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To investigate the prevalence and background of children with medical complexity (CMC) and its secular trend in Japan.CMC were defined as patients under the age of 20 years requiring medical care and devices. The patients were enrolled using the national health insurance claims data of three hospitals and two rehabilitation centers in Tottori Prefecture. The study period was divided into three periods: Period 1, 2007-2010; Period 2, 2011-2014; and Period 3, 2015-2018.A total of 378 CMC were enrolled. The prevalence of CMC was 1.88 per 1000 population among subjects aged20 years in 2018, and it increased by approximately 1.9 times during the study period. The number of CMC who presented with severe motor and intellectual disabilities did not change from Period 1 to Period 3. Meanwhile, the number of CMC who had relatively preserved motor and intellectual abilities increased from 58 to 98. The proportion of CMC who required respiratory management and oxygen therapy increased by 1.3 and 1.8 times, respectively. By contrast, the proportion of CMC who need tube feeding decreased significantly between periods 1 and 3 (P 0.05).The prevalence of CMC increased almost twice during the 12-year study period; however, the increase in the number of patients with relatively preserved motor and intellectual abilities was pronounced. This study showed that the need for medical care and devices differed based on the underlying disorders and severity of CMC; therefore, individualized medical, welfare, and administrative services and education about the various types of CMC must be provided.

Background: Early predictors of status epilepticus (SE)-associated mortality and morbidity have not been systematically studied in children, considerably impeding the identification of patients at risk. Objectives: To determine reliable early predictors of SE-associated mortality and morbidity and identify the etiology of SE-associated sequelae in Japanese children. Methods: We conducted a prospective multicenter study of clinical findings and initial laboratory data acquired at SE onset, and assessed outcomes at the last follow-up examination. In-hospital death during the acute period and neurological sequelae were classified as poor outcomes. Results: Of the 201 children who experienced their first SE episode, 16 exhibited poor outcome that was most commonly associated with acute encephalopathy. Univariate analysis revealed that the following were associated with poor outcomes: young age (⩽24months); seizure duration >90min; seizure intractability (failure of the second anticonvulsive drug); biphasic seizures; abnormal blood glucose levels ( 250mg/dL); serum aspartate aminotransferase (AST) ⩾56U/L; and C-reactive protein (CRP) levels >2.00mg/dL. Multivariate analysis revealed that young age, seizure intractability, abnormal blood glucose levels, and elevated AST and CRP levels were statistically significant. Conclusions: Young age and seizure intractability were highly predictive of poor outcomes in pediatric SE. Moreover, abnormal blood glucose levels and elevated AST and CRP levels were predictors that might be closely associated with the etiology, especially acute encephalopathy and severe bacterial infection (sepsis and meningitis) in Japanese children.

三叉神経痛に対しては carbamazepine が特効薬として使用され, 根治的には Jannetta の手術が行われる。しかし手術を望まず carbamazepine も無効となって, 激痛に悩まされる例もある。今回, 漢方薬が有効であった症例について検討した。漢方薬により carbamazepine が不要となったものを著効例, 半減できたものを有効例としてまとめると, 著効例7例, 有効例7例であった。処方は呉茱萸湯が2例, 五苓散を含む処方が9例, 柴胡桂枝湯・当帰四逆加呉茱萸湯生姜湯・麻黄附子細辛湯が各1例となった。三叉神経痛は上小脳動脈やその周辺血管の三叉神経への癒着・圧迫があり, 三叉神経の浮腫が生じていると考えられている。限局した領域における浮腫であっても五苓散や呉茱萸湯などはその利水効果によって効果を発現できるのではないかと思われた。14例の検討から三叉神経痛は水毒・表寒証が多いと考えられた。

IL-8 is a chemotactic and activating cytokine for neutrophils which eliminate invading bacteria by releasing bactericidal metabolites. Cord blood mononuclear cells (CBMCs) obtained from neonates born to mothers with chorioamnionitis actively produced a significantly higher amount of IL-8 than those of neonates without chorioamnionitis, suggesting that the mononuclear cells of fetuses with chorioamnionitis had been activated in utero. As lipopolysaccharide (LPS) can often be detected in the uteroplacental space in chorioamnionitis, the LPS-mediated activation mechanism of neonatal mononuclear cells was analyzed in vitro to produce IL-8. Neonatal mononuclear cells stimulated with LPS increased IL-8 production in a time- and dose-dependent manner. The ability of term or preterm neonatal mononuclear cells to produce IL-8 was comparable with that of adult (maternal) mononuclear cells, suggesting functional maturity of the neonatal or fetal mononuclear cells to produce IL-8. However, IL-8 production by neonatal CBMCs was down-regulated by dexamethasone, a glucocorticoid which is clinically administered to mothers to promote fetal lung maturity in preterm delivery. Our present study revealed a regulatory mechanism of fetal IL-8 production, suggesting that functionally mature fetal mononuclear cells produce IL-8 in response to LPS in chorioamnionitis and activate the fetal defense mechanism against infection.

Prospective studies of an infant of a mother infected with hepatitis C virus indicated that an HCV infection developed in the infant in early life. Perinatal transmission appeared to be the most likely explanation.

In order to prevent the hepatitis B virus carrier state, 190 infants born to hepatitis-Be antigen positive hepatitis-B surface antigen carrier mothers were treated with hepatitis-B hyperimmune globulin(HBIG) and hepatitis-B vaccine after birth; however, 8 infants(4.2%) ultimately became carriers. There were three different causes for the failure, namely 1) prenatal infection, 2) insufficiency of HBIG to neutralize the virus transmitted, and 3) poor responsiveness of the infant to the vaccine. The present study suggests that early vaccination in the neonatal period increases the rate of poor responders as compared to later vaccination.

HBe抗体陽性HBVキャリア妊婦から出生し,慢性肝障害をきたした姉弟例を経験した.姉は生後2カ月からB型肝炎ウイルスによると考えられる重症肝炎を発症したが,HBs抗体出現後も中等度の肝機能障害が1年間持続した.分娩時に母親からB型肝炎ウイルスと非A非B型肝炎ウイルスの重複垂直感染を受けた可能性が示唆された.弟はB型肝炎の垂直感染防止のため生直後にHBIGを投与されたが,生後2カ月から11カ月間,肝機能障害が持続した.生後8カ月からHBs抗体の上昇およびHBc抗体の再上昇がみられた.非A非B型肝炎ウイルスがB型肝炎の潜伏期を延長した可能性も考えられた.