Verifying the Indonesian version of the Child Behavior Checklist

BACKGROUND

The Child Behavior Checklist for Ages 6-18 (CBCL/6-18) is widely used to assess emotional and behavioral problems in children in the USA and Europe. Given that Indonesia has a more traditional culture that is different from the USA and Europe, it is possible that the CBCL is not effective in assessing the emotional and behavioral problems of Indonesian children, due to a difference in culture. Moreover, the validity and reliability of the Indonesian version of the CBCL/6-18 have not been tested. The purpose of this study was therefore to test the validity and reliability of the Indonesian version of the CBCL/6-18.

METHODS

Three hundred and eight mothers of children attending public primary schools participated in this study by completing the self-administered questionnaire.

RESULTS

All items of the CBCL were positively correlated with total score (0.15-0.59), and total problems score had high internal consistency (r = 0.94). The correlations between questionnaire items and the eight subscales of the CBCL ranged from 0.10 to 0.74 and from 0.12 to 0.64 for the internalizing and externalizing scales, respectively (P < 0.01). The eight subscales of the CBCL had good internal consistency (0.61-0.87).

CONCLUSIONS

The CBCL/6-18 is a valid and reliable instrument to measure emotional and behavioral problems in Indonesian children aged 6-12 years.

A novel PIGN mutation and prenatal diagnosis of inherited glycosylphosphatidylinositol deficiency

Glycosylphosphatidylinositol (GPI) anchors tether proteins to the extracellular face of eukaryotic plasma membranes. Defects in the human GPI anchor biosynthetic pathway cause inherited GPI deficiencies (IGDs) characterized by multiple congenital anomalies: dysmorphic faces, developmental delay, hypotonia, and epilepsy. We report the case of a 6-year-old boy with severe psychomotor developmental delay, epilepsy, and decreased granulocyte surface expression of GPI-anchored protein that suggested autosomal recessive GPI deficiency. The case underwent target exome sequencing to screen for IGDs. Target exome sequencing of the proband identified an apparently homozygous c.808T > C (p.Ser270Pro) mutation in PIGN, a gene involved in the GPI anchor biosynthetic pathway. As his parents were expecting another child, genetic carrier screening was conducted for the parents. Direct sequencing of the parents identified a heterozygous c.808T > C PIGN mutation in the father but none in the mother. To identify the mother's mutation, we performed semi-quantitative real-time PCR of the PIGN exons and long PCR, identifying a microdeletion in PIGN (del exons 2-14). The proband had inherited this microdeletion from his mother. Prenatal diagnosis of the fetus revealed that it was a heterozygous carrier of the mother's pathogenic allele. Here, we report a sporadic case of inherited GPI deficiency with a PIGN mutation and the first case of prenatal diagnosis for GPI deficiency.

Hydrodynamic instabilities in shear flows of dry cohesive granular particles

We extend the dynamic van der Waals model introduced by A. Onuki [Phys. Rev. Lett., 2005, 94, 054501] to the description of cohesive granular flows under a plane shear to study their hydrodynamic instabilities. By numerically solving the dynamic van der Waals model, we observed various heterogeneous structures of density fields in steady states, where the viscous heating is balanced with the energy dissipation caused by inelastic collisions. Based on the linear stability analysis, we found that the spatial structures are determined by the mean volume fraction, the applied shear rate, and the inelasticity, where the instability is triggered if the system is thermodynamically unstable, i.e. the pressure, p, and the volume fraction, ϕ, satisfy ∂p/∂ϕ < 0.

Effectiveness of professional training in bereavement care: Survey of Japanese pediatricians supporting families who have lost a child

BACKGROUND

The aim of this study was to assess the effectiveness of professional training in bereavement care.

METHOD

We mailed a questionnaire to 554 Japanese pediatricians. It asked about demographic characteristics, personal support experiences, professional training, psychological distress, recognition of high risk after a child's death, and eight items relating to awareness in bereavement care. We divided the subjects into two groups based on the presence or absence of professional training and compared them on the basis of each item (χ(2) test), and conducted logistic regression analysis.

