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Background Progress in neonatal medicine has dramatically improved the survival rate of preterm births, but the evidence suggests that these low-birth weight infants (LBWIs) go on to develop pervasive development disorders and attention deficit hyperactivity disorder (ADHD) at greater rates than the general population. Children with neurodevelopmental disorders are known to suffer from deficits in visual cognition, such as in face perception and attentional functions, the characteristics of which already manifest in early infancy. Purpose This study aimed to investigate visual cognition in LBWIs during infancy. Subjects 20 LBWIs and 20 normal-birth-weight infants (NBWIs: control) of age 9–10 months (corrected age was used for LBWIs). Method Children were held seated in front of an eye tracking system by a parent, and presented with facial photos as visual stimuli. During the familiarization phase, the child was presented with two images of the same human face (familiarization stimulus) on the left and right side of a display screen (5 × 10 s trials). Next, during the test phase, the child was presented with the same image on one side of the screen, and a photo of a different person’s face (novel stimulus) on the other (2 × 5 s trials). Gaze behavior was assessed in terms of the total time spent looking at either facial stimulus, and specifically at the eyes of the stimuli, as well as the number of attentional shifts between stimuli, and novelty preference. Results/Discussion LBWIs spent significant less time looking at facial stimuli overall, and less time at the eye region, than NBWIs. These findings seem to evidence developmental differences in functions related to visual cognition.

Objective: Colostrum, the first form of human milk, is strongly encouraged for infants due to its benefits. During the early postpartum (PP) period, the secreted colostrum volume can be minimal, causing concerns among mothers about sufficient milk supply. Few studies have examined temporal changes in the colostrum. This study aimed to elucidate the trajectory of expressed colostrum volume in the first 48 hours after delivery. Materials and Methods: This was a cross-sectional observational study performed at Kagawa National Children's Hospital. One hundred five mothers who did not directly breastfeed in the first 48 hours after delivery were enrolled in the study. Well-trained midwives instructed the mothers on how to express human milk, and mothers started to express as soon as possible after delivery. Mothers were advised to express human milk every 3 hours, and the milk volume was measured. Results: Within 3 hours PP, 60% of mothers expressed milk, and the median frequency of expression was 14 (interquartile range, 11-16) times in the first 48 hours. At 0-3 and 3-6 hours PP, the volume of initially expressed milk was 0.4 (0.0-2.0) mL and 1.0 (0.0-6.0) mL, respectively. Subsequently, milk volume decreased. The volume remained low until 30 hours PP and increased dramatically; this phenomenon is termed secretory activation, which began later in primiparous women than in multiparous women. Conclusion: The decline in expressed milk volume during the early PP period caused concern among mothers. Therefore, mothers should be informed of the PP trajectory of human milk volume.

Background Home-visiting nurses are expected to enhance their ability to provide adequate nursing care in a relatively isolated work environment. However, the isolated work environment leads to less opportunity to share patient information. We investigated factors relevant to better patient information sharing among home-visiting nurses, which would contribute to the improved care performance of these nurses. Methods A cross-sectional study with anonymous self-administered questionnaire was conducted between June 2015 and September 2015 in two districts of Japan. Home-visiting nurses who were working at home health care agencies were recruited. The questionnaires consisted of items on demographic data, job-related variables, communication in the workplace, the current state of patient information sharing, opportunities (or measures) of patient information sharing in the workplace, and job satisfaction. Descriptive analyses were performed on all variables, using the Chi-square test, Fisher’s exact test, or Mann-Whitney U-test. Logistic regression analyses were conducted to identify the factors associated with better information sharing, adjusting the years of home-visiting nursing experience as the control variable. Results Of 762 anonymous self-administered questionnaires were mailed, data from 482 participants who consented to this study and had no missing answer were analyzed. Of the total, 77.2% shared the patients’ information. Having a friendly adviser (OR = 2.51, 95% CI = 1.14–5.55, p = 0.023), attending some conferences (OR = 2.32, 95% CI = 1.12–4.82, p = 0.024), joining workshops (OR = 1.89, 95% CI = 1.15–3.10, p = 0.012), and years of home-visiting nursing experience (OR = 1.27, 95% CI = 1.03–1.57, p = 0.025) were significantly associated with sufficient sharing of the information. Nurses sufficiently sharing the information were well satisfied with their job (OR = 5.38, 95% CI =3.19–9.09, p

Background and Purpose Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective. Methods Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention. Results In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity. Conclusions Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability.

Objective: In patients with hemiplegia, botulinum toxin type A injection for ankle spasticity of the plantar flexors reportedly improves walking speed. This improvement may be affected by background factors and patient baseline physical performance. This study aimed to clarify the factors affecting gait velocity improvement after botulinum toxin type A injection. Methods: Background and evaluation data were collected for 60 patients with stroke who received botulinum toxin type A injection for spasticity of the plantar flexors. The patients were divided into improvement (n=27) and non-improvement (n=33) groups based on the gait velocity change from before injection to 2 weeks after injection. Logistic regression analysis was performed with the improvement and non-improvement groups as response variables and background data and evaluation data at baseline as explanatory variables. Results: The presence or absence of physical therapy following botulinum toxin type A injection (odds ratio: 7.82) was the only significant explanatory variable for gait velocity change. Conclusion: Background factors and physical performance at baseline did not affect gait velocity improvement after botulinum toxin type A injection. If botulinum treatment of the ankle plantar flexors in patients with stroke is targeted at walking performance improvement, then physical therapy following botulinum toxin type A injection should be an essential part of the treatment strategy.

