1
|
Sato Y, Kamei A, Endo F, Matsuyama S, Toda H, Kasai T. Vitamin D Supplementation at a Dose of 10 µg/Day in Institutionalized Children with Severe Motor and Intellectual Disabilities. Nutrients 2023; 16:122. [PMID: 38201951 PMCID: PMC10780696 DOI: 10.3390/nu16010122] [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: 11/02/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Vitamin D (VD) deficiency can lead to health-related consequences. This study determined the effects of VD administration in VD-deficient children with severe motor and intellectual disabilities (SMID). Twenty-eight subjects were included. Among them, 25 subjects with parental consent for VD administration were given 10 µg/day (400 IU/day) of VD in April 2021. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured at least 30 days after the start of VD administration. The total VD intake, serum 25(OH)D levels, and ultraviolet (UV) exposure before the blood tests were investigated. The results showed that the median serum 25(OH)D levels were 8.7 ng/mL (4.3-17.2) and 24.0 ng/mL (7.8-39 ng/mL) from March to May in 2020 and 2021, respectively. Among the 25 subjects, 22 with UV exposure had >20 ng/mL serum 25(OH)D level, and 2 without UV exposure had <20 ng/mL serum 25(OH)D level. Three subjects who did not receive VD supplementation had <20 ng/mL serum 25(OH)D level. Taken together, VD supplementation (10 µg/day) is effective in children with SMID in institutional care. Moreover, it may be sufficient for children with UV exposure, but not for those without.
Collapse
Affiliation(s)
- Yota Sato
- Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
- Department of Pediatrics, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
| | - Atsushi Kamei
- Department of Developmental Disability Medicine, School of Medicine, Iwate Medical University, Morioka 028-3694, Japan
| | - Fumie Endo
- Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
| | - Sakura Matsuyama
- Nutrition Support Team, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
| | - Hiroyuki Toda
- Department of Pediatrics, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
| | - Takeo Kasai
- Department of Pediatrics, Iwate Prefectural Rehabilitation and Nursery Center for Disabled Children, Iwate 028-3603, Japan
| |
Collapse
|
2
|
Kageyama S, Inoue R, Park J, Hosomi K, Yumioka H, Suka T, Teramoto K, Syauki AY, Doi M, Sakaue H, Miyake M, Mizuguchi K, Kunisawa J, Irie Y. Changes in the fecal gut microbiome of home healthcare patients with disabilities through consumption of malted rice amazake. Physiol Genomics 2023; 55:647-653. [PMID: 37694281 DOI: 10.1152/physiolgenomics.00062.2023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/17/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023] Open
Abstract
The aim of the present study was to investigate changes in the gut microbiome both during and after consumption of malted rice amazake (MR-Amazake), a fermented food from Japan, in-home healthcare patients with disabilities, including patients with severe motor and intellectual disabilities. We monitored 12 patients who consumed MR-Amazake for 6 wk and investigated them before and after the intervention as well as 6 wk after the end of intake to compare their physical condition, diet, type of their medication, constipation assessment scale, and analysis of their comprehensive fecal microbiome using 16S rRNA sequencing. Their constipation symptoms were significantly alleviated, and principal coordinate analysis revealed that 30% of patients showed significant changes in the gut microbiome after MR-Amazake ingestion. Furthermore, Bifidobacterium was strongly associated with these changes. These changes were observed only during MR-Amazake intake; the original gut microbiome was restored when MR-Amazake intake was discontinued. These results suggest that 6 wk is a reasonable period of time for MR-Amazake to change the human gut microbiome and that continuous consumption of MR-Amazake is required to sustain such changes.NEW & NOTEWORTHY The consumption of malted rice amazake (MR-Amazake) showed significant changes in the gut microbiome according to principal coordinate analysis in some home healthcare patients with disabilities, including those with severe motor and intellectual disabilities. After discontinuation of intake, the gut microbiome returned to its original state. This is the first pilot study to examine both the changes in the gut microbiome and their sustainability after MR-Amazake intake.
Collapse
Affiliation(s)
- Suzumi Kageyama
- Graduate School of Health and Welfare Science, Okayama Prefectural University, Okayama, Japan
| | - Rikako Inoue
- Department of Nutritional Science, Faculty of Health and Welfare Science, Okayama Prefectural University, Okayama, Japan
- Microbial Research Center for Health and Medicine, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Jonguk Park
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Koji Hosomi
- Microbial Research Center for Health and Medicine, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Hitomi Yumioka
- Microbial Research Center for Health and Medicine, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Faculty of Nutrition, Osaka Seikei College, Osaka, Japan
| | - Tomo Suka
- Kishu Rehabilitation Visiting Care Station, Wakayama, Japan
| | | | - A Yasmin Syauki
- Graduate School of Health and Welfare Science, Okayama Prefectural University, Okayama, Japan
- Department of Nutrition, Faculty of Medicine, Hasanuddin University, Kota Makassar, Indonesia
| | - Miki Doi
- Graduate School of Health and Welfare Science, Okayama Prefectural University, Okayama, Japan
| | - Haruka Sakaue
- Graduate School of Health and Welfare Science, Okayama Prefectural University, Okayama, Japan
| | - Miyuu Miyake
- Graduate School of Health and Welfare Science, Okayama Prefectural University, Okayama, Japan
| | - Kenji Mizuguchi
- Artificial Intelligence Center for Health and Biomedical Research, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
- Institute for Protein Research, Osaka University, Osaka, Japan
| | - Jun Kunisawa
- Microbial Research Center for Health and Medicine, National Institutes of Biomedical Innovation, Health and Nutrition, Osaka, Japan
| | - Yasuyuki Irie
- Department of Nutritional Science, Faculty of Health and Welfare Science, Okayama Prefectural University, Okayama, Japan
| |
Collapse
|
3
|
Ohmori H, Kato A, Shirai Y, Fukano R, Nagae A, Yamasaki M, Komenaka J, Imamura E, Kumode M, Miyachi T. The Effect of Vitamin K2 Supplementation on PIVKA-II Levels in Patients with Severe Motor and Intellectual Disabilities Undergoing Long-Term Tube Feeding. Nutrients 2023; 15:4525. [PMID: 37960177 PMCID: PMC10647752 DOI: 10.3390/nu15214525] [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: 08/25/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Nutritional support is essential for patients with severe motor and intellectual disabilities (SMID) to ensure the smooth provision of medical care. These patients often require long-term tube feeding with enteral formulas, potentially leading to deficiencies in vitamins and trace elements. Additionally, frequent antibiotic use for infections often disrupts gut microbiota, inhibiting vitamin K2 production by intestinal bacteria. We assessed the serum protein induced by vitamin K absence or antagonists-II (PIVKA-II) and undercarboxylated osteocalcin (ucOC) levels to assess the vitamin K status in 20 patients with SMID (median age: 44.1 years, 11 men and 9 women) undergoing long-term tube feeding for durations ranging from 3 to 31 years. Thirteen (65%) and nine (45%) patients had elevated PIVKA-II (<40 mAU/mL) and serum ucOC levels (reference value < 4.50 ng/mL), respectively. Dietary vitamin K1 intake did not differ between patients with and without elevated PIVKA-II levels. Vitamin K2 supplementation for 3 months decreased serum PIVKA-II levels near those within the reference range. Approximately half of the patients with SMID on tube feeding had subclinical vitamin K deficiency. Further studies are needed to ascertain if long-term vitamin K2 supplementation effectively prevents vitamin K deficiency-induced hypercoagulation, osteoporosis, and vascular calcification in patients with SMID.