RESULTS

Of the 239 respondents, 193 (80.8%) had performed bereavement care. The final number included in the analysis was 175, after excluding responses with missing data. A total of 46 respondents (26.3%) had attended bereavement care training. The subjects who had had training were more likely to recognize those at high risk for poor psychological recovery, have information about support groups, have a desire to study bereavement care, and understand the necessity of cooperation with mental health specialists.

CONCLUSION

Many pediatricians had personally provided support for the bereaved. On logistic analysis, it was considered that four factors (recognition of high risk for poor recovery, information about support, desire to study, and cooperation with professionals) were significantly associated with the professional training. There were no significant differences, however, in psychological distress, helplessness, and fatigue. Training programs related to stress management must be improved for pediatricians who feel high levels of psychological distress.

Demographics and outcomes of patients with pediatric febrile convulsive status epilepticus

BACKGROUND

Convulsive status epilepticus with fever is common and may be related to neurological sequela in children. However, there are limited data on the demographics and risk factors of this phenomenon. Thus, we aimed to describe the demographics and risk factors of neurological sequela among children with convulsive status epilepticus with fever.

METHODS

We reviewed convulsive status epilepticus with fever cases in the pediatric intensive care unit at Kobe Children's Hospital between 2002 and 2013. We included patients with intrinsic neurological disease, and excluded those with obvious central nervous system infection. Cases of neurological worsening were categorized as poor outcome using the pediatric cerebral performance category scale. Possible risk factors for poor outcome included age, sex, neurological medical history, seizure duration, body temperature, and level of consciousness.

RESULTS

A total of 253 patients (128 males), aged 1 month to 15 years (mean 45 ± 40 months), were enrolled. Three patients (1.2%) died during hospitalization, and 32 (12.6%) patients had a poor outcome. A univariate analysis identified male sex, absence of epilepsy history, body temperature above 40°C on admission, seizure duration longer than 120 minutes, impaired consciousness at 12 hours after onset, and presence of nonconvulsive seizure as potential predictors of poor outcome. A multivariate analysis, revealed that an absence of epilepsy history (odds ratio = 11.18), body temperature above 40°C on admission (odds ratio = 3.39), or impaired consciousness at 12 hours after onset (odds ratio = 41.85) was associated with poor outcome.

CONCLUSIONS

Our study indicated that absence of epilepsy history, high temperature, and/or prolonged impaired consciousness were associated with brain injury.

[Case of xanthogranulomatous pyelonephritis complicated by simultaneous septic pulmonary embolism]

A 57-year-old man with fever-up and multiple nodules in the peripheral area of the lungs on the chest CT was referred to the department of respiratory medicine of our hospital for further examination. The whole body CT disclosed a space-occupying lesion in the left frontal lobe of his brain, an irregular mass in the left kidney, and swelling of paraaortic lymph nodes. A pathological diagnosis could not be made from the results of the bronchoscopic examination and percutaneous needle biopsy for the renal mass. Left nephrectomy and lymph node dissection were carried out because of possible renal malignancy with distant metastases. The renal lesion was diagnosed as xanthogranulomatous pyelonephritis histopathologically. After the nephrectomy, the multiple lung nodules disappeared spontaneously leaving scars in some lesions. Septic pulmonary embolism was highly suspected on the basis of the clinical course. The brain nodule also decreased in size significantly and is currently under careful surveillance.

Extensive bowel necrosis related to bevacizumab in metastatic rectal cancer patient: a case report and review of literature

Recently, bevacizumab has become a key drug for treatment of metastatic colorectal cancer. Molecularly targeted agents such as bevacizumab can cause life-threatening adverse effects, though they are generally considered less toxic than cytotoxic drugs. Here, we review the case of a 76-year-old male rectal cancer patient with liver metastasis who suffered extensive bowel necrosis after administration of 5-fluorouracil-based chemotherapy with bevacizumab, and required a subtotal colectomy and end-ileostomy. Microscopic findings revealed extensive mucosal necrosis in the resected colon specimen and necrosis at the muscularis propria of the descending colon. Pathological findings suggested that the mucosal damage induced by chemotherapy may be exacerbated by treatment with bevacizumab, resulting in extensive necrosis.