Increasing incidences of swallowing dysfunction, or dysphagia, a risk factor for aspiration pneumonia, are being reported in aging populations.To investigate the relationship between swallowing function and oral bacteria in independent, community-dwelling elderly.This study recruited 139 community-dwelling individuals aged ≥ 70 years with poor swallowing function. The presence of anaerobic (Prevotella spp. and Fusobacterium spp.) and aerobic bacteria was examined in the participants' oral cavity flora. Swallowing function was evaluated using a 30 mL water swallowing test. Multivariate logistic regression analyses were performed to examine the association between oral bacteria and swallowing function.Swallowing function was assessed as abnormal in 2.9% and as abnormal in 47.5% of the subjects. The colony-forming units (CFUs/ml) of Prevotella spp. were associated with the swallowing dysfunction (odds ratio [OR] 3.45, 95% confidence interval [CI] 1.49-8.11). Further, CFUs/ml of Fusobacterium spp. and aerobes did not correlate with the swallowing dysfunction but were related with the number of teeth (OR 2.71; 95% CI 1.28-5.74, and OR 0.40; 95% CI, 0.18-0.91, respectively) CONCLUSIONS: Swallowing dysfunction in community-dwelling elderly is associated with increased abundance of Prevotella spp., which indirectly may be an increased risk factor for aspiration pneumonia.

Summary The treatment of skeletal deep bite does not remain stable. The patient was a Japanese woman aged 16 years and 10 months. Her chief complaint was maxillary protrusion. The degree of overjet was + 10.5 mm and overbite was + 5.0 mm; the intermolar relationship was Angle Class II. An excessive curve of Spee was observed in the mandibular arch. A hypodivergent skeletal pattern was indicated by a small mandibular plane angle and gonial angle. The maxillary incisors were proclined and the mandibular incisors were retroclined. Based on the above findings, the patient was diagnosed with Angle Class II maxillary protrusion and deep bite with hypodivergency. Both maxillary first premolars were extracted and orthodontic treatment was performed using multi-bracket appliances. A proper overbite was achieved by 5.0 mm intrusion of the mandibular incisors. The maxillary incisors were retracted by 11.2 mm and a proper overjet was achieved. Good treatment results were obtained without apical root resorption. After 2 years of retention, the occlusion has been well maintained. This report may constitute a remarkable suggestion for treatment of an unstable deep bite.

There have been a number of recent reports on the occurrence of autoimmune conditions after autologous hematopoietic stem cell transplantation. We describe a rare case of Evans syndrome (ES) that developed in a 16-year-old patient >1 year after autologous peripheral blood stem cell transplantation for recurrent Hodgkin lymphoma. ES is a rare and frequently refractory condition. No therapy for the condition has been established, and it can often be fatal. In the present case, i.v. cyclosporine A injection was significantly effective against the ES, which has not recurred.

Background In Cambodia, the age-standardized prevalence of diabetes mellitus has increased in both men and women. The main objective of this study was to identify factors associated with diabetes medication adherence among people with diabetes mellitus in poor urban areas of Phnom Penh, Cambodia. Methods A cross-sectional study was conducted in 2017 using a structured questionnaire for face-to-face interviews by trained interviewers. The participants were people with diabetes mellitus who were the active members of a peer educator network, lived in poor urban areas of Phnom Penh, and attended weekly educational sessions during the survey period. Diabetes medication adherence was measured using four items of modified Morisky Medication Adherence Scale. Participants were classified into two groups based on their adherence score: 0 (high adherence) and from 1 to 4 (medium or low adherence). Sociodemographic characteristics; medical history; accessibility to health services; and knowledge, attitude, and practices related to diabetes mellitus were examined. A multiple logistic regression analysis was conducted adjusting for sex, age, marital status, and education levels. Results Data from 773 people with diabetes were included in the analyses. Of the total, 49.3% had a high level of diabetes medication adherence. A high level of adherence was associated with higher family income (≥50 USD per month) (adjusted odds ratio [AOR] = 5.00, 95% confidence interval [CI] = 2.25–11.08), absence of diabetes mellitus-related complications (AOR = 1.66, 95% CI = 1.19–2.32), use of health services more than once per month (AOR = 2.87, 95% CI = 1.64–5.04), following special diet for diabetes mellitus (AOR = 1.81, 95% CI = 1.17–2.81), and absence of alcohol consumption (AOR = 13.67, 95% CI = 2.86–65.34). Conclusions High diabetes medication adherence was associated with better family economic conditions, absence of diabetes mellitus-related complications, and healthy behaviors. It would be crucial to improve affordable access to regular follow-ups including promotion of healthy behaviors through health education and control of diabetes mellitus-related complications.