Collapse
Affiliation(s)
- Hiromitsu Ohmori
- Department of Pediatrics, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan;
| | - Yuka Shirai
- Clinical Nutrition Unit, Hamamatsu University Hospital, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan;
| | - Reiji Fukano
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube 755-8505, Japan;
| | - Akiko Nagae
- Department of Pediatrics, Biwako Gakuen Kusatsu Medical and Welfare Center for Children and Persons with Severe Motor and Intellectual Disabilities, 8-3-113 Kasayama, Kusatsu 525-0072, Japan; (A.N.); (M.K.)
| | - Masami Yamasaki
- Department of Neurology, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan; (M.Y.); (E.I.); (T.M.)
| | - Junko Komenaka
- Department of Clinical Nutrition, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan;
| | - Eiji Imamura
- Department of Neurology, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan; (M.Y.); (E.I.); (T.M.)
| | - Masao Kumode
- Department of Pediatrics, Biwako Gakuen Kusatsu Medical and Welfare Center for Children and Persons with Severe Motor and Intellectual Disabilities, 8-3-113 Kasayama, Kusatsu 525-0072, Japan; (A.N.); (M.K.)
| | - Takafumi Miyachi
- Department of Neurology, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai 742-1352, Japan; (M.Y.); (E.I.); (T.M.)
| |
Collapse
|
4
|
Uemura O, Hasegawa Y, Nakashima H, Otobe Y. Evaluation of eGFRs to Calculate Kidney Function in Adults with Severe Motor and Intellectual Disabilities. JMA J 2023; 6:481-486. [PMID: 37941705 PMCID: PMC10628310 DOI: 10.31662/jmaj.2023-0069] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/08/2023] [Indexed: 11/10/2023] Open
Abstract
Introduction The gold standard for evaluating kidney function is kidney inulin clearance (Cin). However, this procedure is difficult to perform in patients with neuromuscular disabilities and/or bladder dysfunction. We aimed to develop a simpler method for determining the estimated glomerular filtration rate (eGFR) using equations and values for three biomarkers: serum creatinine (sCr), serum cystatin C (cysC), and serum beta-2 microglobulin (β2MG). This study evaluated three eGFR equations in patients with severe motor and intellectual disabilities (SMID). Methods We evaluated the equations using data of 18 adult SMID patients with a clinical need for creatinine clearance (Ccr). We compared the results of each equation with Ccr-based eGFR instead of Cin using mean error (ME), root mean square error (RMSE), and P30. Results Based on eGFR, the ME values of Cr, cysC, β2MG, and Ccr were 74.5, 2.3, and 6.5 mL/min/1.73 m2, RMSE values, 92.3, 25.7, and 33.4 mL/min/1.73 m2; and P30, 16.7%, 77.8%, and 72.2%, respectively. Conclusions eGFR-Cr cannot be used to reliably assess kidney function in adult SMID patients. It is better to use eGFR-cysC to evaluate kidney function in this patient population.
Collapse
Affiliation(s)
- Osamu Uemura
- Department of Pediatrics, Ichinomiya Medical Treatment & Habilitation Center, Ichinomiya, Japan
| | - Yuka Hasegawa
- Department of Pharmacy, Ichinomiya Medical Treatment & Habilitation Center, Ichinomiya, Japan
| | - Hideaki Nakashima
- Department of Pharmacy, Ichinomiya Medical Treatment & Habilitation Center, Ichinomiya, Japan
| | - Yoshihiro Otobe
- Department of Rehabilitation, Ichinomiya Medical Treatment & Habilitation Center, Ichinomiya, Japan
| |
Collapse
|
5
|
Kasai R, Funato M, Maruta K, Yasuda K, Minatsu H, Ito J, Takahashi K. Immunogenicity of SARS-CoV-2 mRNA intramuscular vaccination in patients with muscular disorders. Front Immunol 2023; 14:1103196. [PMID: 36825020 PMCID: PMC9941142 DOI: 10.3389/fimmu.2023.1103196] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/23/2023] [Indexed: 02/10/2023] Open
Abstract
Backgrounds Little clinical data is available on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with muscular disorders (MDs). The immunogenicity of SARS-CoV-2 vaccines against MDs, in particular, remains unknown. Thus, this study aimed to confirm the immunogenicity and safety of the SARS-CoV-2 vaccine against MDs. Methods All participants were vaccinated with two doses of mRNA vaccines (BNT162b2, Pfizer-BioNTech). The serum samples were collected from each patient on the day of second dose of vaccination, and then, consecutively, after one month, three months, and six months. Anti-SARS-CoV-2 IgG levels were determined using the Abbott SARS-CoV-2 IgG II Quant assay. Results We evaluated 75 individuals, including 42 patients with MDs and 33 patients with non-muscular disorders (non-MDs). Non-MD patients primarily include those with severe motor and intellectual disabilities. The median age of the patients was 32 years (range 12-64 years). After one and three months following the second immunization, patients with MDs had lower antibody responses. Furthermore, three months following the second immunization, the proportion of high responders among patients with MDs decreased significantly compared to that among patients without MDs (p-value of less than 0.01). No serious adverse events were observed in patients with or without MDs. Conclusion Intensity and latency of antibody response were suppressed in patients with MDs. Although MDs may be a key contributor in predicting the antibody response to SARS-CoV-2 vaccination, SARS-CoV-2 immunization in MDs needs extensive research.
