heterogeneous trajectories in dental sedation and GA in Japan, characterized by robust growth in conscious or moderate sedation and recovery and expansion of dental GA after an initial 2020 decline. The divergent GA age distributions between dentistry and medicine underscore fundamentally different demand profiles.Interpreted within the context of COVID-19, these modality- and age-specific patterns highlight the adaptive and resilient responses of Japan’s dental anesthesia services under pandemic-related constraints and provide a foundation for future policy and workforce planning.

A 40-year-old woman had suffered from genital herpes twice a year since approximately age 25 years. A year and a half before her first visit to our department, the frequency of her genital herpes had increased from 2 to 5 times a month. Continuous suppressive antiviral medication had not worked, and the patient was referred to our department. We discontinued the anti-herpes medication, and started treatment with Kampo (Japanese herbal) medicine. Initially, the patient’s symptoms did not improve with tokishigyakukagoshuyushokyoto for coldness of the hands and feet or hochuekkito for general fatigue. Then, on the basis of her symptoms of irritability, nightmares, dry skin and hair loss, we changed her prescription to juzentaihoto before meals and saikokeishikankyoto after meals. The frequency of genital herpes thereafter gradually decreased, and finally no further recurrences of herpes were observed as long as the patient was taking these two medicines. This result showed that some patients with recurrent genital herpes who fail to respond to antiviral therapy could be managed with Kampo medicine alone.

BACKGROUND: Pruritis caused by atopic dermatitis (AD) is not always well controlled by topical corticosteroid therapy, but use of tacrolimus often helps to soothe such intractable pruritis in clinical settings. OBJECTIVE: To determine the anti-pruritic efficacy of topical tacrolimus in treating AD in induction and maintenance therapy. METHODS: Prior to the study, patients were randomly allocated into two groups, induction therapy followed by tacrolimus monotherapy maintenance, and induction therapy followed by emollient-only maintenance. In the induction therapy, the patients were allowed to use topical tacrolimus and emollients in addition to a low dose (<10 g/week) of topical steroids. Patients showing relief from pruritis were allowed to proceed to maintenance therapy. Recurrence of pruritis in maintenance therapy was examined as a major endpoint. RESULTS: Two-thirds of patients (44/68; 64.7%) showed relief from pruritis after induction therapy. Pruritis recurred in 23.8% (5/21) of the tacrolimus monotherapy group and in 100% (21/21) of the emollient group during maintenance period, a difference that was statistically significant. CONCLUSION: Use of topical tacrolimus is effective in controlling pruritis of AD compared to emollient.
Dermatitis, Atopic ; Emollients ; Humans ; Pruritus ; Recurrence ; Steroids ; Tacrolimus