Simulation of cohesive fine powders under a plane shear

Three-dimensional molecular-dynamics simulations of cohesive dissipative powders under a plane shear are performed. We find the various phases depending on the dimensionless shear rate and the dissipation rate as well as the density. We also find that the shape of clusters depends on the initial condition of velocities of particles when the dissipation is large. Our simple stochastic model reproduces the non-Gaussian velocity distribution function appearing in the coexistence phase of a gas and a plate.

Usefulness of the tri-axial accelerometer for assessing balance function in children

BACKGROUND

The aim of this study was to verify whether the tri-axial accelerometer can be used for quantitatively evaluating balance function in children.

METHODS

In total, 198 participants, including 172 healthy children aged 3-11 years (87 boys, 85 girls) and 26 young adults aged 21-24 years (seven men, 19 women), were enrolled in this study. The participants undertook three types of balance tasks: quiet standing with eyes open and closed, one-leg standing on the dominant leg and non-dominant leg, and walking on the floor and a balance beam. We derived the root mean square from participants' accelerations measured by the tri-axial accelerometer.

RESULTS

We found that for quiet standing, one-leg standing, and walking tasks, postural sway decreased with age. Girls controlled their posture better than boys of the same age on all tasks. There was a significant sex difference in quiet standing for children aged 8-9 years. Furthermore, sex differences existed in one-leg standing for children aged 5-11 years. A mild positive correlation was observed between static and dynamic balance.

CONCLUSIONS

The tri-axial accelerometer is a useful quantitative tool for evaluating both static and dynamic balance function in children. Thus, it has the potential to be used clinically for diagnosis and rehabilitation.

Transmission phase in the Kondo regime revealed in a two-path interferometer

We report on the direct observation of the transmission phase shift through a Kondo correlated quantum dot by employing a new type of two-path interferometer. We observed a clear π/2-phase shift, which persists up to the Kondo temperature TK. Above this temperature, the phase shifts by more than π/2 at each Coulomb peak, approaching the behavior observed for the standard Coulomb blockade regime. These observations are in remarkable agreement with two-level numerical renormalization group calculations. The unique combination of experimental and theoretical results presented here fully elucidates the phase evolution in the Kondo regime.

[A case of giant bladder stone in a young man with neither lower urinary tract dysfunction nor foreign body in the bladder]

A 38-year-old man visited our hospital complaining of lower urinary tract symptoms. He had undergone extracorporeal shockwave lithotripsy to remove a right renal stone two times when he was 24 years old. Since examinations revealed right staghorn calculi and a giant bladder stone, vesicolithotomy was carried out. The removed stone measured 95 × 75 × 55 mm and weighed 250 g. We hypothesized that a fragment of the upper urinary tract stone had reached the bladder which could not be discharged spontaneously, and grew in the bladder. After the operation, uroflowmetry and voiding cystourethrography were performed and the results indicated no abnormalities in the lower urinary tract function.

Anatomical study of phrenic nerve course in relation to neck dissection

The present study sought to clarify the course of the phrenic nerve and its correlation with anatomical landmarks in the neck region. We examined 17 cadavers (30 sides). In each, the phrenic nerves was dissected from the lateral side of the neck, and its position within the triangle formed by the mastoid process and sternal and acromial ends of the clavicle was determined. The point where the phrenic nerve arises in the posterior triangle was found to be similar to the point where the cutaneous blanches of the cervical plexus emerge at the middle of the posterior border of the sternocleidomastoid muscle. In the supraclavian triangle, the phrenic nerve crosses the anterior border of the anterior scalene muscle near Erb's point where the superficial point is 2-3 cm superior from the clavicle and posterior border of the sternocleidomastoid muscle. The phrenic nerve arises in the posterior triangle near the nerve point, then descends to the anterior surface of the anterior scalene muscle in the supraclavian triangle. It is necessary to be aware of the supraclavian triangle below Erb's point during neck dissection procedures.

Speech intonation in children with autism spectrum disorder

OBJECTIVE

The prosody of children with autism spectrum disorder (ASD) has several abnormal features. We assessed the speech tone of children with ASD and of children with typical development (TD) by using a new quantitative acoustic analysis.

METHODS

Our study participants consisted of 63 children (26 with ASD and 37 with TD). The participants were divided into 4 groups based on their developmental features and age. We assessed the variety of the fundamental frequency (F0) pattern quantitatively, using pitch coefficient of variation (CV), considering the different F0 mean for each word.