Collapse
Affiliation(s)
- Ryousuke Kasai
- Department of Pediatrics, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Michinori Funato
- Department of Pediatric Neurology, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Kanako Maruta
- Department of Pediatrics, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Kunihiko Yasuda
- Department of Pediatric Surgery, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Hiroshi Minatsu
- Department of Pediatric Surgery, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Junji Ito
- Department of Clinical Examination, National Hospital Organization Nagara Medical Center, Gifu, Japan
| | - Kazuhiro Takahashi
- Department of Pediatrics, National Hospital Organization Nagara Medical Center, Gifu, Japan
| |
Collapse
|
6
|
Tsuji M, Nishi M, Tabei T, Ishikawa W, Iai M. Endoscopic lithotripsy for upper urinary tract stones in disabled adolescents. Pediatr Int 2022; 64:e14731. [PMID: 34708892 DOI: 10.1111/ped.14731] [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: 01/25/2021] [Revised: 03/10/2021] [Accepted: 04/07/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Megumi Tsuji
- Institution for Children with Profound Multiple Disabilities, Kanagawa Children's Medical Center, Yokohama, Japan.,Department of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Morihiro Nishi
- Department of Urology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tadashi Tabei
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | | | - Mizue Iai
- Institution for Children with Profound Multiple Disabilities, Kanagawa Children's Medical Center, Yokohama, Japan.,Department of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan
| |
Collapse
|
7
|
Zuo S, Sawai T, Kanehiro H, Kuroda Y, Sho M. Gallstones in patients with severe motor and intellectual disability. Pediatr Int 2022; 64:e15220. [PMID: 35727861 DOI: 10.1111/ped.15220] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Asymptomatic gallbladder stones may be detected with ultrasound; some gallstones produce symptomatic diseases, such as cholecystitis, cholangitis, or pancreatitis. Identifying the clinical features of symptomatic gallstones may help prevent severe complications by providing intervention for asymptomatic gallstones. We aimed to investigate risk factors associated with developing symptomatic disease in pediatric patients with severe motor and intellectual disabilities (SMID). METHODS This retrospective study enrolled 30 patients with SMID who were treated at the Nara Medical University between March 2016 and March 2019. We examined the prevalence of gallstones, and the rate at which associated symptoms of gallstones were observed in patients. Furthermore, we compared the clinical features of patients with and without gallstones. RESULTS Among 30 patients with SMID, 7 (23%) had gallstones, with 6 (86%) of them being symptomatic: 3 patients had acute pancreatitis and 3 had cholecystitis or cholangitis. Among 23 patients without gallstones, 2 had acute pancreatitis and 2 had biliary sludge. Patients with gallstones had significantly lower daily calorie intake than those without gallstones (P = 0.042). Furthermore, the incidence of gallstones was higher in patients who received total parenteral nutrition than in those who did not (P = 0.031). Comparative analysis between symptomatic and asymptomatic patients was not performed because almost all cases were symptomatic. CONCLUSION Gallstones were detected in 23% of patients with SMID. The gallstones were symptomatic at a very high rate. Considering this fact, patients with SMID should be surveyed for gallstones; careful management may be needed in such patients.
Collapse
Affiliation(s)
- Shogo Zuo
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Toshio Sawai
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | | | - Yasuhiro Kuroda
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| |
Collapse
|
8
|
Kageyama S, Inoue R, Hosomi K, Park J, Yumioka H, Suka T, Kurohashi Y, Teramoto K, Syauki AY, Doi M, Sakaue H, Mizuguchi K, Kunisawa J, Irie Y. Effects of Malted Rice Amazake on Constipation Symptoms and Gut Microbiota in Children and Adults with Severe Motor and Intellectual Disabilities: A Pilot Study. Nutrients 2021; 13:4466. [PMID: 34960021 DOI: 10.3390/nu13124466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023] Open
Abstract
Constipation is a frequent complication in patients with severe motor and intellectual disabilities (SMID). The aim of this study was to investigate changes in constipation symptoms and gut microbiota associated with the intake of malted rice amazake, a fermented food in Japan, in patients with SMID. Ten patients consumed the test food for six weeks, and their physical condition, dietary and medication status, and constipation assessment scale (CAS) were investigated. Comprehensive fecal microbiome analysis using the 16S rRNA sequence method was performed. The results showed a significant decrease in CAS, and a significant increase in Lactobacillales and decrease in Escherichia-Shigella after consuming malted rice amazake. To investigate the difference in the effects of malted rice amazake consumption, based on the characteristics of the original gut microbiota, the patients were grouped according to the similarity of their gut microbiota before the intervention; Firmicutes-rich Group 1 (n = 5), Actinobacteria-rich Group 2 (n = 4), and Proteobacteria-rich Group 3 (n = 1). The CAS decreased in Groups 1 and 2. The relative abundance of Bifidobacterium showed an increasing tendency both overall and in Group 1, but it was originally higher in Group 2. Our results suggest that malted rice amazake consumption reduces constipation symptoms and simultaneously changes the gut microbiota, but the changes may vary depending on the original composition of the gut microbiota.