BACKGROUND The Japanese government has established a law encouraging early detection and treatment of developmental disorders in children. Child behavior problems (CBP) tend to be recognized at school as a result of developmental disorders. The aim of this study was to identify factors associated with CBP in Japan. We hypothesized that factors other than developmental disorders are important in explaining CBP. METHODS The study was conducted between February and March 2015. Parents of 3,515 children aged 2-5 years attending one of 34 public nursery schools in Takamatsu, Kagawa, Japan received self-administered questionnaires addressing parental socioeconomic factors, mental health, parenting style (i.e. hostile, overreactive, or lax), developmental disorders in children, and CBP. A multiple regression analysis was applied to explore associations between CBP and possible factors. RESULTS Overall, 1,410 mothers were eligible to participate in the study. Children diagnosed with developmental disorders accounted for 7.8% of the sample, while on the Eyberg Child Behavior Inventory 17% of children had behavior problems needing clinical intervention. After adjustment for confounding factors, as well as for the diagnosis of developmental disorders, poor mental status and all three dysfunctional parenting styles had strong associations with CBP, and hostile, overreactive, and lax parenting had standardized β-values (β) of 0.29, 0.28, and 0.15, respectively (P < 0.01). A problematic relationship between the parents was also significantly associated with CBP (β = -0.29, P < 0.01). CONCLUSION When CBP are identified, parenting skills, mental health status and parental relationships should be considered along with the possibility of developmental disorders in the development of interventions.

Background Hypoxic-ischemic encephalopathy (HIE) usually results in a poor clinical outcome even when treated with hypothermic therapy (HT). Early postnatal changes in cerebral blood oxygenation and hemodynamics may be critical determinants of brain injury and the efficacy of HT. Objectives We measured cerebral hemoglobin oxygen saturation (ScO 2 ) and cerebral blood volume (CBV) by near-infrared time-resolved spectroscopy (TRS) in HT-treated and non-HT-treated neonatal HIE patients to assess the influence of these parameters on clinical outcome. Methods We retrospectively compared ScO 2 , CBV, and clinical outcomes of 11 neonates with HIE: 5 were treated by HT (HT-treated; 33.5 °C ± 0.5 °C for 72 h starting approximately 6 h after delivery) and 6 were not (non-HT-treated). Both CBV and ScO 2 were measured by TRS at 6, 24, 48, and 72 h after birth. Magnetic resonance imaging (MRI) was performed 1–2 weeks after birth to assess brain injury. Results Five neonates had adverse outcomes (3 HT-treated, 2 non-HT-treated). Of these, 1 died within 3 days of birth and 4 had abnormal MRI findings, including basal ganglia, white matter, and/or thalamic lesions. The other 6 neonates had normal MRI findings (favorable outcome). At 6 h after birth, CBV was significantly higher in neonates with adverse outcomes compared with those with a favorable outcome. At 24 h after birth, ScO 2 was significantly higher in neonates with adverse outcomes. Furthermore, we found that combined CBV at 24 h after birth plus ScO 2 had the best predictive ability for neurological outcome: sensitivity, specificity, positive predictive value, and negative predictive value were all 100%. Conclusion Early postnatal CBV and ScO 2 elevations were predictive of a poor outcome in HIE. Therefore, measuring combined CBV plus ScO 2 at 24 h after birth can allow more precise prediction of neurological outcome. Control of postnatal CBV and ScO 2 is critical for effective HIE treatment.

Objective The purpose of the present study was to investigate factors associated with quality of life (QOL) among mothers raising 4 and 18-month-old infants. Methods A cross-sectional study was conducted using self-report questionnaires. Participants included 400 women who took their infants for health checkups at a city in Aichi Prefecture, Japan (4-month-olds: n = 197, 18-month-olds: n = 203). Study variables included the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale, mother's lifestyle, support from family, and other factors potentially related to QOL. Results For mothers of 4-month-old infants, total QOL was associated with emotional support from families (OR 6.09, 95% CI 2.13-17.43) and having enough sleep (7 h or more; OR 4.18, 95% CI 1.86-9.36). These mothers had shorter sleeping hours than mothers of 18-month-old infants. QOL of mothers of 18-month-old infants was associated with emotional support from families (OR 3.06, 95% CI 1.14-8.22) and using childrearing support facilities (OR 2.02, 95% CI 1.01-4.01). Conclusion Different factors contributed to mothers' QOL as a function of infant age. Emotional support from families was associated with better QOL in both mother groups. Differences were that for mothers of 4-month-old infants, enough sleep was relevant to QOL, while in mothers of 18-month-old infants, childcare services helped improving their QOL.

The aim of the study was to investigate the difference in response to a motor imagery task between individuals with and without painful temporomandibular disorders (TMDs). The participants were 24 adults with and without TMD (TMD and control group, resp.). A set of photographic images of the profile view of a person’s head and neck and a hand and a foot were presented in a random order. The set consisted of six different orientations with rotations of each image at 0, 60, 120, 180, 240, and 300 degrees and included left and right representations. The participants were required to view the image and make a decision as to whether it was a left or a right side presented, that is, mental rotation (MR) task. Data were collected on 48 tasks (including left and right) at each orientation for each body part. Reaction times (RTs) for correct answers and accuracy in making the left or right judgements were recorded. The RT was slower in the TMD group than in the control group. The RT for the profile image was slower than those for the hand and foot images. For images that were 180 degrees, the RT was slower and the accuracy was lower than those for five of the other image orientations. The judgements made about the 180-degree rotated image were more inaccurate compared to images of all other orientations among all types of stimuli.