RESULTS

(1) No significant difference was observed between the ASD and TD group at pre-school age. However, the TD group exhibited significantly greater pitch CV than the ASD group at school age. (2) In pitch CV, range and standard deviation of the whole speech of each participant, no significant differences were observed between the type of participants and age. (3) No significant correlation was found between the pitch CV of each word and the Japanese Autism Screening Questionnaire total score, or between the pitch CV of each word and the intelligence quotient levels in the ASD group. A significant correlation was observed between the pitch CV of each word and social reciprocal interaction score.

CONCLUSIONS

We assessed the speech tone of children with ASD by using a new quantitative method. Monotonous speech in school-aged children with ASD was detected. The extent of monotonous speech was related to the extent of social reciprocal interaction in children with ASD.

Genotype-phenotype correlations in alternating hemiplegia of childhood

OBJECTIVE

Clinical severity of alternating hemiplegia of childhood (AHC) is extremely variable. To investigate genotype-phenotype correlations in AHC, we analyzed the clinical information and ATP1A3 mutations in patients with AHC.

METHODS

Thirty-five Japanese patients who were clinically diagnosed with AHC participated in this study. ATP1A3 mutations were analyzed using Sanger sequencing. Detailed clinical information was collected from family members of patients with AHC and clinicians responsible for their care.

RESULTS

Gene analysis revealed 33 patients with de novo heterozygous missense mutations of ATP1A3: Glu815Lys in 12 cases (36%), Asp801Asn in 10 cases (30%), and other missense mutations in 11 cases. Clinical information was compared among the Glu815Lys, Asp801Asn, and other mutation groups. Statistical analysis revealed significant differences in the history of neonatal onset, gross motor level, status epilepticus, and respiratory paralysis in the Glu815Lys group compared with the other groups. In addition, 8 patients who did not receive flunarizine had severe motor deteriorations.

CONCLUSIONS

The Glu815Lys genotype appears to be associated with the most severe AHC phenotype. Although AHC is not generally seen as a progressive disorder, it should be considered a disorder that deteriorates abruptly or in a stepwise fashion, particularly in patients with the Glu815Lys mutation.

[Brain metastasis which appeared during complete response of lung metastatic lesion by sunitinib treatment in a patient with renal cell carcinoma]

A 59-year-old man underwent radical nephrectomy for left renal cell carcinoma with multiple lung metastases (cT3bN0M1) in May 2010. Pathological diagnosis was clear cell carcinoma, G2 and pT3b. After sunitinib treatment for 7 months computed tomography (CT) revealed complete response of lung lesions and the treatment was continued. After 10 months, the patient complained of right hemiplegia. Brain magnetic resonance imaging (MRI) revealed a 3 cm tumor in his frontal lobe of cerebrum. He underwent surgical resection of the tumor and pathological diagnosis was metastatic renal cell carcinoma. He has been well without local recurrence or distant metastasis for 18 months.

Imitation of 'bye-bye' in very low-birthweight infants

BACKGROUND

The aim of this study was to clarify the development of imitation skills in very low-birthweight (VLBW) infants compared with full-term infants with regard to the onset of 'bye-bye'.

METHODS

A total of 597 full-term infants (age, 6-21 months) and 95 VLBW infants (corrected age, 6-21 months) participated in this study. The time at which the infants began to imitate bye-bye and how they moved their hands were investigated by direct observations of their behaviors.

RESULT

Some full-term infants began to imitate bye-bye at 9 months, and all full-term infants could imitate bye-bye by 16 months old. The imitation of bye-bye was delayed in VLBW infants, but all of them could imitate it at 17 months old. Bye-bye motions were divided into five types. The 'moving wrist up and down' motion was observed most frequently at the initial bye-bye in both groups, but it was more frequent in VLBW infants at the early stage. The motion types changed with age, with the 'palm facing others' motion observed exclusively at 16 months in full-term infants. All infants of both groups could imitate this type at 17 months old.

CONCLUSION

The development of the ability to imitate bye-bye was delayed in VLBW infants even after correction for gestational age. It was suspected that the fine motor development delay might contribute to the late appearance of bye-bye in VLBW infants. Further follow-up study is required to clarify the clinical significance.

