1
|
Ishikawa T, Uejima Y, Okai M, Shiga K, Shoji K, Miyairi I, Kato M, Morooka S, Kubota M, Tagaya T, Tsuji S, Aoki S, Ide K, Niimi H, Uchiyama T, Onodera M, Kawai T. Melting temperature mapping method in children: Rapid identification of pathogenic microbes. J Infect Chemother 2024; 30:475-480. [PMID: 38036030 DOI: 10.1016/j.jiac.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The melting temperature (Tm) mapping method (TM) identifies bacterial species by intrinsic patterns of Tm values in the 16S ribosomal RNA gene (16S rDNA) extracted directly from whole blood. We examined potential clinical application of TM in children with bloodstream infection (BSI). METHODS This was a prospective observational study at a children's hospital in Japan from 2018 to 2021. In patients with diagnosed or suspected BSI, we investigated the match rates of pathogenic bacteria identified by TM and blood culture (BC), the inspection time to identification of TM, and the amount of bacterial DNA in blood samples. RESULTS The median age of 81 patients (93 samples) was 3.6 years. Of 23 samples identified by TM, 11 samples matched the bacterial species with BC (positive-match rate, 48 %). Of 64 TM-negative samples, 62 samples were negative for BC (negative-match rate, 97 %). Six samples, including one containing two pathogenic bacterial species, were not suitable for TM identification. In total, the matched samples were 73 of 93 samples (match rate, 78 %). There were seven samples identified by TM in BC-negative samples from blood collected after antibiotic therapy. Interestingly, the bacteria were matched with BC before antibiotic administration. These TM samples contained as many 16S rDNA copies as the BC-positive samples. The median inspection time to identification using TM was 4.7 h. CONCLUSIONS In children with BSI, TM had high negative-match rates with BC, the potential to identify the pathogenic bacteria even in patients on antibiotic therapy, and more rapid identification compared to BC. REGISTERING CLINICAL TRIALS UMIN000041359https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000047220.
Collapse
Affiliation(s)
- Takashi Ishikawa
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan.
| | - Yoji Uejima
- Division of Infectious Diseases and Immunology, Saitama Children's Medical Center, Saitama, Japan; Department of Clinical Laboratory and Molecular Pathology, Toyama University Hospital, Toyama, Japan
| | - Masashi Okai
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Kyoko Shiga
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Motohiro Kato
- Department of Pediatric Hematology and Oncology Research, National Center for Child Health and Development, Tokyo, Japan
| | - Shintaro Morooka
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Tagaya
- Division of Pediatric Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Tsuji
- Division of Pediatric Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Aoki
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kentaro Ide
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hideki Niimi
- Department of Clinical Laboratory and Molecular Pathology, Toyama University Hospital, Toyama, Japan
| | - Toru Uchiyama
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Department of Human Genetics, National Center for Child Health and Development, Tokyo, Japan
| | - Masafumi Onodera
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Gene & Cell Therapy Promotion Center, National Center for Child Health and Development, Tokyo, Japan
| | - Toshinao Kawai
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Utsumi S, Maiko S, Moriwaki T, Miyake H, Yuhei S, Kubota S, Uematsu S, Takehara K, Kubota M. Benefits to Clinicians of Nonpharmacological Distraction During Pediatric Medical Procedure. Hosp Pediatr 2024; 14:e123-e131. [PMID: 38273770 DOI: 10.1542/hpeds.2023-007322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
CONTEXT Nonpharmacologic distraction (NPD) during medical procedures in children is known to be beneficial to patients; however, no reviews have assessed their benefits to medical providers. OBJECTIVES We aimed to assess the benefits of NPD to medical providers. DATA SOURCES We searched 5 databases for relevant articles. STUDY SELECTION Peer-reviewed published randomized controlled trials comparing NPD with standard care that included children who had undergone medical procedures were included. DATA EXTRACTION Primary outcomes were procedure time, number of medical staff involved, and initial success rate of venipuncture. Two reviewers assessed the risk of bias by using the Cochrane Collaboration (Oxford, United Kingdom)'s Randomized Controlled Trials Risk of Bias Tool, and we performed a meta-analysis to assess efficacy. RESULTS We included 22 trials with 1968 participants. The main NPD was audiovisual distraction, such as tablets. No significant difference was found in venipuncture procedure time (mean difference: -9.79; 95% confidence interval: -22.38 to 2.81; low certainty). We found no studies on the number of medical staff. CONCLUSIONS Our review did not find any clear NPD-associated benefit for the medical provider. The review included a small amount of literature, analyzed a small number of cases, and had a low certainty of evidence regarding procedure duration; therefore, further studies are needed to conclude the benefits to clinicians of NPD.
Collapse
Affiliation(s)
- Shu Utsumi
- Division of Emergency and Transport Services
| | | | | | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Shimada Yuhei
- School of Public Health, Department of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shoko Kubota
- School of Public Health, Department of Medicine, the University of Tokyo, Tokyo, Japan
| | | | | | - Mitsuru Kubota
- General Medicine and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
3
|
Kaizuka A, Tokuda Y, Morooka S, Gocho Y, Funaki T, Uchiyama T, Hirata Y, Yasumi T, Maekawa T, Kubota M, Ishiguro A. Pediatric hemophagocytic lymphohistiocytosis after concomitant administration of SARS-CoV-2 vaccine and influenza vaccine. J Infect Chemother 2024; 30:67-70. [PMID: 37657516 DOI: 10.1016/j.jiac.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/08/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a highly lethal disease characterized by fever, cytopenia, splenomegaly, and hemophagocytosis. Whereas infectious diseases, malignant tumors, and autoimmune diseases are often triggers for HLH, reports of HLH associated with vaccination are limited. In this report, we describe a case of HLH in a 12-year-old female patient after simultaneous administration of the bivalent messenger RNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine and quadrivalent inactivated influenza vaccine. The patient presented to our hospital with fever on the day after vaccination. Considering the splenomegaly, cytopenia, hemophagocytosis in the bone marrow, and high ferritin level, HLH was diagnosed 12 days after vaccination. Various tests ruled out any infectious disease, malignant tumor, or autoimmune disease. The patient was treated only with 2 mg/kg/day of oral prednisolone, fever improved 13 days after vaccination, and blood test findings rapidly improved. Although HLH after SARS-CoV-2 vaccination or concomitant administration with influenza vaccination is still rare, we emphasize the importance of early HLH diagnosis when persistent fever is observed following vaccination.
Collapse
Affiliation(s)
- Anna Kaizuka
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan; Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan
| | - Yusuke Tokuda
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan; Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan
| | - Shintaro Morooka
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | | | - Takanori Funaki
- Division of Infectious Diseases, Department of Medical Subspecialties, NCCHD, Tokyo, Japan
| | | | - Yuiko Hirata
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Yasumi
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takanobu Maekawa
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan.
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan; Children's Cancer Center, NCCHD, Tokyo, Japan
| |
Collapse
|
4
|
Murata Y, Masuda H, Moroka S, Yotani N, Morimoto N, Kubota M, Ishiguro A. Kawasaki Disease with Facial Nerve Palsy. Indian J Pediatr 2024; 91:101. [PMID: 37658282 DOI: 10.1007/s12098-023-04835-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Yo Murata
- Center for Postgraduate Education and Training, National Center for Child Health and Development (NCCHD), Tokyo, Japan
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Hiroshi Masuda
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan.
| | - Shintaro Moroka
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Nobuyuki Yotani
- Division of Palliative Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Noriko Morimoto
- Division of Otorhinolaryngology, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| |
Collapse
|
5
|
Takezoe T, Murakami K, Fujishiro J, Horikawa M, Kubota M, Kanamori Y, Takahashi N, Nakano Y, Migita M, Matsufuji H, Sasaki S. Intake levels and main sources of nutrients for Japanese children with motor or intellectual disabilities. J Nutr Sci 2023; 12:e126. [PMID: 38155811 PMCID: PMC10753447 DOI: 10.1017/jns.2023.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/05/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023] Open
Abstract
Proper nutritional management is important for the growth and development of children with motor or intellectual disabilities; however, few studies have investigated the nutrient intake of children with disabilities. This study aimed to investigate the nutrient intake and food groups that are the main sources of nutrients for children with disabilities. This cross-sectional observational study included twenty-five children (mean age, 11⋅8 years) from five hospitals in Japan. Using a 3-d weighed dietary record, we estimated the daily nutrient intake and food and beverage sources that contributed to nutrient intake. The mean values of calcium, magnesium, iron, vitamin A, thiamine, riboflavin, and vitamin C intake were below the recommended dietary allowance, and those of dietary fiber and potassium were below the levels recommended by the Tentative Dietary Goal for Preventing Lifestyle-related Diseases (DG). In contrast, the mean intake values of fat, saturated fatty acids, and sodium were above the DG levels. Dairy products, meat, vegetables, and cereals were found to be the major contributors of nutrients. Increased intake of vegetables may help alleviate insufficient micronutrient intake in children with disabilities.
Collapse
Affiliation(s)
- Toshiko Takezoe
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kentaro Murakami
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Miwako Horikawa
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yutaka Kanamori
- Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Nagahisa Takahashi
- Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
| | - Yuko Nakano
- Department of Pediatrics, Ashikaga Hospital, Tochigi, Japan
| | - Misato Migita
- Department of Pediatric Surgery, St. Luke's International Hospitals, Tokyo, Japan
| | - Hiroshi Matsufuji
- Department of Pediatric Surgery, St. Luke's International Hospitals, Tokyo, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
6
|
Ishikawa K, Hayakawa I, Masuda H, Kubota M, Ishiguro A. Multisystem Inflammatory Syndrome in Clinically Mild Encephalitis/Encephalopathy with Reversible Splenial Lesion. Indian J Pediatr 2023; 90:940-941. [PMID: 37083888 PMCID: PMC10119521 DOI: 10.1007/s12098-023-04542-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/28/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Kazu Ishikawa
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Itaru Hayakawa
- Division of Neurology, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Hiroshi Masuda
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
7
|
Tanaka D, Amagasa S, Kikuchi N, Sasaki R, Uematsu S, Tsuji S, Kubota M, Nakagawa S. Clinical Utility and Patient Distribution of Brief Resolved Unexplained Event Classification for Apparent Life-Threatening Events. Pediatr Emerg Care 2023; 39:507-510. [PMID: 37318851 DOI: 10.1097/pec.0000000000002986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES In 2016, brief resolved unexplained events (BRUEs) were proposed as alternative concepts to apparent life-threatening event (ALTE). The clinical utility of managing ALTE cases according to the BRUE classification is controversial. To verify the clinical utility of the BRUE criteria, we evaluated the proportion of ALTE patients who met and those who did not meet the BRUE criteria and assessed the diagnoses and outcomes of each group. METHODS We retrospectively investigated patients with ALTE younger than 12 months who visited the emergency department of the National Center for Child Health and Development from April 2008 to March 2020. The patients were classified into the higher-risk and lower-risk BRUE groups; however, those who did not meet the BRUE criteria were classified into the ALTE-not-BRUE group. We evaluated the diagnoses and outcomes of each group. Adverse outcomes included death, recurrence, aspiration, choking, trauma, infection, convulsions, heart disease, metabolic disease, allergies, and others. RESULTS Over the period of 12 years, a total of 192 patients were included, among which 140 patients (71%) were classified into the ALTE-not-BRUE group, 43 (22%) into the higher-risk BRUE group, and 9 (5%) into the lower-risk BRUE group. Adverse outcomes occurred in 27 patients in the ALTE-not-BRUE group and 10 patients in the higher-risk BRUE group. No adverse outcome occurred in the lower-risk BRUE group. CONCLUSIONS Many of the patients with ALTE were classified into the ALTE-not-BRUE group, suggesting that replacing ALTE with BRUE is difficult. Although patients classified as lower-risk BRUE showed no adverse outcomes, there were only a few of them. In the pediatric emergency medicine setting, the BRUE risk classification may be beneficial for certain patients.