Collapse
|
9
|
Ishimaru K, Akita S, Matsuda S, Yukumi S, Morimoto M, Kikuchi C, Matsui S, Tanigawa K, Kuwabara J, Matsumoto H, Kikuchi S, Yoshida M, Koga S, Watanabe Y. The screening program, incidence, and treatment for tumors in patients with severe motor and intellectual disabilities. J NIPPON MED SCH 2021; 89:212-214. [PMID: 34526464 DOI: 10.1272/jnms.jnms.2022_89-217] [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: 11/19/2022]
Abstract
BACKGROUND Recently, aging in patients with severe motor and intellectual disabilities (SMID) has been causing serious problems. There have been few reports about treatment for tumors in patients with SMID. METHODS The treatments performed for tumors of 12 SMID patients were examined. RESULTS Blood tests and ultrasonography were useful in screening. With regard to treatment, the surgery for SMID patients was performed in the same manner as in healthy cases, and the results were generally satisfactory, without major complications. Typically, the patients were diagnosed in advanced stages; many metachronous double cancers were observed. CONCLUSIONS We reported a tumor therapy to the patients with SMID. Our therapy provides satisfactory results for patients with SMID and their families. Further studies are required to clarify the clinical significance of the screening test and the tumor operative method for the patients with SMID.
Collapse
Affiliation(s)
- Kei Ishimaru
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Satoshi Akita
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Shunji Matsuda
- Department of Pediatrics, National Hospital Organization Ehime Hospital
| | - Shungo Yukumi
- Department of Surgery, National Hospital Organization Ehime Hospital
| | | | - Chiya Kikuchi
- Department of Pediatrics, National Hospital Organization Ehime Hospital
| | - Sayuri Matsui
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Kazufumi Tanigawa
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Jun Kuwabara
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Hironori Matsumoto
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Satoshi Kikuchi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Motohira Yoshida
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Shigehiro Koga
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Yuji Watanabe
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| |
Collapse
|
10
|
Herbuela VRDM, Karita T, Furukawa Y, Wada Y, Yagi Y, Senba S, Onishi E, Saeki T. Integrating Behavior of Children with Profound Intellectual, Multiple, or Severe Motor Disabilities With Location and Environment Data Sensors for Independent Communication and Mobility: App Development and Pilot Testing. JMIR Rehabil Assist Technol 2021; 8:e28020. [PMID: 34096878 PMCID: PMC8218217 DOI: 10.2196/28020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/17/2021] [Revised: 03/25/2021] [Accepted: 04/13/2021] [Indexed: 01/10/2023] Open
Abstract
Background Children with profound intellectual and multiple disabilities (PIMD) or severe motor and intellectual disabilities (SMID) only communicate through movements, vocalizations, body postures, muscle tensions, or facial expressions on a pre- or protosymbolic level. Yet, to the best of our knowledge, there are few systems developed to specifically aid in categorizing and interpreting behaviors of children with PIMD or SMID to facilitate independent communication and mobility. Further, environmental data such as weather variables were found to have associations with human affects and behaviors among typically developing children; however, studies involving children with neurological functioning impairments that affect communication or those who have physical and/or motor disabilities are unexpectedly scarce. Objective This paper describes the design and development of the ChildSIDE app, which collects and transmits data associated with children’s behaviors, and linked location and environment information collected from data sources (GPS, iBeacon device, ALPS Sensor, and OpenWeatherMap application programming interface [API]) to the database. The aims of this study were to measure and compare the server/API performance of the app in detecting and transmitting environment data from the data sources to the database, and to categorize the movements associated with each behavior data as the basis for future development and analyses. Methods This study utilized a cross-sectional observational design by performing multiple single-subject face-to-face and video-recorded sessions among purposively sampled child-caregiver dyads (children diagnosed with PIMD/SMID, or severe or profound intellectual disability and their primary caregivers) from September 2019 to February 2020. To measure the server/API performance of the app in detecting and transmitting data from data sources to the database, frequency distribution and percentages of 31 location and environment data parameters were computed and compared. To categorize which body parts or movements were involved in each behavior, the interrater agreement κ statistic was used. Results The study comprised 150 sessions involving 20 child-caregiver dyads. The app collected 371 individual behavior data, 327 of which had associated location and environment data from data collection sources. The analyses revealed that ChildSIDE had a server/API performance >93% in detecting and transmitting outdoor location (GPS) and environment data (ALPS sensors, OpenWeatherMap API), whereas the performance with iBeacon data was lower (82.3%). Behaviors were manifested mainly through hand (22.8%) and body movements (27.7%), and vocalizations (21.6%). Conclusions The ChildSIDE app is an effective tool in collecting the behavior data of children with PIMD/SMID. The app showed high server/API performance in detecting outdoor location and environment data from sensors and an online API to the database with a performance rate above 93%. The results of the analysis and categorization of behaviors suggest a need for a system that uses motion capture and trajectory analyses for developing machine- or deep-learning algorithms to predict the needs of children with PIMD/SMID in the future.