Adolescents spend an increasing amount of time on mobile phones. The aim of this study was to assess the relationship between duration of mobile phone use and insomnia and depression in senior high school students. The cross-sectional study was conducted on 295 senior high school students in Japan. Mobile phones were owned by 98.6% of students; 58.6% of students used mobile phones for more than 2 h daily and 10.5% used them for 5 h daily. The risk of insomnia was significantly high in students who used mobile phones for 5 h or more (OR: 3.89 [95% CI: 1.21-12.49]). There was no significant association between depression and duration of mobile phone use. However, individuals who spent 120 min or more using mobile phones for social network services (OR: 3.63 [1.20-10.98]) and online chats (OR: 3.14 [1.42-6.95]) were at risk for depression. Excessive mobile phone use is associated with unhealthy sleep habits and insomnia. Moreover, the excessive use of the social network services and online chats are related to depression rather than duration of mobile phone use. Adolescents should use mobile phones appropriately to avoid sleep disturbances and the impairment of mental health.

Background Anemia of prematurity commonly occurs in infants with very low birth weight; blood transfusion is an important treatment. However, there is no clear evidence to support the criteria currently widely used, based on blood hemoglobin (bHb) and hematocrit indices. Previous studies showed that overtransfusion or a low threshold for transfusion could induce complications or neurologic sequelae, respectively. We hypothesized that a cerebral hemodynamic index may provide an appropriate criterion for determining the need for transfusion in anemic preterm infants. Study Design and Methods We used near-infrared time-resolved spectroscopy to measure cerebral hemoglobin oxygen saturation (ScO2) and cerebral blood volume (CBV) before and after transfusion in 19 infants (24 measurements) with anemia of prematurity. The median gestational age was 27 weeks 0 days, median birth weight was 751 g, and median postconceptual age at transfusion was 30 weeks 4 days. Results bHb levels before and after transfusion (mean ± SD) were 9.3 ± 1.4 and 13.7 ± 1.3 g/dL, respectively. After transfusion, CBV significantly decreased from 2.63 ± 0.60 to 2.13 ± 0.26 mL/100 g of brain, and ScO2 significantly increased from 72.8 ± 4.3% to 74.7 ± 4.2%. Conclusion After transfusion, CBV changes were significantly greater with low compared to high pretransfusion Hb levels. This reflected the physiologic response to severe anemia in premature infants, which is to increase CBV and decrease ScO2. Therefore, CBV and ScO2 may be useful markers for determining the need for transfusion in very-low-birth-weight infants.

The purpose of this study was to examine developmental changes in visuocognitive function, particularly face recognition, in early infancy. In this study, we measured eye movement in healthy infants with a preference gaze problem, particularly eye movement between two face stimulations. We used the eye tracker system (Tobii1750, Tobii Technologies, Sweden) to measure eye movement in infants. Subjects were 17 3-month-old infants and 16 4-month-old infants. The subjects looked two types of face stimulation (upright face/scrambled face) at the same time and we measured their visual behavior (preference/looking/eye movement). Our results showed that 4-month-old infants looked at an upright face longer than 3-month infants, and exploratory behavior while comparing two face stimulations significantly increased. In this study, 4-month-old infants showed a preference towards an upright face. The numbers of eye movements between two face stimuli significantly increased in 4-month-old infants. These results suggest that eye movements may be an important index in face cognitive function during early infancy.

Experiments were carried out to investigate whether papillomas could be induced on the teat skin of heifers by intradermal injection with bovine papillomavirus type 9 (BPV-9). Three heifers (#1 and 2, two 0.5-year-old Holsteins; #3, a 1.5-year-old Japanese Black) were injected with BPV-9 and one heifer (#4, a 0.5-year-old Holstein) was mock-infected. Viral DNA load in the inocula was quantified by real-time polymerase chain reaction assay and adjusted to 1.56 × 10 12 copies per injection. Papillomas appeared at the injection sites in the BPV-9-injected heifers #1, 2 and 3 and grew over the 8 (#1 and 2) and 4 (#3) mo observation period, respectively. However, no papillomas were found in the mock-infected heifer #4. The experimentally induced papillomas were excised and examined. Histologically, the lesions were characterized by hyperplasia of the epidermis with hyperkeratosis and marked acanthosis and were morphologically similar to naturally occurring lesions. BPV-9 DNA and bovine papillomavirus capsid antigen were abundant in the lesions. Therefore, we conclude that BPV-9 is an etiological agent causing epithelial papillomas on the teat skin of heifers.

The aim of this study was to evaluate the hypothesis that cerebral hemoglobin (Hb) oxygenation is related to phosphorylation potential during primary and secondary cerebral energy failure in newborn infants who have experienced birth asphyxia. We subjected newborn piglets to severe transient cerebral hypoxic-ischemia followed by resuscitation and examined cerebral energy metabolism by 31P-magnetic resonance spectroscopy and evaluated changes in cerebral Hb oxygen saturation (ScO2) using full-spectrum near-infrared spectroscopy before, during, and up to 54 h after the hypoxic-ischemic insult. ScO2 was significantly decreased during the hypoxic-ischemic insult compared with baseline values. During secondary energy failure, piglets were separated based on the relationship between the ratio of phosphocreatine to inorganic phosphate and ScO2; those with a negative correlation were less injured than those with a positive correlation. These results indicate that changes in ScO2 as measured by near-infrared spectroscopy are related to phosphorylation potential during secondary energy failure in asphyxiated infants.