Collapse
Affiliation(s)
- Daiki Tanaka
- From the Division of Emergency and Transport Services
| | | | - Nanae Kikuchi
- From the Division of Emergency and Transport Services
| | - Ryuji Sasaki
- From the Division of Emergency and Transport Services
| | | | - Satoshi Tsuji
- From the Division of Emergency and Transport Services
| | - Mitsuru Kubota
- Departments of General Pediatrics & Interdisciplinary Medicine
| | - Satoshi Nakagawa
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
8
|
Amagasa S, Uematsu S, Kubota M, Kashiura M, Yasuda H, Hayakawa M, Yamakawa K, Endo A, Ogura T, Hirayama A, Yasunaga H, Tagami T. Relationship between institutional ventilated COVID-19 case volume and in-hospital death: A multicenter cohort study. PLoS One 2023; 18:e0287310. [PMID: 37319278 PMCID: PMC10270613 DOI: 10.1371/journal.pone.0287310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The volume-outcome relationship in patients with severe Coronavirus disease 2019 (COVID-19) is unclear and is important for establishing a system for the medical care of severe COVID-19. This study aimed to evaluate the association between institutional case volume and outcomes in patients with ventilated COVID-19. METHODS We analyzed patients with severe COVID-19 on ventilatory control aged > 17 years who were enrolled in the J-RECOVER study, which is a retrospective multicenter observational study conducted between January 2020 and September 2020 in Japan. Based on the ventilated COVID-19 case volume, the higher one-third of institutions were defined as high-volume centers, the middle one-third as middle-volume centers, and the lower one-third as low-volume centers. The primary outcome measure was in-hospital mortality during hospitalization due to COVID-19. Multivariate logistic regression analysis for in-hospital mortality and ventilated COVID-19 case volume was performed after adjusting for multiple propensity scores and in-hospital variables. To estimate the multiple propensity score, we fitted a multinomial logistic regression model, which fell into one of the three groups based on patient demographics and prehospital factors. RESULTS We analyzed 561 patients who required ventilator management. In total, 159, 210, and 192 patients were admitted to low-volume (36 institutions, < 11 severe COVID-19 cases per institution during the study period), middle-volume (14 institutions, 11-25 severe cases per institution), and high-volume (5 institutions, > 25 severe cases per institution) centers, respectively. After adjustment for multiple propensity scores and in-hospital variables, admission to middle- and high-volume centers was not significantly associated with in-hospital death compared with admission to low-volume centers (adjusted odds ratio, 0.77 [95% confidence interval (CI): 0.46-1.29] and adjusted odds ratio, 0.76 [95% CI: 0.44-1.33], respectively). CONCLUSIONS There may be no significant relationship between institutional case volume and in-hospital mortality in patients with ventilated COVID-19.
Collapse
Affiliation(s)
- Shunsuke Amagasa
- Division of Emergency and Transport Services, National center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Satoko Uematsu
- Department of Interdisciplinary Medicine, Division of General Pediatrics, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Mitsuru Kubota
- Department of Interdisciplinary Medicine, Division of General Pediatrics, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Amanuma-cho, Omiya-ku, Saitama City, Saitama, Japan
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Amanuma-cho, Omiya-ku, Saitama City, Saitama, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Daigakumachi, Takatsuki, Osaka, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Takebayashi-machi, Utsunomiya, Tochigi, Japan
| | - Atsushi Hirayama
- Department of Social Medicine, Public Health, Graduate School of Medicine, Osaka University, Yamadaoka, Suita, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, Japan
| |
Collapse
|
9
|
Sato J, Yotani N, Shoji K, Mori T, Fujino A, Hikosaka M, Kubota M, Ishiguro A. Necrotizing fasciitis following rapidly deteriorating neonatal omphalitis with good initial presentation. IDCases 2023; 32:e01750. [PMID: 37063783 PMCID: PMC10091041 DOI: 10.1016/j.idcr.2023.e01750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Neonatal omphalitis is a postpartum infection of periumbilical superficial soft tissues that usually has a good prognosis in developed countries. In rare cases, it could progress to periumbilical necrotizing fasciitis (NF), which is an infection of the deep soft tissues, including muscle fascia, and has a high mortality rate. However, the signs and timing of developing NF secondary to omphalitis are unclear. We encountered a neonatal case of NF following omphalitis. In the initial days of the clinical course, general symptoms and condition of the patient were good, and abdominal physical findings were mild; however, the patient rapidly developed NF. The patient was successfully treated by emergent surgical debridement, broad-spectrum antibiotics, and intensive care. To determine the area of blood perfusion, we intravenously injected indocyanine green by intraoperative angiography, and then extensively removed necrotic and hypoperfused tissues. In neonatal omphalitis, the deterioration can suddenly occur despite good initial conditions; intensive monitoring should be required during the first few days of the clinical course.
Collapse
Affiliation(s)
- Jin Sato
- National Center for Child Health and Development (NCCHD), Department of General Pediatrics and Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
- NCCHD, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Nobuyuki Yotani
- NCCHD, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
- NCCHD, Division of Palliative Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
- Correspondence to: Division of Palliative Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.
| | - Kensuke Shoji
- NCCHD, Division of Infectious Diseases, Department of Medical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Teizaburo Mori
- NCCHD, Division of Surgery, Department of Surgical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Akihiro Fujino
- NCCHD, Division of Surgery, Department of Surgical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Makoto Hikosaka
- NCCHD, Division of Plastic Surgery, Department of Surgical Subspecialties, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Mitsuru Kubota
- National Center for Child Health and Development (NCCHD), Department of General Pediatrics and Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Akira Ishiguro
- NCCHD, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| |
Collapse
|
10
|
Amagasa S, Utsumi S, Moriwaki T, Yasuda H, Kashiura M, Uematsu S, Kubota M. Advanced airway management for pediatric out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Am J Emerg Med 2023; 68:161-169. [PMID: 37027937 DOI: 10.1016/j.ajem.2023.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Although airway management is important in pediatric resuscitation, the effectiveness of bag-mask ventilation (BMV) and advanced airway management (AAM), such as endotracheal intubation (ETI) and supraglottic airway (SGA) devices, for prehospital resuscitation of pediatric out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to determine the efficacy of AAM during prehospital resuscitation of pediatric OHCA cases. METHODS We searched four databases from their inception to November 2022 and included randomized controlled trials and observational studies with appropriate adjustments for confounders that evaluated prehospital AAM for OHCA in children aged <18 years in quantitative synthesis. We compared three interventions (BMV, ETI, and SGA) via network meta-analysis using the GRADE Working Group approach. The outcome measures were survival and favorable neurological outcomes at hospital discharge or 1 month after cardiac arrest. RESULTS Five studies (including one clinical trial and four cohort studies with rigorous confounding adjustment) involving 4852 patients were analyzed in our quantitative synthesis. Compared with ETI, BMV was associated with survival (relative risk [RR] 0.44 [95% confidence intervals (CI) 0.25-0.77]) (very low certainty). There were no significant association with survival in the other comparisons (SGA vs. BMV: RR 0.62 [95% CI 0.33-1.15] [low certainty], ETI vs. SGA: RR 0.71 [95% CI 0.39-1.32] [very low certainty]). There was no significant association with favorable neurological outcomes in any comparison (ETI vs. BMV: RR 0.33 [95% CI 0.11-1.02]; SGA vs. BMV: RR 0.50 [95% CI 0.14-1.80]; ETI vs. SGA: RR 0.66 [95% CI 0.18-2.46]) (all very low certainty). In the ranking analysis, the hierarches for efficacy for survival and favorable neurological outcome were BMV > SGA > ETI. CONCLUSION Although the available evidence is from observational studies and its certainty is low to very low, prehospital AAM for pediatric OHCA did not improve outcomes.
Collapse
|
11
|
Fuseda Y, Tagaya T, Tsuji S, Nosaka S, Fujino A, Kubota M, Ishiguro A. Ball-valve syndrome mimicking gastric perforation in a toddler with gastrostomy. Pediatr Int 2023; 65:e15694. [PMID: 37968898 DOI: 10.1111/ped.15694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 09/05/2023] [Accepted: 09/28/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Yasuyuki Fuseda
- Division of Emergency Service and Transport Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
- Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan
| | - Takashi Tagaya
- Division of Emergency Service and Transport Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
- Department of General Pediatrics and Interdisciplinary Medicine, NCCHD, Tokyo, Japan
| | - Satoshi Tsuji
- Division of Emergency Service and Transport Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
- Department of General Pediatrics and Interdisciplinary Medicine, NCCHD, Tokyo, Japan
| | | | | | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, NCCHD, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan
| |
Collapse
|
12
|
Mori J, Furukawa T, Kodo K, Nakajima H, Yuasa M, Kubota M, Shigematsu Y. A patient with urinary succinylacetone-negative hereditary tyrosinemia type 1. Pediatr Int 2023; 65:e15644. [PMID: 37795850 DOI: 10.1111/ped.15644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Jun Mori
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Taizo Furukawa
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuki Kodo
- Department of Pediatrics, Kyoto Saiseikai Hospital, Kyoto, Japan
| | - Hisakazu Nakajima
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Miori Yuasa
- Department of Pediatrics, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yosuke Shigematsu
- Department of Pediatrics, Faculty of Medical Science, University of Fukui, Fukui, Japan
| |
Collapse
|
13
|
Iijima H, Kubota M, Ogimi C. Change in Seizure Incidence in Febrile Children With COVID-19 in the Era of Omicron Variant of Concern. J Pediatric Infect Dis Soc 2022; 11:514-517. [PMID: 35984115 DOI: 10.1093/jpids/piac085] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/28/2022] [Indexed: 01/05/2023]
Abstract
In this single-center retrospective observational study, we report that the incidence of seizures in febrile children with COVID-19 was significantly higher in the Omicron era than in the pre-Omicron era (14.6% vs 1.7%, P < .001). One-third of the cases in the Omicron era were older than 5 years.