Collapse
Affiliation(s)
| | - Tomonori Karita
- Department of Special Needs Education, Graduate School of Education, Ehime University, Matsuyama, Ehime, Japan
| | - Yoshiya Furukawa
- Department of Special Needs Education, Graduate School of Education, Ehime University, Matsuyama, Ehime, Japan.,Graduate School of Humanities and Social Sciences, Hiroshima University, Higashihiroshima, Hiroshima, Japan
| | - Yoshinori Wada
- Department of Special Needs Education, Graduate School of Education, Ehime University, Matsuyama, Ehime, Japan
| | - Yoshihiro Yagi
- Department of Special Needs Education, Graduate School of Education, Ehime University, Matsuyama, Ehime, Japan.,Department of Contemporary Liberal Arts, Faculty of Humanities and Social Sciences, Showa Women's University, Setagaya-ku, Tokyo, Japan
| | | | | | | |
Collapse
|
11
|
Watanabe T, Fukuyama T, Yanagisawa R, Hiroma T, Sakashita K. Cord blood transplantation in a patient with severe motor and intellectual disabilities and myelodysplastic syndrome. Pediatr Int 2020; 62:1115-1117. [PMID: 33000567 DOI: 10.1111/ped.14260] [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: 08/12/2019] [Revised: 04/02/2020] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tatsuo Watanabe
- Division of Pediatric Hematology and Oncology, Nagano Children's Hospital, Nagano, Japan
| | - Tetsuhiro Fukuyama
- Division of Neurology, Nagano Children's Hospital, Nagano, Japan.,Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | - Ryu Yanagisawa
- Division of Pediatric Hematology and Oncology, Nagano Children's Hospital, Nagano, Japan.,Division of Neonatology, Nagano Children's Hospital, Nagano, Japan
| | - Takehiko Hiroma
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuo Sakashita
- Division of Pediatric Hematology and Oncology, Nagano Children's Hospital, Nagano, Japan
| |
Collapse
|
12
|
Ohmori H, Kada A, Nakamura M, Saito AM, Sanayama Y, Shinagawa T, Fujita H, Wakisaka A, Maruhashi K, Mizukami A, Takizawa N, Murata H, Inoue M, Kaneko H, Taniguchi H, Sano N, Tanuma N, Kumode M, Takechi T, Koretsune Y, Sumimoto R, Miyanomae T. Deep Vein Thrombosis in Severe Motor and Intellectual Disabilities Patients and Its Treatment by Anticoagulants of Warfarin Versus Edoxaban. Ann Vasc Dis 2019; 12:372-378. [PMID: 31636749 PMCID: PMC6766770 DOI: 10.3400/avd.oa.19-00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/17/2022] Open
Abstract
Objective: Patients with severe motor and intellectual disabilities (SMID) often develop complications, including paralysis of the extremities due to abnormal muscular tonicity. Furthermore, the incidence of sudden death, which may be caused by pulmonary thromboembolism (PTE), is approximately 4.2%. Deep vein thrombosis (DVT) is attracting attention as an embolic source. In this study, DVT was confirmed in SMID patients by lower extremity venous ultrasound. The oral anticoagulant, warfarin, and novel oral anticoagulant, edoxaban tosilate hydrate, were administered, and their efficacies and safeties were evaluated. Materials and Methods: DVT patients were randomly allocated to warfarin and edoxaban groups. The frequency of hemorrhagic events and incidence of adverse events were investigated to evaluate efficacy and safety. Results: DVT was detected in 14 (8.4%) out of 167 patients. Four (0.067/person-month) hemorrhagic events occurred in the warfarin group from subcutaneous hemorrhage due to bruises caused by postural changes. Three (0.042/person-month) events occurred in the edoxaban group due to nasal hemorrhage caused by tracheal aspiration. There was no significant difference (p=0.5383) between groups. Conclusion: No significant differences were observed in hemorrhagic events between SMID patients with DVT treated with warfarin and edoxaban.
Collapse
Affiliation(s)
- Hiromitsu Ohmori
- Department of Pediatrics, National Hospital Organization Yanai Medical Center, Yanai, Yamaguchi, Japan.,Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Akiko Kada
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Mashio Nakamura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Akiko M Saito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yoshitami Sanayama
- Department of Pediatrics, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, Japan
| | - Tomoe Shinagawa
- Department of Pediatrics, National Hospital Organization Aomori Hospital, Aomori, Aomori, Japan
| | - Hiroshi Fujita
- Department of Pediatrics, National Hospital Organization Aomori Hospital, Aomori, Aomori, Japan
| | - Akiko Wakisaka
- Department of Pediatrics, National Hospital Organization Iou Hospital, Kanazawa, Ishikawa, Japan
| | - Keiko Maruhashi
- Department of Pediatrics, National Hospital Organization Iou Hospital, Kanazawa, Ishikawa, Japan
| | - Akiko Mizukami
- Department of Pediatrics, National Hospital Organization Toyama Hospital, Toyama, Toyama, Japan
| | - Noboru Takizawa
- Department of Pediatrics, National Hospital Organization Toyama Hospital, Toyama, Toyama, Japan
| | - Hiroaki Murata
- Department of Pediatrics, National Hospital Organization Mie Hospital, Tsu, Mie, Japan
| | - Michiko Inoue
- Department of Pediatrics, National Hospital Organization Minami-Okayama Medical Center, Tsukubo, Okayama, Japan
| | - Hideo Kaneko
- Department of Clinical Research, National Hospital Organization Nagara Medical Center, Gifu, Gifu, Japan
| | - Hidekazu Taniguchi
- Department of Pediatric Neurosurgery, National Hospital Organization Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa, Japan
| | - Nozomi Sano
- Department of Pediatrics, National Hospital Organization Minami-Kyushu Hospital, Aira, Kagoshima, Japan
| | - Naoyuki Tanuma
- Department of Pediatrics, Tokyo Metropolitan Fuchu Medical Center for the Disabled, Fuchu, Tokyo, Japan
| | - Masao Kumode
- Department of Pediatrics, Biwako Gakuen Kusatsu Medical and Welfare Center, Kusatsu, Shiga, Japan
| | - Tomoki Takechi
- Department of Pediatrics, National Hospital Organization Kochi Hospital, Kochi, Kochi, Japan
| | - Yukihiro Koretsune
- National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Ryo Sumimoto
- National Hospital Organization Yanai Medical Center, Yanai, Yamaguchi, Japan
| | - Takeshi Miyanomae
- National Hospital Organization Minami Kyoto Hospital, Joyo, Kyoto, Japan
| |
Collapse
|
13
|
Ao A, Tokunaga O, Aita C, Samura T, Sasaki Y, Miyashita R, Miyanomae T. An Open-Label Uncontrolled Trial of the Efficacy and Safety of a Hug with Singing and Rocking for Promotion of Relaxation in Pediatric Patients with Severe Motor and Intellectual Disabilities: Study Protocol. Kurume Med J 2019; 65:91-97. [PMID: 30487379 DOI: 10.2739/kurumemedj.ms652004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/23/2022]
Abstract
Children with severe motor and intellectual disabilities (SMID) are continually exposed to stress due to their need to receive daily care. In particular, chronic physical and acute mental stress derived from daily medical care due to unstable health status are issues specific to SMID children. Therefore, it is important to approach these issues for the maintenance of their lives and quality of life. Seventeen children with a SMIDmedical care dependent group (SMID-MCDG) score of 25 or more will be enrolled in this study. Intervention by a hug while singing and rocking will be performed once a week for 24 weeks. The practitioner will sing, and slowly rock the child back and forth. Primary endpoint is high-frequency component of heart rate variability by frequency analysis. Secondary endpoints are low-frequency/high-frequency components of heart rate variability by frequency analysis, activity of salivary amylase, the incidence of adverse events, and changes in appearance. Frequency analysis of heart beat changes and salivary amylase activity are used as physiological indexes for assessing response to being held while singing and rocking. In this study, we will examine the efficacy and safety of hugging while singing and rocking as a practice of Ryouiku to promote relaxation in SMID-MCDG children.