[Reliability of the measurement of stature in subjects with severe motor and intellectual disabilities]

OBJECTIVE

The objective of this study was to examine the reliability of the measurement of stature in individuals with severe motor and intellectual disabilities.

METHODS

Using a stratified sampling method 12 subjects (mean age of 28.7 +/- 11.5), were selected from 73 subjects with severe motor and intellectual disabilities (mean age of 37.1 +/- 15.0). Each subjects'stature was measured using two measurement methods. One measured the tibia length (TL-method) and, the other measured the whole body by measuring three sections. (Division-method). 3 examiners measured all subjects using the TL-method and Division-method two times repeatedly. In addition, one examiner measured all subjects within two weeks following the initial measurement. Intra-rater reliability was calculated from single and two times measurements using each method. The Inter-rater reliability was calculated using measurement results from 2 or 3 examiners in both single and two times measurements. The correlation between values measured by the TL-method and the Division-method was calculated using Spearman rank correlation coefficient.

RESULTS

The TL-method and Division-method had good intra-rater reliability (ICC>0.90, 95%CI>0.80) and good inter-rater reliability (ICC>0.90, 95%CI>0.70) in both measurement methods. For both measurement methods, inter-rater reliability was more preferable when 3 examiners measured two times repeatedly (ICC>0.90, 95%CI>0.90). There was good correlation between values measured by TL-method and the Division-method (r=0.83).

CONCLUSIONS

Both TL-method and Division-method had good reliability. However, the TL-method could be considered a more useful measurement method as it can be completed more easily and in a short period of time.

Relation between sleep status of preterm infants aged 1-2 years and mothers' parenting stress

BACKGROUND

The aim of this study was to compare infants' sleep measures through an actigraph and maternal parenting stress among preterm and full-term mothers, and to explore the factors affecting maternal parenting stress in relation to infants' sleep.

METHODS

The subjects were 44 pairs of mothers and children. Twenty-one were in the preterm group, and 23 were in the full-term group. Inclusion criteria for preterm infants were born at less than 36 weeks and birthweight of less than 2500 g. The Parenting Stress Index (PSI) Short Form assesses maternal perception of the degree of parenting stress: the children's domain, and the parent's domain. An actigraph was applied to assess the infants' sleep measures.

RESULTS

The PSI showed significant differences, with high scores in parenting stress in the preterm group. Also, the number of mothers who complained about their infant's sleep issues was significantly higher in the preterm group. Most of the sleep measures showed improvement by their age in both preterm and full-term infants. Multiple linear regression analysis showed that sleep efficiency, longest sleep duration at nighttime accounted for 71% of stress in the children's domain of the PSI of the preterm group.

CONCLUSION

The parenting stress among mothers of preterm infants was significantly higher than that of mothers of full-term infants. The mothers of preterm infants were concerned about their infant's nocturnal sleep quality.

Quantification of changes in metamorphopsia and retinal contraction in eyes with spontaneous separation of idiopathic epiretinal membrane

BACKGROUND

To quantify changes in metamorphopsia and retinal contraction in eyes with idiopathic epiretinal membrane (ERM) before and after a spontaneous separation of ERM.

METHODS

Among 92 eyes of 92 patients with idiopathic ERM who were followed up at our hospital, 5 eyes of 5 patients had experienced a spontaneous separation of ERM during the follow-up period. Patient's metamorphopsia was assessed horizontally and vertically by a metamorphopsia chart developed by our group, M-CHARTS, to obtain the horizontal (MH) and vertical (MV) metamorphopsia scores. Difference in the scores before and after the membrane separation represents change in patient's metamorphopsia. Changes in retinal contraction were also evaluated horizontally and vertically with our original software for fundus image analysis. The difference between M-CHARTS scores and distances of retinal vessel movements with before and after membrane separation were measured.

RESULTS

All five subjects showed a decrease in the retinal contraction. Improved visual acuity was observed in three subjects, and no change was seen in the other two. Four subjects obtained better metamorphopsia scores after the membrane separation, while the other one was not detected with metamorphopsia by M-CHARTS either before or after the separation. In subjects with an improved MV, horizontal retinal movement was seen larger than the vertical movement. Similarly, the subjects with an improved MH indicated a larger vertical retinal movement than the horizontal movement.