Collapse
Affiliation(s)
- Hiroyuki Iijima
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Chikara Ogimi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
14
|
Hoshina Y, Iijima H, Kubota M, Murakami T, Nagai A. Case of atrial septal defect closure relieving refractory migraine. Clin Case Rep 2022; 10:e6484. [DOI: 10.1002/ccr3.6484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/12/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yuta Hoshina
- Department of General Pediatrics and Interdisciplinary Medicine National Center for Child Health and Development Tokyo Japan
| | - Hiroyuki Iijima
- Department of General Pediatrics and Interdisciplinary Medicine National Center for Child Health and Development Tokyo Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine National Center for Child Health and Development Tokyo Japan
| | - Tsutomu Murakami
- Department of Cardiology Tokai University School of Medicine Hiratsuka Japan
| | - Akira Nagai
- Department of General Pediatrics and Interdisciplinary Medicine National Center for Child Health and Development Tokyo Japan
| |
Collapse
|
15
|
Iijima H, Kubota M. A simple screening method for heterozygous female patients with ornithine transcarbamylase deficiency. Mol Genet Metab 2022; 137:301-307. [PMID: 36252454 DOI: 10.1016/j.ymgme.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/08/2022] [Accepted: 10/08/2022] [Indexed: 11/24/2022]
Abstract
Ornithine transcarbamylase deficiency (OTCD), caused by X-linked OTC mutations, is characterized by life-threatening hyperammonemia. Heterozygous female patients are often asymptomatic and usually have milder disease than affected male patients, but can have higher morbidity and mortality rates if the disease progresses prior to diagnosis. Our purpose was to establish a screening method for female heterozygotes with OTCD. We retrospectively identified female patients who underwent plasma amino acid analysis at the National Center for Child Health and Development, using data from electronic medical records from March 2002 to September 2021. We extracted patient age, medical history, and biochemical data, including plasma amino acid levels. Patients were categorized into several groups according to their underlying diseases; those with underlying diseases that could potentially affect plasma amino acid levels, such as mitochondrial disease or short bowel syndrome, were excluded, except for untreated OTCD. Biochemical values were compared between OTCD patients and others using the Mann-Whitney U test. The receiver operator characteristic analysis was performed to assess the diagnostic capability for detecting OTCD in each subject. For patients with multiple test data, the most recent of the measurement dates was used in the analysis. The data sets of 976 patients were included. There were significant differences in values of glutamine, citrulline, arginine, and ammonia, but the diagnostic capacity of each alone was inadequate. By contrast, the (glutamine + glycine)/(citrulline + arginine) ratio was appropriate for discriminating heterozygous female patients with OTCD, with a sensitivity of 100% and specificity of 98.6% when the cutoff level was 15.8; the AUC for this discrimination was 0.996 (95% confidence interval, 0.992 to 1.000). These findings could help identify heterozygous female patients with OTCD before the onset of clinical disease.
Collapse
Affiliation(s)
- Hiroyuki Iijima
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
16
|
Takamura A, Machino A, Sugiyama Y, Sako A, Kohashi K, Yabe C, Ichinose H, Kitanishi F, Kubota M, Miyazaki K. The present circumstances of pediatric practice by family physicians in Japan: Cross sectional research. J Gen Fam Med 2022; 24:16-23. [PMID: 36605911 PMCID: PMC9808155 DOI: 10.1002/jgf2.580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 01/04/2023] Open
Abstract
Background In Japan, pediatric primary care has often been provided not by general practitioners, but by specialists. Although official pediatric training of general practitioners started in Japan in 2018 no studies to date show the extent to which Japanese general practitioners are committed to pediatric care. Methods We conducted a questionnaire survey on pediatric training and current pediatric practice for family physicians certified by the Japan Primary Care Association. Results Of 1067 Japan Primary Care Association certified family physicians, 288 (27%) responded to the survey. More than 90% had received at least 3 months of pediatric training. Family physicians who completed 6 or more months of pediatric training provided significantly more pediatric care (p = 0.005). However, nearly 40% were currently not involved in pediatric care. Japan Primary Care Association certified family physicians are treating acute and chronic common diseases as well as diseases that may intersect with other departments. However, most respondents indicated there are not many opportunities to learn systematically about the care of these diseases. Conclusions In Japan, general practitioners are still not actively involved in pediatric care, but they treat patients with diseases that make it difficult to determine the most appropriate department to see and a wide range of age groups. It will become increasingly important to provide learning opportunities and better training environments in these areas with related organizations.
Collapse
Affiliation(s)
- Akiteru Takamura
- Department of Medical Education, Graduate School of MedicineUniversity of ToyamaToyamaJapan
| | - Ako Machino
- Department of Family MedicineMadoka Family ClinicOgooriJapan
| | - Yukari Sugiyama
- Department of Home Care MedicineKojunkai Social Medical Corporation, Daido ClinicNagoyaJapan
| | - Atsunori Sako
- Department of Family MedicineMiyoshi City Sakugi ClinicMiyoshiJapan
| | - Kosuke Kohashi
- Department of PediatricsMatsudo City General HospitalMatsudoJapan
| | - Chizuru Yabe
- Department of Family MedicineTsu Family ClinicTsuJapan
| | | | - Fuminao Kitanishi
- Department of Family MedicineKitanishi Clinic for Total Family CareFujiJapan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary MedicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Kei Miyazaki
- Department of General Practice, Nabari Community MedicineMie UniversityTsuJapan,Department of Education for Community‐Oriented Medicine, Graduate School of MedicineNagoya UniversityNagoyaJapan
| | | |
Collapse
|
17
|
Takase R, Sasaki R, Tsuji S, Uematsu S, Kubota M, Kobayashi T. Benzodiazepine Use for Pediatric Patients With Suspected Nonconvulsive Status Epilepticus With or Without Simplified Electroencephalogram: A Retrospective Cohort Study. Pediatr Emerg Care 2022; 38:e1545-e1551. [PMID: 35947072 DOI: 10.1097/pec.0000000000002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In the present study, we aimed to determine the changes in the administration rate of benzodiazepines for pediatric patients with suspected nonconvulsive status epilepticus (NCSE) before and after the introduction of simplified electroencephalography (sEEG) in the emergency department. METHODS This retrospective cohort study included patients who were younger than 18 years and were admitted to the emergency department from August 1, 2009, to July 31, 2017, with altered level of consciousness and nonpurposeful movement of eyes or extremities after the cessation of convulsive status epilepticus. Patients with apparent persistent convulsions, those who were fully conscious on arrival, and those who were transferred from another hospital were excluded. The patients were categorized into pre and post groups based on the introduction of sEEG, and benzodiazepine administration was compared between the 2 groups. RESULTS During the study period, 464 patients with status epilepticus visited our emergency department and 69 and 93 patients fulfilling the study criteria were categorized into the pre and post groups, respectively. There were no significant differences in patient background characteristics between the 2 groups. Simplified electroencephalography was recorded in 52 patients in the post group. Benzodiazepines were administered in 44 of 69 patients (63.8%) in the pre group and 44 of 93 (47.3%) in the post group, and the benzodiazepine administration rate was significantly decreased after the introduction of sEEG ( P = 0.04). The hospitalization rate was significantly lower in the post group, but there were no significant differences in the rates of intensive care unit admission, reconvulsion after discharge, and final diagnoses between the 2 groups. CONCLUSIONS Simplified electroencephalography might aid in determining the need for anticonvulsant treatment for suspected NCSE in pediatric patients. Albeit not a definitive diagnostic tool, sEEG might be a reliable choice in the evaluation of pediatric patients with suspected NCSE.
Collapse
Affiliation(s)
- Ryo Takase
- From the Department of Pediatric Emergency and Transport Services
| | - Ryuji Sasaki
- From the Department of Pediatric Emergency and Transport Services
| | - Satoshi Tsuji
- From the Department of Pediatric Emergency and Transport Services
| | - Satoko Uematsu
- From the Department of Pediatric Emergency and Transport Services
| | | | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
18
|
Fukayama H, Nakao H, Nishi K, Kubota M, Ishiguro A. Transient hypertension with urinary tract infection in congenital hydronephrosis. Germs 2022; 12:400-403. [PMID: 37680674 PMCID: PMC10482482 DOI: 10.18683/germs.2022.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 09/09/2023]
Abstract
Introduction Hypertension is occasionally associated with congenital hydronephrosis. Case report The authors report a four-month-old boy with severe left congenital hydronephrosis and transient hypertension triggered by his first urinary tract infection (UTI). Despite the satisfactory UTI clinical course, he suddenly developed severe hypertension (130/80 mmHg) on the ninth day of UTI. His aldosterone level was within the reference range and his plasma renin activity was slightly elevated. Although his hypertension was refractory to calcium channel blockers, an angiotensin-converting enzyme inhibitor was effective for hypertension. On day 24, he was able to discontinue the antihypertensive without organ damage. Conclusions Although the precise cause of hypertension was unclear in our case, we considered it to be temporary renin-associated hypertension due to decreasing renal blood flow due to UTI in a patient with severe congenital hydronephrosis. In pediatric UTI, particularly in patients with unilateral hydronephrosis, blood pressure monitoring is very important.
Collapse
Affiliation(s)
- Haruka Fukayama
- MD, National Center for Child Health and Development, Department of General Pediatrics & Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan, and National Center for Child Health and Development, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Hiro Nakao
- MD, National Center for Child Health and Development, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Kentaro Nishi
- MD, National Center for Child Health and Development, Division of Nephrology and Rheumatology, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Mitsuru Kubota
- MD, PhD, National Center for Child Health and Development, Department of General Pediatrics & Interdisciplinary Medicine, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Akira Ishiguro
- MD, PhD, National Center for Child Health and Development, Center for Postgraduate Education and Training, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| |
Collapse
|
19
|
Ishijima M, Nakamura T, Shimizu K, Hayashi K, Kikuchi H, Soen S, Omori G, Yamashita T, Uchio Y, Chiba J, Ideno Y, Kubota M, Kaneko H, Kurosawa H, Kaneko K. Different changes in the biomarker C-terminal telopeptides of type II collagen (CTX-II) following intra-articular injection of high molecular weight hyaluronic acid and oral non-steroidal anti-inflammatory drugs in patients with knee osteoarthritis: a multi-center randomized controlled study. Osteoarthritis Cartilage 2022; 30:852-861. [PMID: 35331859 DOI: 10.1016/j.joca.2022.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We previously reported, based on a multicenter randomized-control study, that the efficacy of intra-articular injections of hyaluronic acid (IA-HA) was not inferior to that of oral non-steroidal anti-inflammatory drugs (NSAIDs) in patients with knee osteoarthritis (OA). However, the molecular effects on the pathophysiology of knee OA remain unclear. C-terminal telopeptides of type II collagen (CTX-II) is reported to primarily originate from the interface between articular cartilage and subchondral bone, which is a site of potential remodeling in OA. We performed a predefined sub-analysis of the previous study to compare the changes of urinary CTX-II (uCTX-II) in response to IA-HA to those in response to NSAID for knee OA. DESIGN A total of 200 knee OA patients were registered from 20 hospitals and randomized to receive IA-HA (2,700 kDa HA, 5 times at 1-week intervals) or NSAID (loxoprofen sodium, 180 mg/day) for 5 weeks. The uCTX-II levels were measured before and after treatment. RESULTS The uCTX-II levels were significantly increased by IA-HA treatment (337.7 ± 193.8 to 370.7 ± 234.8 ng/μmol Cr) and were significantly reduced by NSAID treatment (423.2 ± 257.6 to 370.3 ± 250.9 ng/μmol Cr). The %changes of uCTX-II induced by IA-HA (11.6 ± 29.5%) and NSAID (-9.0 ± 26.7%) was significantly different (between-group difference: 20.6, 95% confidence intervals: 10.6 to 30.6). CONCLUSIONS While both IA-HA and NSAID improved symptoms of knee OA, uCTX-II levels were increased by IA-HA and reduced by NSAIDs treatment, suggesting these treatments may improve symptoms of knee OA through different modes of action.