Collapse
Affiliation(s)
- Aritomo Ao
- Department of Child Studies, Tokyo Kasei Gakuin University.,Clinical Research Center, National Hospital Organization Nagoya Medical Center
| | - Osamu Tokunaga
- Department of Pediatrics, National Hospital Organization Minami Kyoto Hospital
| | - Chie Aita
- Department of Psychiatry, National Hospital Organization Hizen Psychiatric Center
| | - Tomoya Samura
- Department of Educational Therapy, National Hospital Organization Nara Medical Center
| | - Yuji Sasaki
- Department of Educational Therapy, National Hospital Organization Higashitokushima Medical Center
| | - Reiko Miyashita
- Department of Educational Therapy, National Hospital Organization Kanagawa Hospital
| | | |
Collapse
|
14
|
Hirano D, Taniguchi T. Skin injuries and joint contractures of the upper extremities in Rett syndrome. J Intellect Disabil Res 2018; 62:53-59. [PMID: 29214702 DOI: 10.1111/jir.12452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/28/2017] [Accepted: 10/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the incidence and type of skin injuries and joint contractures of the upper extremities in individuals with Rett syndrome. METHODS In 2016, a questionnaire regarding skin injuries and joint contractures was sent to 1016 directors of schools for special needs education and 204 directors of departments of rehabilitation [consisting of 130 facilities for persons with severe motor and intellectual disabilities (SMID), 73 wards for patients with SMID, and the National Hospital Organisation and National Centre Hospital, National Centre of Neurology and Psychiatry] in Japan. Descriptive statistics were used to indicate frequency in each question. RESULTS Information was acquired from 216 cases (3-53 years old) with Rett syndrome. Skin injuries and joint contractures of the upper extremities were observed in 41% and 49% of individuals with Rett syndrome, respectively. Most of the skin injuries were observed on the hands (19%) and fingers (29%). The incidence of skin injuries was not affected by age or disease severity. Many joint contractures were observed in the shoulder (33%) and elbow (29%) joints. Joint contractures tended to occur in individuals aged over 10 years or with severe locomotor impairment. CONCLUSION Almost half of the Rett syndrome subjects assessed in the present study had skin injuries and joint contractures. Especially, the incidence of joint contractures was affected by age and disease severity. Thus, it is important that medical staff attempt to prevent the occurrence of skin injuries and joint contractures in this patient population.
Collapse
Affiliation(s)
- D Hirano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Japan
- Department of Occupational Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Japan
| | - T Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Japan
- Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Japan
| |
Collapse
|
15
|
Matsubasa T, Mitsubuchi H, Kimura A, Shinohara M, Endo F. Medically dependent severe motor and intellectual disabilities: Time study of medical care. Pediatr Int 2017; 59:714-719. [PMID: 28164411 DOI: 10.1111/ped.13256] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 01/11/2017] [Accepted: 01/31/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Improvements in neonatal medicine and pediatric emergency medicine have led to an increasing number of children with severe disabilities requiring medical care, such as tracheal suction, on a daily basis. Most of these children, discharged directly from hospitals to their parents' homes, need home medical support. To provide data for the establishment of appropriate support systems, we analyzed the care for such children in a time study conducted at an institution. METHODS A minute-by-minute time study of the work of 33 staff members in a ward for patients (medically dependent severe motor and intellectual disabilities [SMID]) requiring frequent medical care was carried out over 48 h. Data were compared with those from a ward for ordinary non-medically dependent SMID patients. RESULTS Time of life care for medically dependent SMID and ordinary SMID was almost identical, but the time for medical care for the former was 10-fold longer than that of the latter. Also, tasks involving information exchange and recording of the time of care were performed fourfold more frequently in the medically dependent SMID than in the ordinary SMID ward. CONCLUSIONS Medically dependent SMID children and adults, predominantly with tracheostomies, needed much more medical care and more concentrated involvement of the staff compared with ordinary SMID. This study provides valuable data for the development of support systems for medically dependent SMID children being cared for at home. In addition, it sheds light on the situation faced by non-SMID children requiring frequent medical care.
Collapse
Affiliation(s)
- Tadashi Matsubasa
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto, Japan.,Kumamoto-Ashikita Institution for Developmental Disabilities, Kumamoto, Japan
| | - Hiroshi Mitsubuchi
- Department of Neonatology, Kumamoto University Hospital, Kumamoto, Japan
| | - Akihiko Kimura
- Kumamoto-Ashikita Institution for Developmental Disabilities, Kumamoto, Japan
| | - Makoto Shinohara
- Kumamoto-Ashikita Institution for Developmental Disabilities, Kumamoto, Japan
| | - Fumio Endo
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
16
|
Murata S, Inoue K, Aomatsu T, Yoden A, Tamai H. Supplementation with carnitine reduces the severity of constipation: a retrospective study of patients with severe motor and intellectual disabilities. J Clin Biochem Nutr 2017; 60:121-124. [PMID: 28366991 PMCID: PMC5370531 DOI: 10.3164/jcbn.16-52] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 06/10/2016] [Accepted: 07/21/2016] [Indexed: 12/12/2022] Open
Abstract
Carnitine is an essential nutrient for the mitochondrial transport of fatty acids. Carnitine deficiency causes a variety of symptoms in multiple organs. Patients with severe motor and intellectual disabilities often have carnitine deficiency. This study aimed to determine the correlation between constipation and carnitine deficiency in them. Patients with severe motor and intellectual disabilities at our hospital were retrospectively reviewed. The correlation between level of free carnitine and severity of constipation was examined. Constipation and non-constipation groups were compared for age; sex; body mass index; bed rest period; use of anti-epileptic drugs, valproate sodium, or enteral nutrition; and serum levels of albumin, pre-albumin, totalcholesterol, free carnitine, folic acid, and trace elements. Moreover, severity of constipation before and after carnitine supplementation was assessed. Twenty-seven patients were enrolled. Of these, 14 were assigned to the constipation group and 13 to the non-constipation group. The free carnitine level was significantly correlated with severity of constipation (R = 0.7604, p<0.01). Free carnitine was significantly lower in the constipation compared with the non-constipation group (p<0.01). No other significant differences between the groups were found. The severity of constipation was significantly relieved after carnitine supplementation (p<0.001). In conclusion, carnitine supplementation could reduce the severity of constipation.