The purpose of the present study was to measure changes in blood volume and the oxygenation state of breast tissue during breastfeeding with the use of near-infrared time-resolved spectroscopy (TRS) as a noninvasive method. Forty breastfeeding mothers were divided into 2 groups in which measurements were made in the contralateral breast (group A) and in the ipsilateral breast (group B). The tissue concentrations of oxyhemoglobin, deoxyhemoglobin, and total hemoglobin and the hemoglobin oxygen saturation were measured in the breast by using TRS during a breastfeed. In both groups A and B, the values of all parameters decreased significantly after the start of breastfeeding compared with the pre-breastfeeding values. The values of all parameters fluctuated cyclically after the beginning of the breastfeed. Time-resolved spectroscopy is an effective noninvasive method for investigating the hemodynamics of the breast during breastfeeding. J Hum Lact. 24(4):415-421.

Using optical topography, changes in the cerebral oxygenation were compared in the parieto-temporal lobe of preterm and term infants of equal postconceptional age in response to verbal stimulation. Eight preterm infants of gestational age 23-34 weeks were studied at postconceptional term age (38-46 weeks). Ten term infants were studied at 2-11 days after birth. Twenty-four-channel near-infrared optical topography (NIOT) was used to measure changes in concentration of oxyhemoglobin ([oxyHb]), deoxyhemoglobin ([deoxyHb]) and total hemoglobin ([totalHb]) in the bilateral temporal cortices. Verbal stimulation was provided by a recording of a Japanese fairy tale. The latency in response to verbal stimulation was significantly shorter in the preterm infants than in the term infants. This time is thought to reflect brain development, particularly the development of the neuro-vascular coupling mechanisms in the cerebral cortex. The present results indicate that the number of days after birth is more closely related to development of auditory system and neuro-vascular coupling than is postconceptional age. Thus, this suggests that early extrauterine environment affects the cortical responses to verbal stimulation in preterm infants.

Aim To determine if nurse managers’ leadership style is related to Japanese staff nurses’ affective commitment to their hospital. Background In Western countries, nurse managers’ transformational leadership style has been found to increase staff nurses’ affective commitment to their hospital. However, there are few studies examining this relationship in the context of acute care hospitals in Japan. Methods Staff nurses completed measures of their nurse managers’ perceived leadership style and factors related to their own affective commitment. The association between affective commitment and perception of leadership style was assessed with multiple logistic regression. Results Of 736 questionnaires distributed, 579 (78.9%) were returned, and data from 396 (53.8%) fully completed questionnaires were analysed. The intellectual stimulation aspect of transformational leadership positively increased staff nurses’ affective commitment (odds ratio: 2.23). Nurse managers’ transactional and laissez-faire leadership styles were not related to affective commitment among staff nurses. Conclusions The intellectual stimulation aspect of transformational leadership may increase the retention of staff nurses through enhanced affective commitment. Implications for nursing management To increase staff nurses’ affective commitment to their hospital, we suggest that hospital administrators equip nurse managers with intellectual stimulation skills.

Background: The light-emitting diode is used as one of the new light sources for phototherapy. NeoBLUE (Atom Medical, Tokyo, Japan) incorporates blue light-emitting diodes for the treatment of neonatal hyperbilirubinemia. The authors compared the in vitro efficacy of neoBLUE with conventional phototherapy devices. Methods: The three light devices used included neoBLUE and two conventional phototherapy devices with six blue–white (BW) or six green (GR) fluorescent tubes. A bilirubin/human serum albumin solution (15 mg/dL) in 200 × 300 mm elliptical bag was irradiated with each three light device. The average light intensity of neoBLUE, BW and GR was 22.5, 10.2 and 2.6 μW/cm2 per nm, respectively, for the irradiated area. Bilirubin photoisomers and native bilirubin were measured by high-performance liquid chromatography. Results: In neoBLUE, BW and GR, the respective production rate of cyclobilirubin was 6.0, 3.7 and 3.9 × 10−2 mg/dL/min, and the respective (4Z, 15E)-bilirubin/(4Z, 15Z)-bilirubin ratio after irradiation was 0.44, 0.33 and 0.12; the (4Z, 15Z)-bilirubin reduction rate at 20 min after irradiation was 60, 68 and 82%, respectively. The reduction rate of (4Z, 15Z)-bilirubin correlated with the (4Z, 15E)-bilirubin/(4Z, 15Z)-bilirubin ratio. Conclusion: Phototherapy using the neoBLUE under high level may be clinically more effective than therapy using the conventional light source from the results of the production rate of cyclobilirubin.

The Clinical Trial Management Center in Kyushu University Hospital was originally established in April 1999 and was later reorganized to form the Clinical Research Center in October 2003 due to the expansion of support activities for clinical trials. In pace with this, the number of clinical research coordinators (CRCs) increased from 2 in 1999 to 13 in 2005. To improve the performance of clinical research for physicians, CRCs and secretariats, we conducted a questionnaire survey of sponsors of clinical trials (pharmaceutical company staff) to see how they evaluated the work done by our Clinical Research Center. The questionnaire consisted of 10 items regarding our overall conduct of trial practice for which scores were obtained anonymously. We sent the questionnaire to 116 sponsor staff and received replies from 101 of them, a recovery of rate of 87%. The sponsors were generally satisfied with the conduct of clinical research at our Center, but were not fully satisfied regarding a few items which included the payment system for trial expenses, physicians' awareness, and recruitment of subjects by CRCs.Based on the results, we have recently introduced a new education system designed to increase physicians' motivation. Under this system, the conduct of clinical trials is limited to physicians who receive regular lectures on clinical research and are certified by our Clinical Research Center.