Collapse
Affiliation(s)
- M Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - T Nakamura
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Fukuoka, Japan.
| | - K Shimizu
- Department of Orthopaedic Surgery, Gifu University, School of Medicine, Gifu, Japan.
| | - K Hayashi
- Department of Laboratory Sciences, School of Health Sciences, Faculty of Medicine, Gunma University, Gunma, Japan.
| | - H Kikuchi
- Department of Orthopaedic Surgery, Kinki University Sakai Hospital, Osaka, Japan.
| | - S Soen
- Department of Orthopaedic Surgery and Rheumatology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan; Department of Laboratory Sciences, School of Health Sciences, Faculty of Medicine, Gunma University, Gunma, Japan.
| | - G Omori
- Center of Transdisciplinary Research, Institute for Research Promotion, Niigata University, Niigata, Japan.
| | - T Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Hokkaido, Japan.
| | - Y Uchio
- Department of Orthopaedic Surgery, Faculty of Medicine, Shimane University School of Medicine, Shimane, Japan.
| | - J Chiba
- Department of Orthopaedic Surgery, Tokyo Women's Medical University, Medical Center East, Tokyo, Japan.
| | - Y Ideno
- Center of Mathematics and Data Sciences, Gunma University, Maebashi, Japan.
| | - M Kubota
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - H Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - H Kurosawa
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - K Kaneko
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | | |
Collapse
|
20
|
Fujisawa C, Kodama H, Sato Y, Mimaki M, Yagi M, Awano H, Matsuo M, Shintaku H, Yoshida S, Takayanagi M, Kubota M, Takahashi A, Akasaka Y. Early clinical signs and treatment of Menkes disease. Mol Genet Metab Rep 2022; 31:100849. [PMID: 35242581 PMCID: PMC8861833 DOI: 10.1016/j.ymgmr.2022.100849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Menkes disease (MD) is an X-linked recessive disorder caused by mutations in ATP7A. Patients with MD exhibit severe neurological and connective tissue disorders due to copper deficiency and typically die before 3 years of age. Early treatment with copper injections during the neonatal period, before the occurrence of neurological symptoms, can alleviate neurological disturbances to some degree. We investigated whether early symptoms can help in the early diagnosis of MD. Abnormal hair growth, prolonged jaundice, and feeding difficulties were observed during the neonatal period in 20 of 69, 16 of 67, and 3 of 18 patients, respectively. Only three patients visited a physician during the neonatal period; MD diagnosis was not made at that point. The mean age at diagnosis was 8.7 months. Seven patients, who were diagnosed in the prenatal stage or soon after birth, as they had a family history of MD, received early treatment. No diagnosis was made based on early symptoms, highlighting the difficulty in diagnosing MD based on symptoms observed during the neonatal period. Patients who received early treatment lived longer than their elderly relatives with MD. Three patients could walk and did not have seizures. Therefore, effective newborn screening for MD should be prioritized.
Collapse
Affiliation(s)
- Chie Fujisawa
- Department of Pediatrics, School of Medicine, Teikyo University, Itabashi-ku, Tokyo 173-8606, Japan
- Department of Research Unit, Faculty of Medicine, Toho University, Ota-ku, Tokyo 143-8540, Japan
- Corresponding authors at: Department of Research Unit, Faculty of Medicine, Toho University, Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan.
| | - Hiroko Kodama
- Department of Pediatrics, School of Medicine, Teikyo University, Itabashi-ku, Tokyo 173-8606, Japan
- Graduate School of Health Sciences, Teikyo Heisei University, Toshima-ku, Tokyo 170-8445, Japan
- Corresponding authors at: Department of Research Unit, Faculty of Medicine, Toho University, Omori-Nishi, Ota-ku, Tokyo 143-8540, Japan.
| | - Yasuhiro Sato
- Department of Pediatrics, School of Medicine, Teikyo University, Itabashi-ku, Tokyo 173-8606, Japan
| | - Masakazu Mimaki
- Department of Pediatrics, School of Medicine, Teikyo University, Itabashi-ku, Tokyo 173-8606, Japan
| | - Mariko Yagi
- Department of Childhood Development and Education, Faculty of Human Science, Konan Women's University, Higashinada-ku, Kobe-shi, Hyogo 658-0001, Japan
| | - Hiroyuki Awano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Chuo-ku, Kobe-shi, Hyogo 650-0017, Japan
| | - Muneaki Matsuo
- Department of Pediatrics, Faculty of Medicine, Saga University, Nabeshima, Saga-shi, Saga 840-8502, Japan
| | - Haruo Shintaku
- Department of Pediatrics, Graduate School of Medicine, Osaka City University, Abeno-ku, Osaka-City, Osaka 545-8585, Japan
| | - Sayaka Yoshida
- Department of Pediatrics, Nara Prefecture General Medical Center, Nara-shi, Nara 630-8581, Japan
| | - Masaki Takayanagi
- Department of Pediatrics, Chiba Children's Hospital, Chiba-shi, Chiba 266-0007, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo 157-8535, Japan
| | - Akihito Takahashi
- Department of Pediatrics, Kurashiki Central Hospital, Kurashiki, Okayama 710-8602, Japan
| | - Yoshikiyo Akasaka
- Unit of Regenerative Diseases Research, Division of Research Promotion and Development, Advanced Medical Research Center, Toho University Graduate School of Medicine, Ota-ku, Tokyo 143-8540, Japan
| |
Collapse
|
21
|
Myojin S, Pak K, Sako M, Kobayashi T, Takahashi T, Sunagawa T, Tsuboi N, Ishikura K, Kubota M, Kubota M, Igarashi T, Morioka I, Miyairi I. Interventions for Shiga toxin-producing Escherichia coli gastroenteritis and risk of hemolytic uremic syndrome: A population-based matched case control study. PLoS One 2022; 17:e0263349. [PMID: 35120154 PMCID: PMC8815883 DOI: 10.1371/journal.pone.0263349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background The role of antibiotics in the treatment of Shiga toxin-producing Escherichia coli (STEC) infection is controversial. Objectives To evaluate the association between treatment (antibiotics, antidiarrheal agents, and probiotics) for STEC infection and hemolytic uremic syndrome (HUS) development. Patients and methods We performed a population-based matched case-control study using the data from the National Epidemiological Surveillance of Infectious Diseases (NESID) between January 1, 2017 and December 31, 2018. We identified all patients with STEC infection and HUS as cases and matched patients with STEC infection without HUS as controls, with a case-control a ratio of 1:5. Further medical information was obtained by a standardized questionnaire. Multivariable conditional logistic regression model was used. Results 7760 patients with STEC infection were registered in the NESID. 182 patients with HUS and 910 matched controls without HUS were selected. 90 patients with HUS (68 children and 22 adults) and 371 patients without HUS (266 children and 105 adults) were included in the main analysis. The matched ORs of any antibiotics and fosfomycin for HUS in children were 0.56 (95% CI 0.32–0.98), 0.58 (0.34–1.01). The matched ORs for HUS were 2.07 (1.07–4.03), 0.86 (0.46−1.61) in all ages treated with antidiarrheal agent and probiotics. Conclusions Antibiotics, especially fosfomycin, may prevent the development of HUS in children, while use of antidiarrheal agents should be avoided.
Collapse
Affiliation(s)
- Shota Myojin
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Kyongsun Pak
- Biostatistics Unit, Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Mayumi Sako
- Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tohru Kobayashi
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takuri Takahashi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norihiko Tsuboi
- Division of Critical Care Medicine, Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Ishikura
- Department of Pediatrics, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masaya Kubota
- Division of Neurology, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
- * E-mail:
| |
Collapse
|
22
|
Iwai K, Tetsuhara K, Tsuji S, Kubota M. A Pitfall of Wheezing – A Large Mediastinal Mass Presenting as Persistent Wheezing: A Case Report. Cureus 2022; 14:e21340. [PMID: 35186598 PMCID: PMC8849505 DOI: 10.7759/cureus.21340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
Anchoring bias is the tendency to pursue only the most salient feature, which can lead to closed-minded thinking in the early stage of the diagnostic process. Wheezes are one of the most frequent chief complaints and highly likely to become an anchoring bias. We described a patient initially receiving a diagnosis of asthma after presenting with persistent wheezes; however, there was no improvement upon treatment for asthma and eventually, an anterior mediastinal mass was found. The patient’s respiratory condition suddenly deteriorated when he was placed in a prone position and eventually extracorporeal membrane oxygenation (ECMO) was introduced. We must recognize the danger of anchoring bias with any symptoms. A wheezing patient with an atypical clinical course should undergo further investigations, given the possibility of other etiologies such as a mediastinal tumor. In addition, we have to pay close attention to the patient’s position when a mediastinal tumor is suspected.
Collapse
|
23
|
Tanaka Y, Maekawa T, Eura R, Hasegawa Y, Kubota M. Neurogenic bladder as a lurking complication in Moebius syndrome. Brain Dev 2022; 44:73-76. [PMID: 34400011 DOI: 10.1016/j.braindev.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
Moebius syndrome (MBS) is a congenital disorder characterized by facial and abducens palsy, sometimes accompanied with other cranial nerve palsies and comorbid conditions. Anatomical anomalies of the brainstem are assumed to be major etiologies of MBS. Its phenotypic presentation can be variable. We report a female patient with MBS who presented with neurogenic bladder (NB). She was born via normal vaginal delivery. At birth, she showed bilateral abducens palsy and right facial palsy. We diagnosed MBS by cranial computed tomography scan and magnetic resonance imaging. She had recurrent urinary tract infection. Hydronephrosis was noted on ultrasonography and bilateral vesicoureteral reflux (grade 5) on voiding cystourethrography. Urodynamic investigation showed detrusor overactivity and detrusor-sphincter dyssynergia, which follow the pattern of NB resulting from infrapontine-suprasacral lesions. Patients with MBS have lower brainstem dysfunction, and accordingly we should be aware of NB.