CONCLUSIONS

The direction of patient's metamorphopsia closely associated with the direction of retinal contraction before and after a spontaneous separation of ERM.

High-Strength PET Fibers Produced by Conjugated Melt Spinning and Laser Drawing

The mechanical properties of conjugated-spun and laser drawn poly(ethylene terephthalate) (PET) fibers were investigated. The as-spun fibers used for the laser drawing were made by conjugated melt spinning with the copolymer of p-hydroxybenzoicacid and 2-hydroxy-6-naphthoicacid or polystyrene. The PET fibers prepared by conjugated spinning could be laser drawn to higher draw ratios under lower drawing stresses. The drawn fiber could be re-drawn up to a higher total draw ratio. Thus, a PET fiber having a tensile strength of 1.14 N/tex could be produced.

Post-Traumatic Stress Disorders and mental health care (lessons learned from the Hanshin-Awaji Earthquake, Kobe, 1995)

The Hanshin-Awaji Earthquake of 1995 and has moved through the various phases into the recovery stage. After the earthquake we conducted two surveys involving approximately 8000 families with pre-school aged children and 466 families with disabled children. Symptoms related to PTSD were found more frequently in the small children whose houses had been severely damaged one year after the earthquake. Although the symptoms decreased, they were still present more frequently in the children and their mothers with severely damaged homes in 1998. Our results show children with intellectual or emotional disabilities displayed many behavioral problems. The physically disabled children required medical resources and specialized support in a structured environment. Both groups voiced the need to set up specialized facilities for people with disabilities. Following the Central Java Earthquake in 2006, we have engaged in "children house" activities in the disaster stricken area in collaboration with Gadjah Mada University. Through this activity, we have been able to share what works in helping children with disabilities and their families. From our experience we have found exchanging of information among the people in the disaster stricken areas helps to reduce the psychological damage of the children and aids in their recovery process.

Associated factors of psychological distress among Japanese pediatricians in supporting the bereaved family who has lost a child

PURPOSE

The psychological distress of pediatricians is a major problem in bereavement care. In this study, the primary factor related to distress is clarified and the future directions of bereavement care provided by pediatricians are examined.

METHOD

A questionnaire was mailed to Japanese pediatricians belonging to the High-risk Infant Follow-up Association and the Society of Child Neurology. Doctors who actually experienced bereavement care were divided into high and low distress groups. We conducted a comparison of the variables for the two groups using a logistic regression analysis, and the primary factor related to psychological distress was analyzed by the odds ratio (OR) and 95% confidence intervals.

RESULTS

The primary factors related to psychological distress were found to be the following 4 items: "gender," "years of experience," "acquisition of coping method," and "feelings of helplessness." In the high distress group, most pediatricians were women, lacked experience, had no coping methods, and felt helplessness.

CONCLUSION

Countermeasures are required for people feeling strong psychological distress. It is necessary to let pediatricians know that their support is helping the bereaved families and to strive to improve their feelings of helplessness. Education for appropriate coping methods and self-care is required for pediatricians desiring to study bereavement care. Consideration is particularly required for doctors who are female and those who lack experience.

[Chronic urinary retention in women caused by primary bladder neck obstruction : report of two cases treated successfully with transurethral resection of bladder neck]

A 60-year-old female was referred to our hospital for the treatment of chronic urinary retention which had compelled her to continue clean intermittent self catheterization (CIC) for several years. After further examination including physical examinations, urodynamic study, cystography, and urethrocystoscopy, she was diagnosed with primary bladder neck obstruction (PBNO). Transurethral resection of the bladder neck (TURBN) was performed to relieve the bladder outlet obstruction and she was free from CIC thereafter. Another 61-year-old female on CIC was also referred to our hospital and diagnosed with PBNO through detailed examinations including urodynamics. She was also successfully relieved of CIC after TURBN. Primary bladder neck obstruction is a condition which can be effectively treated by a less-invasive procedure when properly diagnosed by urodynamic examination. Urologists must keep this rare condition in mind as a possible cause of chronic urinary retention in women.