The Clinical Trial Management Center of Kyushu University Hospital was originally established in April 1999 and reorganized as the Clinical Research Center in October 2003 due to the expansion of support for clinical trials and general clinical research. In pace with this, the number of full-time clinical research coordinators (CRCs) increased from 2 in 1999 to 11 in 2004. To evaluate our function as CRCs and further improve it, we surveyed the opinions of physicians who have been in charge of clinical trials by questionnaire. Although most of the physicians generally appreciated the service we provide as CRCs, several of them said that there were not enough CRCs and that we had to provide better support. In conclusion, we felt there was a need to revise the content of the support provided to physicians by CRCs in the future. Also, in order to ensure the smooth conduct of clinical trials, in addition to enhancing physicians' appreciation of clinical research, we must further improve the situation of clinical trials, for instance by introducing a new system for evaluating their performance.

Background: The developmental changes of the umbilical cortisol levels in neonates at gestational age of 23–41 weeks were studied and the effect of antenatal steroid administration on the umbilical cortisol levels were examined. Methods: Cortisol levels in the umbilical vein (UV) and the umbilical artery (UA) were studied in 35 neonates at the gestational age (GA) of 23–41 weeks with or without antenatal administration of corticosteroids. Serum cortisol concentrations were measured by the high performance liquid chromatography method. Results: The correlation between cortisol levels in UV and birthweight (BW) was weak and negative in premature infants. UV cortisol levels in the neonates with antenatal corticosteroid were lower than those in the neonates without antenatal corticosteroid, but the relation was not significant. The developmental changes of UV cortisol levels were the same as those in Murphy's study (spontaneous-onset labor). The cortisol levels in UV and UA had a significantly positive correlation and both had almost equal concentrations. There were no correlations between cortisol levels in UV and placental weight, Apgar Score at 1 and 5 min. Conclusions: In the neonates whose birthweight was less than 2000 g without antenatal corticosteroid, there was a negative correlation between cortisol levels in UV and BW but there was no correlation between cortisol levels in UV and GA. That the neonates with antenatal corticosteroid would have a suppressed adrenocortical function after birth could not be proved.

Background: The clinical effect of phototherapy for neonatal hyperbilirubinemia is based on the production and elimination of cyclobilirubin. Generally, the clinical effect of light sources is estimated by the reduction in the total serum bilirubin level. One procedure with less invasiveness than blood collecting is urine collection. Whether the effectiveness of light sources used for phototherapy could be assessed using measurements of bilirubin photoisomers in urine was studied. Methods: This study was a retrospective analysis of 38 term infants with hyperbilirubinemia who underwent phototherapy. Bilirubin fractions in serum and urine before and 24 h after the phototherapy were measured by high-performance liquid chromatography. The light sources used for the phototherapy were blue-white light (n = 11), Biliblanket plus high output (n = 13) or green light (n = 14). The relationships between serum and urine bilirubin photoisomers after phototherapy and whether the levels of urine bilirubin photoisomer are affected by the light sources with different wavelength characteristic were analyzed. Results: There was no correlation between serum (ZE)-bilirubin and urine configurational isomers, but a weak positive correlation between serum (EZ)-cyclobilirubin and urine structural isomers after phototherapy. Although serum (ZE)-bilirubin levels depended on the wavelength characteristic of each light source during phototherapy, the urine configurational isomer levels did not depend on it. The increase in serum (EZ)-cyclobilirubin levels and the urine structural isomer levels were mostly in agreement. Conclusions: The urine bilirubin structural isomers may be used to estimate the serum (EZ)-cyclobilirubin levels and to evaluate the clinical effects of light sources.

Noroviruses (NVs) cause many cases of oyster- or clam-associated gastroenteritis in various countries. We collected 191 samples from Japanese oysters intended for raw consumption that had been harvested from the sea in two different areas between December 2001 and February 2002. To detect, quantitate, and phylogenetically analyze the NV genome in purified concentrates from the stomachs and digestive diverticula of these oysters, we amplified the NV capsid gene by reverse transcription-PCR. Phylogenetic analysis was performed by using the neighbor-joining method. We detected the NV genome in 17 of 191 oysters (9%). Phylogenetic analysis indicated genogroup I (Norwalk virus type) in 3 of the 17 oysters and genogroup II (Snow Mountain virus type) in the other 14. Both genogroups showed wide genetic diversity. To quantify the NV capsid gene in these oysters, we performed real-time PCR using genogroup-specific probes. More than 10 2 copies of the NV genome were detected in 11 of 17 oysters. The results suggested that about 10% of Japanese oysters intended for raw consumption harbored NVs, and more than 50% of those oysters in which NVs were detected had a large amount.

The aim of the present study was to investigate what kinds of social supports contribute to the higher quality of life (QOL) of home care patients with intractable neurological disease. We investigated the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and social supports to 74 patients with intractable neurological disease in a city of the Aichi prefecture, Japan. Association between WHOQOL and social supports was examined using multiple logistic regression analyses adjusting activities of daily living (ADL). High WHOQOL scores were associated with “attending patient gatherings held by the public health center,” “having someone who will listen empathically to anxieties or troubles,” and ADL. Physical health was associated with ADL, while psychological well-being was related to “having a hobby,” “having someone who will listen,” and “having a hospital for admission in emergencies.” Patients not having someone who will listen were more likely to participate in the gatherings. The present findings suggest that having someone who will provide emotional support is important for home care patients with neurological diseases. Patient gatherings held by the public health center were expected to provide patients with emotional support.