Collapse
Affiliation(s)
- Yuichiro Tanaka
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Takanobu Maekawa
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Rumiko Eura
- Department of Urology, Kagoshima University, Kagoshima, Japan
| | - Yuichi Hasegawa
- Division of Pediatric Urology, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
24
|
Iijima H, Yanagi K, Kaname T, Kubota M. Feeding disorder in a patient with Wiedemann-Steiner syndrome. Pediatr Int 2022; 64:e15203. [PMID: 35770806 DOI: 10.1111/ped.15203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Hiroyuki Iijima
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kumiko Yanagi
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Tadashi Kaname
- Department of Genome Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
25
|
Nakao H, Nomura O, Kubota M, Ishiguro A. Long-term impact of overnight shiftwork implementation on pediatric residents' mental wellness: A repeated cross-sectional survey. J Occup Health 2022; 64:e12349. [PMID: 35906714 PMCID: PMC9338226 DOI: 10.1002/1348-9585.12349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/25/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives The Japanese government partially enacted the “Work Style Reform Bill” in 2019. The National Center for Child Health and Development (NCCHD) introduced an Overnight Call Shift (OCS) system for pediatrician training. We conducted a follow‐up survey in 2019 to investigate the long‐term effectiveness of the OCS system to improve the pediatric residents' mental wellness at NCCHD. Methods We conducted a questionnaire‐based cross‐sectional survey for pediatric residents in 2019 to compare the data with those of the previous survey in 2012. The questionnaire includes demographic data, working conditions data, and mental wellness assessment by the Center for Epidemiologic Studies Depression scale (CES‐D) and the Maslach Burnout Inventory (MBI). Results The collection rate for the 2019 survey was 94.5% (37 participants/39 eligible). Compared to 2012, there were no significant changes in demographic data and working hours, a significant increase by about 30% in residents who took daytime off after night work, about 10% decrease in residents who scored 16 and above on the CES‐D, and a significant decrease in the mean score for depersonalization (DP) in the MBI. Multiple regression analyses showed that daytime off after night work was the decreasing factor for CES‐D and Emotional exhaustion (EE). Conclusions The overnight shiftwork system shortened the pediatric residents' duty hours somewhat, and imposed an impact on the pediatric residents' mental wellness.
Collapse
Affiliation(s)
- Hiro Nakao
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya-ku, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Osamu Nomura
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan.,Department of Emergency and Disaster Medicine, Hirosaki University, Hirosaki, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan
| |
Collapse
|
26
|
Ansai H, Masuda H, Nakao H, Nishimura N, Kubota M. Plasma exchange and infliximab as a third-line therapy for refractory infantile Kawasaki disease. Pediatr Int 2022; 64:e15226. [PMID: 35831245 DOI: 10.1111/ped.15226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment for Kawasaki disease (KD) patients refractory to intravenous immunoglobulin (IVIG) therapy is still controversial, and the efficacy of plasma exchange (PE) and infliximab (IFX) therapy for infantile KD is unknown. METHODS A total of 22 infantile KD patients refractory to initial and additional IVIG, who received either PE or IFX as third-line therapy from October 2008 to February 2020 were examined retrospectively. The patients' sex, age, days of first IVIG, days of PE or IFX therapy, laboratory data preceding PE or IFX therapy, coronary artery lesions (CALs), and adverse effects were investigated. RESULTS Thirteen patients received PE and nine patients received IFX as the third-line therapy. For the median age at onset, the median days of first IVIG and PE or IFX, and pre-PE or IFX therapy blood test results, there were no significant between-group differences. At admission, and before and after the third-line therapy, there were also no significant differences in occurrence of CALs. The frequency of serious adverse events was significantly higher in the PE group than in the IFX group. CONCLUSIONS Although there were no significant differences in patient background, blood test results, or frequency of CALs, the frequency of adverse events was significantly higher in the PE group. With the trend of expansion of IFX therapy for KD patients refractory to IVIG, the role of PE as the additional therapy may become more limited.
Collapse
Affiliation(s)
- Hideto Ansai
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Masuda
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Hiro Nakao
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nao Nishimura
- Division of Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
27
|
Kobayashi M, Takeuchi I, Kubota M, Ishiguro A, Arai K. Severe hip arthritis as an initial presenting symptom of pediatric ulcerative colitis. Pediatr Int 2022; 64:e15067. [PMID: 35484916 DOI: 10.1111/ped.15067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Madoka Kobayashi
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Ichiro Takeuchi
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Katsuhiro Arai
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
28
|
Sakamoto K, Yamamoto-Hanada K, Kubota M, Ishiguro A, Ohya Y. Type B adverse drug reactions to antibiotics and antibiotic allergy in infants and children. Pediatr Int 2022; 64:e15126. [PMID: 35616171 DOI: 10.1111/ped.15126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/23/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Distinguishing allergic reactions from non-allergic type B adverse drug reactions (ADRs) to antibiotics is challenging, particularly in children, because we lack epidemiological information that can be used in primary care situations. This study aimed to investigate the characteristics of type B ADRs to antibiotics and antibiotic allergy (AA) in previously healthy children. METHODS This was a retrospective cohort study of previously healthy children admitted for treating urinary tract infections over a 10 year period. The primary outcome was the frequency of type B ADRs and AAs that were assessed by pediatricians. Secondary outcomes include demographic data about patients' backgrounds, infections, treatments, ADRs, and action against ADRs. All the data were collected via patients' medical records. RESULTS Out of 791 participants, type B ADRs were reported in 77 children (9.7%), and AA labeling was performed in six children (0.8%). Physicians assessed 30.4% of type B ADRs as severe or life-threatening symptoms. All patients were discharged without long-term complications. Physicians detected the primary cause (individual patient host factors or environmental risks) in 39 cases of type B ADRs. CONCLUSION Type B ADRs to antibiotics were frequently reported even in previously healthy children. Physicians should use appropriate techniques (e.g., specialist consulting and skin testing) when they suspect that a type B ADR might be an AA. Labeling and de-labeling programs and tools for type B ADRs related to antibiotics should be implemented to prevent the mislabeling of AA.
Collapse
Affiliation(s)
- Kei Sakamoto
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | | | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
29
|
Tabata K, Fukuie T, Narita M, Inagaki S, Ohnishi S, Tsuji S, Kubota M, Ishiguro A, Ohya Y. Food-Induced Anaphylaxis among Children Weighing <15 kg: A Single-Center Case Series of the Pediatric Emergency Department. Int Arch Allergy Immunol 2021; 183:507-516. [PMID: 34883479 DOI: 10.1159/000520646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/26/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Food-induced anaphylaxis among infants shows an increasing prevalence; however, the prescription of epinephrine auto-injectors (EAIs) for children weighing <15 kg is associated with issues of the needle length and the epinephrine dose. Several studies have shown age-related differences in food-induced anaphylaxis, although little is known about the weight-related differences in food-induced anaphylaxis. This study aimed to reveal the incidence, clinical characteristics, and management of food-induced anaphylaxis in children weighing <15 kg. METHODS This chart review included children who visited the pediatric emergency department (ED) of the National Center for Child Health and Development (Tokyo, Japan) from January 2014 to December 2016 and were diagnosed with food-induced anaphylaxis. The severity of anaphylaxis was evaluated using the Sampson Grading Scale. RESULTS Of 89,232 ED visits, 444 visits included patients with food-induced anaphylaxis, after excluding cases of food-induced anaphylaxis related to oral desensitization therapy. The incidence was 4.98 per 1,000 visits. More than half of the children (n = 247/444, 55.6%) weighed <15 kg. The proportion of grade 3 and higher severity anaphylactic symptoms was 74.5% (184/247) in children weighing <15 kg and 79.2% (156/197) in children weighing 15 kg or more. The recurrence rate of food-induced anaphylaxis was 22.3% (55/247) in children weighing <15 kg and 48.7% (96/197) in children weighing 15 kg or more. Among the children weighing <15 kg, the proportion of those with recurrent food-induced anaphylaxis was 4 times higher in children weighing 10-15 kg than in those weighing <10 kg (32.2% [47/146] vs. 7.9% [8/101]). The proportion of patients who were prescribed EAIs before each visit was 25.5% (14/55) in children weighing <15 kg with a history of food-induced anaphylaxis. CONCLUSION Food-induced anaphylaxis among children weighing <15 kg occurred as frequently and was as severe as that among children weighing 15 kg or more. However, the proportion of patients prescribed EAIs was very low in children weighing <15 kg with food-induced anaphylaxis. The potential need for EAIs is suggested among children weighing <15 kg, especially among children weighing 10 kg or more but <15 kg.
Collapse
Affiliation(s)
- Kenshiro Tabata
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Tatsuki Fukuie
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Masami Narita
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Shinichiro Inagaki
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Shima Ohnishi
- Division of Pediatric Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Tsuji
- Division of Pediatric Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
30
|
Utsumi S, Ohnishi S, Amagasa S, Sasaki R, Uematsu S, Kubota M. Role of Routine Repeat Head CT for Pediatric Patients under 2 Years Old with Mild-to-moderate Traumatic Brain Injury. Neurol Med Chir (Tokyo) 2021; 62:133-139. [PMID: 34880194 PMCID: PMC8918364 DOI: 10.2176/nmc.oa.2021-0221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Repeat head computed tomography (RHCT) is common and routine for pediatric traumatic brain injury (TBI) patients. In mild (Glasgow Coma Scale; GCS 13–15) to moderate (GCS 9–12) TBI, recent studies have shown that RHCT without clinical deterioration does not alter management. However, the effectiveness of routine RHCT for pediatric TBI patients under 2 years has not been investigated. This study aims to investigate whether routine RHCT changes management in mild-to-moderate TBI patients under 2 years. We performed a retrospective review at the emergency department of the National Center for Child Health and Development between January 2015 and December 2019. Mild-to-moderate TBI patients under 2 years with an acute intracranial injury on initial head CT scan and receiving follow-up CT scans were included. Mechanism, severity of TBI, indication for RHCT, and their findings were listed. Study outcome was intervention based on the findings of RHCT. Intervention was defined as intubation, ICP monitor placement, or neurosurgery. We identified 50 patients who met inclusion criteria and most patients (48/50) had mild TBI. The most common mechanism was ‘fall’ (68%). Almost all RHCT was routine and the overall incidence of radiographic progression on RHCT was 12%. RHCT without clinical deterioration did not lead to intervention, although one patient with moderate TBI required intervention due to radiographic progression with clinical symptoms. Our study showed that routine RHCT without clinical deterioration for mild TBI patients under 2 years may not alter clinical management. We suggest that RHCT be considered when there is clinical deterioration such as decrease in GCS.