Collapse
Affiliation(s)
- Shinya Murata
- Department of Pediatrics, Hirakata City Hospital, 2-14-1 Kinya-honmachi, Hirakata, Osaka 573-1013, Japan
| | - Keisuke Inoue
- Department of Pediatrics, Hirakata City Hospital, 2-14-1 Kinya-honmachi, Hirakata, Osaka 573-1013, Japan
| | - Tomoki Aomatsu
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Atsushi Yoden
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| |
Collapse
|
17
|
Hayashi M, Sakuma H. Immunohistochemical Analysis of Brainstem Lesions in the Autopsy Cases with Severe Motor and Intellectual Disabilities Showing Sudden Unexplained Death. Front Neurol 2016; 7:93. [PMID: 27445960 PMCID: PMC4921467 DOI: 10.3389/fneur.2016.00093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 05/10/2016] [Accepted: 06/07/2016] [Indexed: 11/28/2022] Open
Abstract
It is known that patients with severe motor and intellectual disabilities (SMID) showed sudden unexplained death (SUD), in which autopsy failed to identify causes of death. Although the involvement of brainstem dysfunction is speculated, the detailed neuropathological analysis still remains to be performed. In order to clarify pathogenesis, we investigated the brainstem functions in autopsy cases of SMID showing SUD. We immunohistochemically examined expressions of tyrosine hydroxylase, tryptophan hydroxylase, substance P, methionine-enkephalin, and c-fos in the serial sections of the midbrain, pons, and medulla oblongata in eight SUD cases and seven controls, having neither unexplained death nor pathological changes in the brain. Expressions of tyrosine hydroxylase and tryptophan hydroxylase were reduced in two of eight cases, and those of substance P and/or methionine-enkephalin were augmented in the pons and medulla oblongata in seven of eight cases, including the aforementioned two cases, when compared with those in controls. The hypoglossal nucleus and/or the dorsal vagal nucleus demonstrated increased neuronal immunoreactivity for c-fos in seven of eight cases, although there was no neuronal loss or gliosis in both the nuclei. Controls rarely showed immunoreactivity for c-fos in the medulla oblongata. These data suggest the possible involvement of brainstem dysfunction in SUD in patients with SMID, and consecutive neurophysiological evaluation of brainstem functions, such as all-night polysomnography and blink reflex, may be useful for the prevention of SUD, because some parameters in the neurophysiological examination are known to be related to the brainstem catecholamine neurons and the spinal tract nucleus of trigeminal nerve.
Collapse
Affiliation(s)
- Masaharu Hayashi
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan
| | - Hiroshi Sakuma
- Department of Brain Development and Neural Regeneration, Tokyo Metropolitan Institute of Medical Science , Tokyo , Japan
| |
Collapse
|
18
|
Ebihara T, Oshima S, Okita M, Shiina S, Negishi A, Ohara K, Ohshima S, Iwasaki H, Yoneyama A, Kitazumi E, Kobayashi D. Absorption Kinetics of Subcutaneously Administered Ceftazidime in Hypoperfused Guinea Pigs. Curr Ther Res Clin Exp 2015; 77:7-13. [PMID: 26649076 PMCID: PMC4644240 DOI: 10.1016/j.curtheres.2014.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
Background Pneumonia is the most common cause of death in patients with severe motor and intellectual disabilities (SMID), and intravenous ceftazidime (CAZ) is a widely used treatment for such infections. However, intravenous administration in patients with SMID may be difficult because of insufficient vascular development. Objectives The aim of our study was to determine the feasibility of subcutaneous drug administration by mentholated warm compresses (WMCs) as an alternative delivery method for ceftazidime in patients with SMID. Methods CAZ was subcutaneously administered to the abdominal region of naphazoline-treated hypoperfused guinea pigs, which were used as a hemodynamic model of patients with SMID. MWCs or warm compresses (WCs) were applied to the injection site to increase blood flow. We calculated the cumulative CAZ absorption over time by using the deconvolution method. Results Application of MWCs or WCs increased blood flow at the administration site and increased CAZ plasma levels. Application of MWCs or WCs after subcutaneous CAZ injection led to higher CAZ plasma levels than the mutant prevention concentration for a longer period than was observed for CAZ administration without the application of MWCs or WCs. Conclusions The application of MWCs or WCs enhanced subcutaneous CAZ absorption by increasing blood flow. MWCs and WCs are considered to be safe and routine methods to induce defecation after surgery on the digestive system; thus, the combination of these methods and subcutaneous CAZ administration is a potential method for treating pneumonia in patients with SMID.
Collapse
Affiliation(s)
- Tsuyoshi Ebihara
- Department of Pharmacy Services, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
| | - Shinji Oshima
- Department of Analytical Pharmaceutics and Informatics, Faculty of Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Mitsuyoshi Okita
- Department of Analytical Pharmaceutics and Informatics, Faculty of Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Sayumi Shiina
- Department of Analytical Pharmaceutics and Informatics, Faculty of Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Akio Negishi
- Department of Analytical Pharmaceutics and Informatics, Faculty of Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Kousuke Ohara
- Department of Analytical Pharmaceutics and Informatics, Faculty of Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Shigeru Ohshima
- Department of Analytical Pharmaceutics and Informatics, Faculty of Pharmaceutical Sciences, Josai University, Saitama, Japan
| | - Hiroyuki Iwasaki
- Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
| | - Akira Yoneyama
- Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
| | - Eiji Kitazumi
- Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
| | - Daisuke Kobayashi
- Department of Analytical Pharmaceutics and Informatics, Faculty of Pharmaceutical Sciences, Josai University, Saitama, Japan
- Address correspondence to: Daisuke Kobayashi, PhD, Department of Analytical Pharmaceutics and Informatics, Faculty of Pharmaceutical Sciences, Josai University, 1-1 Keyakidai, Sakado-shi, 350-0295 Saitama, Japan.