Low-frequency oscillations in cerebral blood flow that are suggestive of resting-state brain activity have recently been reported, but no study on the development of resting-state brain activity in preterm infants has been performed. The objective of this study was to measure the cerebral blood flow oscillations, which are assumed to represent brain function in the resting state, in preterm and term infants of the same postconceptional age. The subjects were 9 preterm infants who had reached full term (gestational age (GA): 23-34 weeks, postconceptional age: 37-46 weeks) and 10 term infants (GA: 37-40 weeks, postconceptional age: 37-41 weeks). Their changes in concentration of oxyhemoglobin ([oxyHb]) and deoxyhemoglobin ([deoxyHb]) were measured in the parieto-temporal region during quiet sleep using multi-channel near-infrared spectroscopy, and the power spectral densities (PSD) of the oscillations in the concentrations of these molecules were analyzed and compared. The preterm infants displayed a higher proportion of 0.06-0.10 Hz low frequency oscillations of [oxyHb] and [deoxyHb] than the term infants, and the gestational age and the proportion of low frequency oscillations were inversely correlated. These findings suggest that resting-state cerebral blood flow oscillations differ between preterm and term infants, and that the development of circulatory regulation and nerve activity in preterm infants are influenced by the extrauterine environment.

The number of young women who are underweight has recently increased in Japan. The aim of the present study was to investigate the nutritional problems of young Japanese women by measuring serum albumin, prealbumin, and lymphocyte count as indicators of nutritional status.The subjects were 912 women aged 19-39 years who participated in an annual health checkup for residents in a city of Aichi prefecture, Japan. Questionnaire data, physical measurements, and blood tests were analyzed in relation to weight categories of underweight (body mass index [BMI]18.5 kg/m(2)), normal (BMIor =18.5-25 kg/m(2)), and obese (BMIor =25 kg/m(2)).Lymphocyte counts were significantly lower in the underweight group. A multivariate logistic regression analysis showed an association of low lymphocyte count (1500/microL) with underweight (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.35-2.83). Low prealbumin (20 mg/dL) was associated with weight loss (OR 1.42, 95% CI 1.00-2.02) but not with underweight. Albumin was not lower in the underweight group. The prevalence of low lymphocyte count was higher by 35% among underweight women who lost weight ofor =1 kg in the past 3 months and higher by 50% among those who lost weight ofor = 2 kg.The present study suggests that underweight women in their 20s and 30s can be at risk for low lymphocyte count or potential malnutrition. The risk is particularly high in underweight women who have lost weight in recent months.

A case of intranuclear coccidiosis in an 11-month-old female Japanese Black calf is described. Because the calf exhibited diarrhea and failure to grow and then became moribund, euthanasia was performed. Histologically, the small intestinal villi were highly atrophic, and the epithelial cells frequently had meronts or merozoites within the nuclei. A few intranuclear gametocytes were also seen. The presence of Eimeria alabamensis-specific DNA in the lesions was demonstrated by polymerase chain reaction and nucleotide sequence analyses. Electron microscopy disclosed that most parasites were within nuclear inclusions encircled by the two membranes derived from the nuclear envelope, and that intracytoplasmic meronts and merozoites were in direct contact with the cytosol. Apparently, mature merozoites could be free without destruction of the host cells, and this may be associated with the relatively low pathogenicity of this coccidium.

Adenine phosphoribosyltransferase deficiency is a disorder in which 2,8-dihydroxyadenine (2,8-DHA) crystalluria is caused by a congenital deficiency in the enzyme adenine phosphoribosyltransferase (APRT). In most cases, APRT deficiency is caused by autosomal recessive inheritance of a homozygote of the mutant gene APRT*Q0 or APRT*J, but there are also some cases in which the disorder is caused by the compound heterozygote APRT*Q0 and APRT*J. In the patients described here, brown round crystals were found in their urinary sediment. Crystalluria was the first sign of APRT deficiency, thereafter confirmed by genetic screening for APRT*/Q0 and APRT*. We performed genetic screening for APRT*Q0 and APRT*J in two families and diagnosed three cases of APRT*Q0 /APRT*J compound heterozygote-type APRT deficiency. Genetic screening for APRT*Q0 and APRT*J of family members is effective for early diagnosis and early treatment for family members.

Young women being underweight is a public health problem in Japan. The aim of this study was to investigate this problem by measuring lymphocyte count as an indicator of nutritional status.The subjects were 114 women aged 20-39 who participated in an annual health checkup for residents in a city in Aichi, Japan. Data from a questionnaire, physical examination, and blood tests were analyzed in relation to women who were severely underweight [body mass index (BMI)/= 17.5 kg/m(2)], slightly underweight (17.5BMI18.5 kg/m(2)), of normal weight (18.5/= BMI25 kg/m(2)), and obese (BMI/= 25 kg/m(2)).Lymphocyte count tended to be lower with a decrease in BMI. The prevalence of low lymphocyte count of1,500/mm(3) increased in underweight women. In women who had restricted food intake for weight loss, leukocyte count, and total serum protein, and lymphocyte count were lower. A multivariate logistic regression analysis showed the association of low lymphocyte count to being severely underweight [odds ratio (OR): 1.95; 95% confidence interval (CI): 1.07-3.56] and to restricted food intake for weight loss (OR: 3.73; 95% CI: 0.91-15.30).This study suggests that being severely underweight and on restricted food intake for weight loss in adult women can be risk factors for low lymphocyte count, an indicator of malnutrition. It is important for young women to maintain BMI17.5 kg/m(2) and not to restrict food intake when of normal weight or underweight in order to prevent malnutrition.