Collapse
Affiliation(s)
- Shu Utsumi
- Division of Emergency and Transport Services, National Center for Child Health and Development
| | - Shima Ohnishi
- Division of Emergency and Transport Services, National Center for Child Health and Development
| | - Shunsuke Amagasa
- Division of Emergency and Transport Services, National Center for Child Health and Development
| | - Ryuji Sasaki
- Division of Emergency and Transport Services, National Center for Child Health and Development
| | - Satoko Uematsu
- Division of Emergency and Transport Services, National Center for Child Health and Development
| | - Mitsuru Kubota
- Department of General Medicine and Interdisciplinary Medicine, National Center for Child Health and Development
| |
Collapse
|
31
|
Tetsuhara K, Tsuji S, Sasaki R, Kubota M. The Caregiver's Report of an Appearance of Illness May Not Be Predictive of a Serious Condition in Children. Pediatr Emerg Care 2021; 37:e1763. [PMID: 32149990 DOI: 10.1097/pec.0000000000001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
32
|
Amagasa S, Uematsu S, Tsuji S, Nagai A, Abe Y, Kubota M. Identification of children with first afebrile seizure for whom neuroimaging is unnecessary. Seizure 2021; 93:140-144. [PMID: 34749253 DOI: 10.1016/j.seizure.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/01/2021] [Accepted: 10/27/2021] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To find ways to identify children with first afebrile seizure for whom neuroimaging is unnecessary. METHODS We retrospectively reviewed the clinical records of children younger than 19 years of age with the first afebrile seizure who visited the emergency department of the National Center for Child Health and Development in Japan between May 2014 and December 2020. We investigated the relationship between age, sex, focal seizure, seizure duration, seizure cluster, neurological findings, and CT and/or MRI abnormalities by univariate analysis. Furthermore, to identify children with low probability of intracranial abnormality, we performed decision tree analysis by classification and regression tree methods. RESULTS Among the eligible 611 children, 14 children had a CT abnormality (4.2% of patients who underwent CT) and 26 had a CT or MRI abnormality (7.1% of patients who underwent CT or MRI). Six children had an urgent neuroimaging abnormality. In the univariate analysis, seizure cluster (P = 0.02) was significantly associated with CT abnormality, and focal seizure (P = 0.01) and seizure prolonged for more than 5 min (P = 0.04) were significantly associated with CT or MRI abnormality. The decision tree analysis identified seizure cluster, prolonged seizure, neurological disorder, and focal seizure as risk factors for CT abnormalities in that order. CONCLUSION Children without seizure cluster, seizure prolonged for more than 5 min, and neurological disorder may not require CT in the emergency room. The clinician could determine the necessity of neuroimaging by seizure cluster, prolonged seizure, focal seizure, and neurological disorder.
Collapse
Affiliation(s)
- Shunsuke Amagasa
- Division of Emergency and Transport Services, National Center for Child Health and Development.
| | - Satoko Uematsu
- Division of Emergency and Transport Services, National Center for Child Health and Development.
| | - Satoshi Tsuji
- Division of Emergency and Transport Services, National Center for Child Health and Development.
| | - Akira Nagai
- Division of General Pediatrics, Department of Interdisciplinary Medicine, National Center for Child Health and Development.
| | - Yuich Abe
- Division of Neurology, National Center for Child Health and Development.
| | - Mitsuru Kubota
- Division of General Pediatrics, Department of Interdisciplinary Medicine, National Center for Child Health and Development.
| |
Collapse
|
33
|
Hoshina Y, Nakao H, Yoshida M, Kubota M, Ishiguro A. Calcaneal osteomyelitis caused by Pseudomonas aeruginosa without foot injury. Pediatr Int 2021; 63:601-602. [PMID: 33818855 DOI: 10.1111/ped.14457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/15/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Yuta Hoshina
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Hiro Nakao
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Michiko Yoshida
- Office for Infection Control, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
34
|
Morimoto N, Maekawa T, Kubota M, Kitamura M, Takahashi N, Kubota M. Challenge for management without tracheostomy tube after laryngo-tracheal separation in children with neurological disorders. Laryngoscope Investig Otolaryngol 2021; 6:332-339. [PMID: 33869766 PMCID: PMC8035946 DOI: 10.1002/lio2.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/26/2020] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The present study analyzed surgical outcomes of laryngotracheal separation (LTS) in children with neurological disorders. The purpose of this study was to investigate respiratory impairment and severe complications after LTS in children, and identify the possibility of permanent tracheostomy without a tracheostomy tube as the safest respiratory management method. METHODS Twenty-eight patients (male:female = 16:12) with neurological disorders (6 months to 32 years) who underwent LTS between January 2012 and April 2018 were reviewed. Tracheal diameter, Cobb angle, and sternocervical spine distance (SCD) were measured to assess the potential risk and possibility of removing tracheostomy tube management. RESULTS Tracheostomy tube could be removed shortly after LTS in 57% (16/28). However, nine of these patients developed respiratory problems that required tracheostomy tube placement 2 years after LTS. New requirements for a tracheostomy tube as a stent were strongly correlated with SCD (P < .05, odds ratio > 1) as well as tracheal deformity. CONCLUSIONS Respiratory management in neurologically impaired children after LTS without a tracheostomy tube is challenging because thoracic deformity during physical growth affects tracheal disfiguration. Thoracic deformities and progression of scoliosis should be considered in respiratory management approaches in children with neurological disorders, and long-term follow-up by computed tomography is necessary. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Noriko Morimoto
- Department of OtolaryngologyNational Center for Child Health and DevelopmentTokyoJapan
| | - Takanobu Maekawa
- Department of General Pediatrics and Interdisciplinary medicineNational Center for Child Health and DevelopmentTokyoJapan
| | - Masaya Kubota
- Department of NeurologyNational Center for Child Health and DevelopmentTokyoJapan
| | - Masayuki Kitamura
- Department of RadiologyNational Center for Child Health and DevelopmentTokyoJapan
| | - Nozomi Takahashi
- Department of OtolaryngologyNational Center for Child Health and DevelopmentTokyoJapan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary medicineNational Center for Child Health and DevelopmentTokyoJapan
| |
Collapse
|
35
|
Minato S, Iijima H, Nakao H, Nishi K, Hidaka Y, Inoue N, Kubota M, Ishiguro A. Anti-complement factor H (CFH) antibodies and a novel CFH gene mutation in an atypical hemolytic uremic syndrome patient with complement activation of the classical pathway. Immunol Med 2021; 44:274-277. [PMID: 33784485 DOI: 10.1080/25785826.2021.1905303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Atypical hemolytic uremic syndrome (aHUS) is a rare disease caused by overactivation of the complement alternative pathway. aHUS involves the presence of antibodies against complement factor H and its mutations in the complement genes. A 2-month-old boy presented with discoid rash, hemolytic anemia, thrombocytopenia, multiple antibodies, and hypocomplementemia with a very low level of C4 (< 3 mg/dL), indicating activation of the complement pathway, together fulfilling the systemic lupus erythematosus (SLE) criteria of the American College of Rheumatology at 5 months of age. However, most of these findings normalized spontaneously without any intervention. Further investigations revealed a high level of anti-complement factor H antibodies and a novel heterozygous missense mutation (p.Glu1172Ala, located in exon 22) in a complement gene, CFH. At 2 years of age, his SLE-like symptoms have not recurred, but hematuria and schistocytes were persistent. Eventually, aHUS was diagnosed rather than SLE. Our findings suggest that multiple antibody complex, including anti-complement factor H antibody, may temporarily activate the classical pathway, resulting in SLE-like findings.
Collapse
Affiliation(s)
- Sonoko Minato
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan.,Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan
| | - Hiroyuki Iijima
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Hiro Nakao
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, NCCHD, Tokyo, Japan
| | - Yoshihiko Hidaka
- Department of Molecular Genetics, Wakayama Medical University, Wakayama, Japan
| | - Norimitsu Inoue
- Department of Molecular Genetics, Wakayama Medical University, Wakayama, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development (NCCHD), Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, NCCHD, Tokyo, Japan.,Division of Hematology, NCCHD, Tokyo, Japan
| |
Collapse
|
36
|
Igawa S, Ono T, Kasajima M, Yamada K, Oguri A, Kameda A, Yamamoto H, Kakegawa M, Hiyoshi Y, Kusuhara S, Ozawa T, Otani S, Fukui T, Mitsufuji H, Masaru K, Yokoba M, Kubota M, Sasaki J, Naoki K. P76.55 Real-world Experience of the Utility in Afatinib Therapy for Patients with EGFR-Mutant Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
37
|
Minato S, Yoshida M, Shoji K, Yotani N, Takeshita K, Takeuchi N, Ishiwada N, Kubota M, Ishiguro A, Miyairi I. A Case Report of Bacterial Meningitis Caused by an Emerging Strain of Penicillin-Resistant Non-vaccine Serotype 10A. Jpn J Infect Dis 2021; 74:477-480. [PMID: 33518624 DOI: 10.7883/yoken.jjid.2020.841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The pneumococcal conjugate vaccines successfully decreased the incidence of invasive pneumococcal diseases and pneumococcal antibiotic resistance. However, it has also led to serotype replacement. According to the report from the National Institute of Infectious Diseases (NIID) in 2017, 96% of pneumococcal isolates obtained from IPD children aged <5 years were non-PCV13-serotype. Here, we report a Japanese immunocompetent and vaccinated child who developed refractory meningitis caused by Streptococcus pneumoniae, nonvaccine serotype 10A. PCR revealed genotypic penicillin-resistant Streptococcus pneumoniae (gPRSP) with triple mutations (pbp1a + 2b + 2x). Multilocus sequence typing identified the strain as sequence type (ST) 11189. ST11189 strain has not been reported in Japan, but has recently been reported as a cause of invasive infections in Korea. The clinical course was complicated by development of brain and subdural abscesses that necessitated prolonged antibiotic treatment and multiple burr hole drainages. Unfortunately, neurological sequelae remained. Continued molecular surveillance is needed to monitor emerging virulent clinical strains.