| |
Collapse
|
19
|
Ochi F, Fukuda M, Ohmori H, Yano Y, Wakamoto H, Suzuki Y, Ishii E. KL-6 as a biomarker of respiratory complications in severely disabled children. Pediatr Int 2015; 57:439-42. [PMID: 25405273 DOI: 10.1111/ped.12537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/03/2014] [Revised: 10/01/2014] [Accepted: 10/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to assess the importance of KL-6 level in evaluating the status of stabilized chronic pneumonia in children in the severe motor and intellectual disabilities-medical care-dependent (SMID-MCD) category. METHODS A total of 20 SMID-MCD children were enrolled in this study. Serum KL-6, white blood cell count, C-reactive protein, chest computed tomography (CT) and other factors related to respiratory complications were analyzed in all children under stable respiratory conditions. RESULTS Mean age was 5.8 ± 1.0 years (mean ± SE). Serum KL-6 was significantly higher in those SMID-MCD children with abnormal CT than in those with normal CT: 316 ± 39 U/mL versus 190 ± 11, respectively (P = 0.0075). CONCLUSIONS Measures of serum KL-6 level provide valuable information for determining the respiratory management of SMID-MCD children with occult chronic pneumonia.
Collapse
Affiliation(s)
- Fumihiro Ochi
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan.,Department of Pediatrics, Ehime Prefectural Central Hospital, Matsuyama, Japan.,Department of Pediatrics, Sumitomobesshi Hospital, Niihama, Japan
| | - Mitsumasa Fukuda
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hiromitsu Ohmori
- Department of Pediatrics, Ehime Prefectural Central Hospital, Matsuyama, Japan.,Department of Pediatrics, National Hospital Organization Yanai Medical Center, Yanai, Yamaguchi, Japan
| | - Yoshiaki Yano
- Department of Pediatrics, Sumitomobesshi Hospital, Niihama, Japan
| | - Hiroyuki Wakamoto
- Department of Pediatrics, Ehime Rehabilitation Center for Children, Toon, Japan
| | - Yuka Suzuki
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan.,Department of Pediatrics, Ehime Rehabilitation Center for Children, Toon, Japan
| | - Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Toon, Japan
| |
Collapse
|
20
|
Yotani N, Ishiguro A, Sakai H, Ohfuji S, Fukushima W, Hirota Y. Factor-associated caregiver burden in medically complex patients with special health-care needs. Pediatr Int 2014; 56:742-7. [PMID: 24628805 DOI: 10.1111/ped.12339] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 10/07/2013] [Revised: 01/29/2014] [Accepted: 03/03/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many medically complex patients with special health-care needs (PSHCN) receive home-based medical support, placing a major burden on their caregivers. We characterized the caregiving factors involved in PSHCN and their relationship with caregiver burden. METHODS The PSHCN and their families were recruited from children's hospitals and rehabilitation centers. A medical information handbook was distributed to the families on enrollment, followed by a self-report questionnaire 1 year later. Data on the type of caregiving involved, family circumstances, and caregiver burden were collected. The Zarit caregiver burden scale (ZS) was used to evaluate caregiver burden. Logistic regression (proportional odds model) was used to determine associations between each variable and caregiver burden in each of two PSHCN age groups: <15 years old (younger group) and ≥ 15 years (older group). RESULTS Sixty-eight PSHCN and their families were included in the analysis. The mean age of the PSHCN was 15.4 ± 11.8 years. On multivariate analysis there was a significant positive correlation between ZS score and older siblings (odds ratio [OR], 3.65), but no significant correlation between caregiver burden and type of care involved in the younger group. In the older group, a positive correlation was observed between caregiver burden and home mechanical ventilation with tracheostomy (OR, 15.16), but a negative correlation with younger siblings (OR, 0.04). CONCLUSIONS Family circumstances play a bigger role than type of care required in increasing caregiver burden in families of PSHCN aged less than 15 years.
Collapse
Affiliation(s)
- Nobuyuki Yotani
- Department of Public Health, Graduate School of Medicine, Osaka City University, Osaka, Japan; Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
21
|
Tamasaki A, Nishimura Y, Kondo N, Shirai K, Maegaki Y, Ohno K. Risk factors for acute pancreatitis in patients with severe motor and intellectual disabilities. Pediatr Int 2014; 56:240-3. [PMID: 24476552 DOI: 10.1111/ped.12231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 03/24/2013] [Revised: 09/01/2013] [Accepted: 10/04/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute pancreatitis in patients with severe motor and intellectual disability (SMID) is a rare but life-threatening condition. Possible causes of acute pancreatitis in these patients including valproic acid therapy, hypothermia and nasoduodenal tube feeding, have not yet been investigated in detail. The aim of this study was therefore to investigate the risk factors for acute pancreatitis in patients with SMID. METHODS Five SMID patients with acute pancreatitis and 15 SMID patients without acute pancreatitis were reviewed. Age; serum total cholesterol, triglyceride, total protein, and albumin; height; bodyweight; body surface area; body mass index; daily calorie intake; daily calorie intake per unit of body mass surface area; daily calorie intake per kilogram bodyweight; and valproic acid usage were examined. RESULTS A statistically significant difference was observed in serum albumin level between the two groups (P = 0.026). CONCLUSION The mechanism of acute pancreatitis in these patients was considered as pancreatic morphological change, acinar damage, and elevated serum trypsinogen level caused by malnutrition. It is likely that acute pancreatitis in patients with SMID occurs due to the same mechanism as in anorexia nervosa and malnourished patients. To prevent acute pancreatitis in these patients, it is important to maintain adequate nutritional status.
Collapse
Affiliation(s)
- Akiko Tamasaki
- Division of Child Neurology, Institute of Neurological Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | | | | | | | | |
Collapse
|