Norovirus (NV) is a causative agent of acute gastroenteritis in humans, and shellfishes including oysters act as major vehicles of the virus. To investigate the genetic characteristics of NVs, we collected 1,512 oysters for raw consumption between October 2002 and March 2005 from two distinct areas (area A: the Sanriku Sea area; area B: the Setouchi Sea area). We detected the capsid gene and subjected it to phylogenetic analysis. By further quantification of the copy number of the genome by using real-time PCR, the NV capcid gene was detected in approximately 5% of the oysters, and they showed wide diversity. Two percent of the oysters from area B showed relatively large number of NVs, i.e., over 100 copies of capsid gene/oyster, whereas this was not observed in area A. Most of the detected NVs from oysters and humans were genetically related when the capsid region was compared. These results suggested that NVs obtained from humans and those obtained from oysters showed a potential relationship to each other and that some populations of Japanese oysters accumulated a relatively large number of NVs.

Near-infrared spectroscopy has been used for measurement of changes in cerebral Hb concentrations in infants to study cerebral oxygenation and hemodynamics. In this study, measurements by time-resolved spectroscopy (TRS) were performed in 22 neonates to estimate the values of light absorption coefficient and reduced scattering coefficient (mu'(s)), cerebral Hb oxygen saturation (SCO2), cerebral blood volume (CBV), and differential pathlength factor (DPF), and the relationships between postconceptional age and mu'(s), SCO2, CBV, and DPF were investigated. A portable three-wavelength TRS system with a probe attached to the head of the neonate was used. The mean mu'(s) values at 761, 795, and 835 nm in neonates were estimated to be (mean +/- SD) 6.46 +/- 1.21, 5.90 +/- 1.15 and 6.40 +/- 1.16/cm, respectively. There was a significant positive relationship between postconceptional age and mu'(s) at those three wavelengths. The mean SCO2 value was calculated to be 70.0 +/- 4.6%, and postconceptional age and SCO2 showed a negative linear relationship. The mean value of CBV was 2.31 +/- 0.56 mL/100 g. There was a significant positive relationship between postconceptional age and CBV. The mean DPF values at 761, 795, and 835 nm were estimated to be 4.58 +/- 0.41, 4.64 +/- 0.46, and 4.31 +/- 0.42, respectively. There was no relationship between postconceptional age and DPF at those three wavelengths. The results demonstrated that our near-infrared TRS method can be used to monitor mu'(s), SCO2, CBV, and DPF in the neonatal brain at the bedside in an intensive care unit.

We investigated contamination of environmental surfaces by Staphylococcus aureus from April 1 to the end of June in 2002 in the dermatological ward (37 beds) of a university hospital. For surfaces contaminated by high levels of S. aureus, disinfection methods were evaluated. 100-10(5) colony forming units (cfu) of methicillin-resistant S. aureus (MRSA) or methicillin-sensitive S. aureus (MSSA) were detected on items such as an immersion bathtub (examined area, about 900 cm2), foot washbowl, stretcher for an immersion bath, and chair for the shower. After disinfection, no S. aureus was detected on smooth surfaces such as the immersion bathtub and foot washbowl; however, S. aureus was detected even after disinfection on porous surfaces made of sponge-like materials (polyethylene foam) such as the stretcher for the immersion bath and the shower chair. Scanning electron microscopy of the porous surfaces showed formation of a large amount of coccus and bacillus biofilms on the walls of pores in the multi-pore structure. Material that is porous should not be used in patient care settings because it is not possible to disinfect it properly.

Background Phototherapy has been a standard treatment for neonatal hyperbilirubinemia for more than 40 years, but it has remained sub-optimal. Aims To clarify the developmental changes in parameters of (4 E , 15 Z )-cyclobilirubin (( EZ )-C) elimination in order to obtain basic data for establishing optimal phototherapy. Study design Blood samples were taken at regular intervals after stopping phototherapy, and bilirubin fractions were analyzed by high-performance liquid chromatography. Subjects and methods The subjects were 46 infants with hyperbilirubinemia who underwent phototherapy. The gestational age and birth weight of the subjects ranged from 25.0 to 41.0 weeks and from 656 to 3810 g, respectively, and the age at cessation of phototherapy was a median of 5 days. A kinetic model of ( EZ )-C elimination was established, and the serum half-life of ( EZ )-C was calculated on the basis of the determined model. Relationships of the half-life of ( EZ )-C with birth weight and gestational age were investigated. Results Serum ( EZ )-C elimination followed a first-order kinetic model in 43 infants and a zero-order kinetic model in three extremely low birth weight infants. The half-life of ( EZ )-C calculated on the basis of a first-order elimination model in serum ranged from 68 to 274 min and showed weak negative correlations with birth weight and gestational age. Conclusions Serum ( EZ )-C excretion followed a first-order kinetic model in most of the neonates. The half-life of ( EZ )-C becomes more prolonged in the very low birth weight infant and early gestational age.