Collapse
Affiliation(s)
- Sonoko Minato
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Japan
| | - Michiko Yoshida
- Office of Infection Control, National Center for Child Health and Development, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, Japan
| | - Nobuyuki Yotani
- Department of Palliative Medicine, National Center for Child Health and Development, Japan
| | - Kenichi Takeshita
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Japan
| | - Noriko Takeuchi
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Japan
| | - Naruhiko Ishiwada
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Japan.,Division of Hematology, National Center for Child Health and Development, Japan
| | - Isao Miyairi
- Office of Infection Control, National Center for Child Health and Development, Japan.,Division of Infectious Diseases, National Center for Child Health and Development, Japan
| |
Collapse
|
38
|
Asada-Utsugi M, Uemura K, Kubota M, Noda Y, Tashiro Y, Uemura TM, Yamakado H, Urushitani M, Takahashi R, Hattori S, Miyakawa T, Ageta-Ishihara N, Kobayashi K, Kinoshita M, Kinoshita A. Mice with cleavage-resistant N-cadherin exhibit synapse anomaly in the hippocampus and outperformance in spatial learning tasks. Mol Brain 2021; 14:23. [PMID: 33494786 PMCID: PMC7831172 DOI: 10.1186/s13041-021-00738-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/16/2021] [Indexed: 11/30/2022] Open
Abstract
N-cadherin is a homophilic cell adhesion molecule that stabilizes excitatory synapses, by connecting pre- and post-synaptic termini. Upon NMDA receptor (NMDAR) activation by glutamate, membrane-proximal domains of N-cadherin are cleaved serially by a-disintegrin-and-metalloprotease 10 (ADAM10) and then presenilin 1(PS1, catalytic subunit of the γ-secretase complex). To assess the physiological significance of the initial N-cadherin cleavage, we engineer the mouse genome to create a knock-in allele with tandem missense mutations in the mouse N-cadherin/Cadherin-2 gene (Cdh2 R714G, I715D, or GD) that confers resistance on proteolysis by ADAM10 (GD mice). GD mice showed a better performance in the radial maze test, with significantly less revisiting errors after intervals of 30 and 300 s than WT, and a tendency for enhanced freezing in fear conditioning. Interestingly, GD mice reveal higher complexity in the tufts of thorny excrescence in the CA3 region of the hippocampus. Fine morphometry with serial section transmission electron microscopy (ssTEM) and three-dimensional (3D) reconstruction reveals significantly higher synaptic density, significantly smaller PSD area, and normal dendritic spine volume in GD mice. This knock-in mouse has provided in vivo evidence that ADAM10-mediated cleavage is a critical step in N-cadherin shedding and degradation and involved in the structure and function of glutamatergic synapses, which affect the memory function.
Collapse
Affiliation(s)
- M. Asada-Utsugi
- School of Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Neurology, Shiga University of Medical Science, Seta-Tsukinowa-Cho Otsu, Shiga, 520-2192 Japan
| | - K. Uemura
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M. Kubota
- School of Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y. Noda
- School of Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Y. Tashiro
- School of Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T. M. Uemura
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - H. Yamakado
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M. Urushitani
- Department of Neurology, Shiga University of Medical Science, Seta-Tsukinowa-Cho Otsu, Shiga, 520-2192 Japan
| | - R. Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - S. Hattori
- Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, 470-1192 Japan
| | - T. Miyakawa
- Division of Systems Medical Science, Institute for Comprehensive Medical Science, Fujita Health University, Toyoake, 470-1192 Japan
| | - N. Ageta-Ishihara
- Division of Biological Sciences, Department of Molecular Biology, Nagoya University Graduate School of Science, Nagoya, 464-8602 Japan
| | - K. Kobayashi
- Department of Pharmacology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8602 Japan
| | - M. Kinoshita
- Division of Biological Sciences, Department of Molecular Biology, Nagoya University Graduate School of Science, Nagoya, 464-8602 Japan
| | - A. Kinoshita
- School of Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
39
|
Iijima H, Ago Y, Fujiki R, Takayanagi T, Kubota M. Novel GYS2 mutations in a Japanese patient with glycogen storage disease type 0a. Mol Genet Metab Rep 2021; 26:100702. [PMID: 33489759 PMCID: PMC7808955 DOI: 10.1016/j.ymgmr.2020.100702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Glycogen storage disease type 0a (GSD 0a), caused by GYS2 mutations, has a broad phenotypic spectrum, mostly associated with hypoglycemia. This disease has been characterized by the inability to store glycogen in the liver, leading to no hepatomegaly. Although the prevention of hypoglycemia has been considered the first therapeutic goal, the long-term complications remain unclear. In addition, few studies summarized clinical or biochemical features or examined genotype-phenotype correlation. Case presentation A 4-year-old Japanese boy was admitted to our hospital because of hypoglycemia. We suspected GSD 0a based on recurrent irritability episodes before feeding, fasting ketotic hypoglycemia, postprandial hyperglycemia/hyperlactatemia, and no hepatomegaly. Mutation analyses revealed novel mutations (p.His610fs and deletion of exons 8-10) in the GYS2 gene. At 5 years old, his growth and development are normal. Fasting symptoms and hypoglycemia remain controlled by dietary management. Review of literature We summarized the clinical and biochemical features of 33 patients with GSD 0a and 27 different mutations in the GYS2 gene. Nonspecific fasting symptoms (lethargy, drowsiness, nausea, and irritability) were found in 39% of patients, whereas 41% were asymptomatic. All patients had a combination of fasting ketotic hypoglycemia and postprandial hyperglycemia/hyperlactatemia. Hepatomegaly and hepatic steatosis were observed in 12% and 73% of patients. There was no genotype-phenotype correlation in patients with GSD 0a. Conclusion This is a clinical report of a Japanese GSD 0a patient with novel GYS2 mutations and a review of cases. As secondary hepatic disorders may occur due to postprandial hyperglycemia, the treatment's ultimate goal is to prevent both hypoglycemia and hyperglycemia.
Collapse
Affiliation(s)
- Hiroyuki Iijima
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Yasuhiko Ago
- Department of Pediatrics, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Ryoji Fujiki
- Department of Applied Genomics, Kazusa DNA Research Institute, 2-6-7 Kazusa-Kamatari, Kisarazu City, Chiba 292-0818, Japan
| | - Takaaki Takayanagi
- Department of Pediatrics, Ebara Hospital, 4-5-10 Higashiyukigaya, Ohta-ku, Tokyo 145-0065, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
- Corresponding author.
| |
Collapse
|
40
|
Kumagai H, Kudo T, Uchida K, Kunisaki R, Sugita A, Ohtsuka Y, Arai K, Kubota M, Tajiri H, Suzuki Y, Shimizu T. Transitional care for inflammatory bowel disease: A survey of Japanese pediatric gastroenterologists. Pediatr Int 2021; 63:65-71. [PMID: 32621773 DOI: 10.1111/ped.14376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In 2019 we reported the results of a Japanese national survey designed to explore the views of adult gastroenterologists regarding transitional care for patients with childhood-onset inflammatory bowel disease (IBD). For the present study, we conducted a similar survey of pediatric gastroenterologists to compare the views of the two sets of specialists. METHODS The survey conducted in 2019 involved 48 representative members of the Japanese Society for Pediatric Gastroenterology, Hepatology and Nutrition. They were contacted by conventional mail and their answers were not anonymized. Respondents who had already referred patients with IBD to adult gastroenterologists were asked in a questionnaire to rank the importance of specific statements on a Likert scale. RESULTS The response rate was 79% and 29 (60%) of the respondents had experienced transitional care for patients with IBD. Transfer to adult care was considered by 90% of the respondents to be the ideal form of medical care for adolescents/young adults with IBD. However, 59% of the respondents had experienced some degree of difficulty when making referrals for such care. The majority of pediatric gastroenterologists considered that the ideal age for transfer was 18-22 years. Among the respondents, physicians at municipal hospitals considered that the presence of diseases other than IBD and a shortage of manpower were significantly more important issues than other practice settings. CONCLUSIONS The present survey revealed that the general views regarding transitional care for IBD between pediatric and adult gastroenterologists were similar, except for the appropriate time for transfer. The results underline the importance of preparing a transition program appropriate to practice settings.
Collapse
Affiliation(s)
- Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Takahiro Kudo
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama City, Kanagawa, Japan
| | - Akira Sugita
- Inflammatory Bowel Disease Center, Yokohama Municipal Hospital, Yokohama City, Kanagawa, Japan
| | - Yoshikazu Ohtsuka
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Mitsuru Kubota
- Division of General Practice, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Hitoshi Tajiri
- Department of Pediatrics, Osaka General Medical Center, Toshima, Osaka, Japan
| | - Yasuo Suzuki
- Inflammatory Bowel Disease Center, Sakura Medical Hospital, Toho University Medical Center, Sakura City, Chiba, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| |
Collapse
|
41
|
Honda A, Nakao H, Shoji K, Kubota M, Ishiguro A. Neonatal group B streptococcal ventriculitis without red flags for meningitis. Pediatr Int 2020; 62:996-998. [PMID: 32686327 DOI: 10.1111/ped.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/09/2020] [Accepted: 03/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Aiko Honda
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.,Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Hiro Nakao
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
42
|
Imamura T, Shoji K, Kono N, Kubota M, Nishimura N, Ishiguro A, Miyairi I. Allele frequencies of Bordetella pertussis virulence-associated genes identified from pediatric patients with severe respiratory infections. J Infect Chemother 2020; 26:765-768. [PMID: 32334951 DOI: 10.1016/j.jiac.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/29/2020] [Accepted: 02/21/2020] [Indexed: 11/30/2022]
Abstract
Bordetella pertussis (B. pertussis) infection occasionally causes severe respiratory infections in children. Potential association between virulence-associated gene alleles and severe clinical outcomes has been suggested; however, frequencies of these alleles in pediatric patients with severe pertussis have not been clarified. We retrospectively tested stored respiratory samples collected from B. pertussis-positive patients by polymerase chain reaction targeting for major virulence-associated genes; fimbrae (fim) serotype 3 (fim3), pertactin (prn), pertussis toxin A (ptxA), and pertussis toxin promotor (ptxP). Based on the identified sequences, multilocus sequence typing (MLST) was conducted. Association of gene allele frequency and clinical outcomes such as management in pediatric intensive care unit, intubation, and mortality was analyzed. Out of 25 patients with available samples, the most prevalent allele for each virulence-associated gene was fim3A (17/21, 83%), ptxA1 (20/23, 87%), prn2 (13/16, 81%), and ptxP3 (14/17, 82%). In the study, total of 3 MLST types were identified; MLST-1 from 3 patients (19%), MLST-2 from 10 patients (63%), and MLST-4 from 3 patients (19%). Detection rate of the major MLST type; MLST-2 was significantly higher for patients who required intubation compared to those who did not (6/6, 100% vs 4/10, 40%; p = 0.034). In conclusion, MLST-2 was the most common MLST type in B. pertussis isolated from Japanese children with severe pertussis. Further studies investigating its causal association with disease severity is warranted.
Collapse
Affiliation(s)
- Tadatsugu Imamura
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan; Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Naoko Kono
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nao Nishimura
- Division of Critical Care Medicine, Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan.
| |
Collapse
|
43
|
Kobayashi T, Fukami H, Ishikawa E, Shibata K, Kubota M, Kondo H, Sahara Y. An fMRI Study of the Brain Network Involved in Teeth Tapping in Elderly Adults. Front Aging Neurosci 2020; 12:32. [PMID: 32256334 PMCID: PMC7090023 DOI: 10.3389/fnagi.2020.00032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/03/2020] [Indexed: 11/18/2022] Open
Abstract
Cortical activity during jaw movement has been analyzed using various non-invasive brain imaging methods, but the contribution of orofacial sensory input to voluntary jaw movements remains unclear. In this study, we used functional magnetic resonance imaging (fMRI) to observe brain activities during a simple teeth tapping task in adult dentulous (AD), older dentulous (OD), and older edentulous subjects who wore dentures (OEd) or did not wear dentures (OE) to analyze their functional network connections. (1) To assess the effect of age on natural activation patterns during teeth tapping, a comparison of groups with natural dentition—AD and OD—was undertaken. A general linear model analysis indicated that the major activated site in the AD group was the primary sensory cortex (SI) and motor cortex (MI) (p < 0.05, family wise error corrected). In the OD group, teeth tapping induced brain activity at various foci (p < 0.05, family wise error corrected), including the SI, MI, insula cortex, supplementary motor cortex (SMC)/premotor cortex (PMA), cerebellum, thalamus, and basal ganglia in each group. (2) Group comparisons between the OD and OEd subjects showed decreased activity in the SI, MI, Brodmann’s area 6 (BA6), thalamus (ventral posteromedial nucleus, VPM), basal ganglia, and insular cortex (p ¡ 0.005, uncorrected). This suggested that the decreased S1/M1 activity in the OEd group was related to missing teeth, which led to reduced periodontal afferents. (3) A conjunction analysis in the OD and OEd/OE groups revealed that commonly activated areas were the MI, SI, cerebellum, BA6, thalamus (VPM), and basal ganglia (putamen; p < 0.05, FWE corrected). These areas have been associated with voluntary movements. (4) Psychophysiological interaction analysis (OEd vs OE) showed that subcortical and cortical structures, such as the MI, SI, DLPFC, SMC/PMA, insula cortex, basal ganglia, and cerebellum, likely function as hubs and form an integrated network that participates in the control of teeth tapping. These results suggest that oral sensory inputs are involved in the control of teeth tapping through feedforward control of intended movements, as well as feedback control of ongoing movements.
Collapse
Affiliation(s)
- T Kobayashi
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Japan
| | - H Fukami
- Department of Physiology, School of Dentistry, Iwate Medical University, Shiwa-gun, Japan.,Department of Oral Health Sciences, Faculty of Nursing and Health Care, Baika Women's University, Osaka, Japan
| | - E Ishikawa
- Department of Physiology, School of Dentistry, Iwate Medical University, Shiwa-gun, Japan
| | - K Shibata
- Department of Physiology, School of Dentistry, Iwate Medical University, Shiwa-gun, Japan
| | - M Kubota
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Japan
| | - H Kondo
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Japan
| | - Y Sahara
- Department of Physiology, School of Dentistry, Iwate Medical University, Shiwa-gun, Japan
| |
Collapse
|
44
|
Iijima H, Ishige N, Kubota M. Clinical Application of Liquid Chromatography Tandem Mass Spectrometry Using Dried Blood Spot as a More Rapid Method for Determination of Methylmalonic Acid, Propionylcarnitine, and Total Homocysteine. J inborn errors metab screen 2020. [DOI: 10.1590/2326-4594-jiems-2019-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
45
|
Igawa S, Ono T, Ozawa T, Sone H, Kusuhara S, Harada S, Ishihara M, Kasajima M, Hiyoshi Y, Fukui T, Kubota M, Sasaki J, Mitsufuji H, Naoki K. EP1.01-68 Impact of EGFR Genotype on the Efficacy of Osimertinib in Patients with Non-Small Cell Lung Cancer: A Prospective Observational Study. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
46
|
Hayakawa T, Soda I, Sekiguchi A, Kawakami S, Kubota M, Mitsufuji H, Igawa S, Fukui T, Naoki K, Hayakawa K, Ishiyama H. EP1.12-36 Treatment Outcomes and Risk Factors of Limited-Stage Small Cell Lung Cancer Patients Treated with Chemoradiotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Kumagai H, Kudo T, Uchida K, Kunisaki R, Sugita A, Ohtsuka Y, Arai K, Kubota M, Tajiri H, Suzuki Y, Shimizu T. Adult gastroenterologists' views on transitional care: Results from a survey. Pediatr Int 2019; 61:817-822. [PMID: 31206932 DOI: 10.1111/ped.13912] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/16/2019] [Accepted: 05/15/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND In 2018, Japanese guidelines for autonomy support of patients with inflammatory bowel disease (IBD) in the transitional period were published. These guidelines, however, were prepared mainly by pediatric gastroenterologists. In order to improve such supportive guidelines, it is necessary for pediatric gastroenterologists to be aware of the attitudes and expectations of adult gastroenterologists. Accordingly, the first Japanese national survey designed to explore the views of adult gastroenterologists regarding successful transitional care was conducted. METHODS The survey involved institutions at which adult gastroenterologists in the Ministry of Health, Labor and Welfare of Japan's Inflammatory Bowel Diseases Study Group, were working. Physicians were contacted by conventional mail, and their answers were not anonymized. A total of 100 eligible adult institutions were identified. Further specific subgroup analysis was conducted. RESULTS A response rate of 34% was achieved. Seventy-six percent of the respondents had experienced some degree of difficulty when accepting patients with childhood-onset IBD referred from pediatric gastroenterologists. With regard to the ideal form of medical care for adolescent patients with IBD, transfer to adult care was supported by 94% of the respondents. Only 27% of respondents, however, stated they would have no hesitation in accepting patients referred from pediatric care centers. Two crucial areas requiring improvement were identified: inadequate clinical summaries and lack of patient independence from their parents/caregivers. CONCLUSIONS The present survey results reinforce the importance of a transitional program of education for childhood-onset IBD patients and the need to improve communication between adult and pediatric gastroenterologists.
Collapse
Affiliation(s)
- Hideki Kumagai
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Takahiro Kudo
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu City, Mie, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama City, Kanagawa, Japan
| | - Akira Sugita
- Inflammatory Bowel Disease Center, Yokohama Municipal Hospital, Yokohama City, Kanagawa, Japan
| | - Yoshikazu Ohtsuka
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Mitsuru Kubota
- Division of General Practice, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Hitoshi Tajiri
- Department of Pediatrics, Osaka General Medical Center, Toshima, Osaka, Japan
| | - Yasuo Suzuki
- Inflammatory Bowel Disease Center, Sakura Medical Hospital, Toho University Medical Center, Sakura City, Chiba, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Bunkyo, Tokyo, Japan
| |
Collapse
|
48
|
Tao C, Kinoshita N, Shoji K, Motooka D, Nakamura S, Eura R, Ueoka K, Kubota M, Ishiguro A, Miyairi I. Urinary tract infection due to anaerobic bacteria in a two-month-old infant. J Infect Chemother 2019; 25:368-370. [PMID: 30686700 DOI: 10.1016/j.jiac.2018.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/22/2018] [Indexed: 11/26/2022]
Abstract
The significance of anaerobic bacteria as a pathogen in urinary tract infection (UTI) in children is unclear. A two-month-old infant presenting with poor feeding received a diagnosis of polymicrobial anaerobic UTI by next-generation sequencing and was found to have obstructive uropathy. Anaerobic bacteria may be a cause of UTI in children with urinary tract obstruction.
Collapse
Affiliation(s)
- Chiaki Tao
- Center for Postgraduate Education and Training, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Noriko Kinoshita
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Daisuke Motooka
- Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shota Nakamura
- Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Rumiko Eura
- Division of Urology, Department of Surgical Subspecialties, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Katsuhiko Ueoka
- Division of Urology, Department of Surgical Subspecialties, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Mitsuru Kubota
- Division of General Pediatrics, Department of Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Akira Ishiguro
- Center for Postgraduate Education and Training, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, Japan; Department of Microbiology, Immunology, and Biochemistry, University of Tennessee Health Science Center, Memphis, TN, USA.
| |
Collapse
|
49
|
de Nijs J, Schnack HG, Koevoets MGJC, Kubota M, Kahn RS, van Haren NEM, Cahn W. Reward-related brain structures are smaller in patients with schizophrenia and comorbid metabolic syndrome. Acta Psychiatr Scand 2018; 138:581-590. [PMID: 30264457 DOI: 10.1111/acps.12955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Metabolic syndrome (MS) is highly prevalent in schizophrenia and often a consequence of unhealthy behaviour. Reward-related brain areas might be associated with MS, since they play a major role in regulating health behaviour. This study examined the relationship between MS and brain volumes related to the reward system in schizophrenia. METHOD We included patients with schizophrenia, with MS (MS+; n = 23), patients with schizophrenia, without MS (MS-; n = 48), and healthy controls (n = 54). Global brain volumes and volumes of (sub)cortical areas, part of the reward circuit, were compared between patients and controls. In case of a significant brain volume difference between patients and controls, the impact of MS in schizophrenia was examined. RESULTS Patients had smaller total brain (TB; P = 0.001), GM (P = 0.010), larger ventricles (P = 0.026), and smaller reward circuit volume (P < 0.001) than controls. MS+ had smaller TB (P = 0.017), GM (P = 0.008), larger ventricles (P = 0.015), and smaller reward circuit volume (P = 0.002) than MS-. MS+ had smaller orbitofrontal cortex (OFC; P = 0.002) and insula volumes (P = 0.005) and smaller OFC (P = 0.008) and insula cortical surface area (P = 0.025) compared to MS-. CONCLUSION In schizophrenia, structural brain volume reductions in areas of the reward circuitry appear to be related to comorbid MS.
Collapse
Affiliation(s)
- J de Nijs
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - H G Schnack
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M G J C Koevoets
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M Kubota
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Functional Brain Imaging Research, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - R S Kahn
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
| | - N E M van Haren
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - W Cahn
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
50
|
Abstract
Anchoring bias is one of the most common diagnostic biases that may lead to closed-minded thinking and could result in unnecessary tests, inappropriate patient management and even misdiagnosis. A 4-year-old boy was brought to the emergency department because of shaking chills. On the basis of bilateral swollen preauricular areas, high level of serum amylase and the prevalence of mumps, he initially received a diagnosis of mumps in spite of the shaking chills. However, blood culture turned out to be positive for two different kinds of bacteria. The patient finally received a diagnosis of polymicrobial bacteraemia resulting from suppurative appendicitis. We must consider and rule out bacteraemia in the differential diagnosis for patients who present with shaking chills, even in the presence of symptoms or information consistent with a more common viral infection such as mumps. In addition, intra-abdominal infection should be ruled out in the presence of polymicrobial enterobacteriaceae bacteraemia.
Collapse
Affiliation(s)
- Kenji Iwai
- Division of Emergency Service and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kenichi Tetsuhara
- Division of Emergency Service and Transport Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Eiki Ogawa
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|