The Relationship between Functional Constipation and Dietary Habits in School-Age Japanese Children

Functional constipation negatively affects school-related quality of life for children and adolescents. We investigated the association between functional constipation, defined according to the Rome criteria version III, and dietary habits. The subjects of this cross-sectional study were 1,140 5th graders and 1,054 8th graders attending schools in Shunan City, Japan in 2012. Functional constipation was defined as having two or more symptoms of constipation. Dietary habits were assessed using a brief questionnaire. Self-reported biological, demographic and lifestyle information was obtained. Using multiple logistic models, dose-dependent associations among subgroups stratified with quintiles of nutrient and food intake were examined. The prevalence of functional constipation ranged from 3.7% to 8.3% across the grades. The most prevalent symptom was pain or hard stools. There was a link between higher rates of functional constipation and lower levels of dietary fiber intake, vegetables, and fruits (p_trend=0.010-0.030). Associations with vegetables and fruits attenuated when controlling for dietary fiber intake (p_trend=0.074-0.150). When 5th and 8th graders were separately analyzed, intake of dietary fiber, water from foods, and vegetables had beneficial effects on functional constipation in 8th graders (p_trend=0.005-0.038), and fruit intake had a beneficial effect in 5th graders (p_trend=0.012). Modification of dietary habits may have a positive effect in reducing functional constipation in school-age children. Diets rich in fiber, vegetables, and fruits, have the potential to improve functional constipation in Japanese children and adolescents.

Physical activity modifies the FTO effect on body mass index change in Japanese adolescents

BACKGROUND

Evidence of the effects of fat mass and obesity-associated (FTO) variation and long-term effects of physical activity (PA) on adiposity in adolescents is largely scarce. This study therefore investigated whether PA modulates the effects of the FTO on body mass index (BMI) changes in Japanese adolescents between the ages of 13 and 18 years.

METHODS

Data on 343 subjects (156 boys; 187 girls) who were enrolled in 2006 and 2007 at schools in Shunan City, Japan, were collected. Genotyping (rs1558902) was conducted, and anthropometry and blood test results were recorded for subjects in the eighth grade. A second survey involving self-reporting of anthropometry was conducted when the subjects were in the 12th grade. PA was estimated using the International Physical Activity Questionnaire. BMI and the standard deviation score for BMI (BMI-SDS) were calculated. BMI changes and BMI-SDS changes were compared between FTO genotypes using a multivariate model.

RESULTS

The effect of the interaction between PA and the FTO genotype on BMI changes was significant in boys but not in girls. In boys, PA had a significant negative influence on BMI-SDS changes in those with the AA genotype and a significant positive influence on BMI and BMI-SDS changes in those with the TT genotype.

CONCLUSION

The influence of PA on BMI change and BMI-SDS change varies on the basis of genotype. PA modified the effect of FTO on BMI change in Japanese boys.

Dietary Fiber Consumption Decreases the Risks of Overweight and Hypercholesterolemia in Japanese Children

AIMS

It remains inconclusive whether high dietary fiber intake decreases the risk of obesity, hypercholesterolemia or high blood pressure during childhood. Therefore, this study investigated the relationships of dietary fiber intake with weight status and related clinical parameters among Japanese children.

METHODS

We analyzed the data of 5,600 subjects aged 10-11 years, between 2006 and 2010. Fiber intake was assessed using the Brief-type Diet History Questionnaire. Body height and weight and blood pressure were measured. Serum levels of total cholesterol, low- and high-density lipoprotein cholesterol and triglycerides were analyzed. Fiber intake was categorized into quintiles, and multivariate models were used to adjust for lifestyle factors.

RESULTS

Total fiber intake decreased the risks of overweight and high total cholesterol (OR Quintile 5 vs. Quintile 1 overweight: 0.71 for boys, 0.40 for girls; total cholesterol: 0.60 for boys, 0.66 for girls). Water-soluble fiber intake was associated with a lower risk of high blood pressure, although the ORs were not significant.

CONCLUSIONS

Increasing the dietary fiber intake in Japanese children may have favorable effects on overweight and hypercholesterolemia.

Assessment of lower urinary tract function in children with Down syndrome

BACKGROUND

Despite the fact that functional lower urinary tract symptoms are common among people with Down syndrome (DS), their voiding function has not been studied precisely. Our goal was to assess the lower urinary tract functions in DS.

METHODS

Fifty-five DS children aged 5-15 years old and 35 age-matched control children were evaluated by ultrasonography and uroflowmetry.

RESULTS

Eleven (20%) DS children had no uresiesthesia, 21 (38%) were urinated under guidance, nine (16%) urinated fewer than three times a day, two (4%) urinated more than 10 times a day, three (5%) used diapers, and 26 (47%) had urinary incontinence. Seven (13%), 15 (27%), and 10 (18%) DS children had weak, prolonged and intermittent urination, respectively, and seven (13%) had urination with straining. In contrast, none of the control subjects had urinary problems. In the uroflowmetrical analysis, 10 (18%), 20 (37%), 11 (20%) and five (9%) DS children showed "bell-shaped," "plateau," "staccato" and "interrupted" patterns, respectively; the remaining nine (16%) could not be analyzed. In contrast, 21 (60%), one (3%), four (11%), three (9%) and two (6%) control subjects showed bell-shaped, tower-shaped, plateau, staccato and interrupted patterns, respectively; the remaining four (11%) could not be analyzed. Residual urine was demonstrated in four (7%) DS children and one (3%) control child.

CONCLUSIONS

Lower urinary tract symptoms and abnormal uroflowmetry findings, which can lead to further progressive renal and urinary disorders, are common in DS children. Therefore, lower urinary tract functions should be assessed at the life-long regular medical check-ups for subjects with DS.

Survey of brain temperature management in patients with traumatic brain injury in the Japan neurotrauma data bank

The goal of this study was to evaluate the clinical characteristics and effects of brain temperature management in patients with severe traumatic brain injury (TBI). A total of 1091 patients were registered from the Japan Neurotrauma Data Bank Project 2009. Those with a Glasgow Coma Scale (GCS) score of 9 or more, a GCS score of 3, bilateral dilated pupils, or cardiopulmonary arrest on arrival were excluded. This left a total of 401 patients. Patients were classified into three groups: no temperature management, with no intervention for brain temperature (225 patients, 56.1%), intensive normothermia (129 patients, 32.2%), and hypothermia (47 patients, 11.7%). Patient age, GCS score, pupillary abnormality, Injury Severity Score (ISS), intracranial pressure (ICP) monitoring, and outcome according to CT classification (Traumatic Coma Data Bank classification) on admission were examined. Patients were significantly older in the no temperature management group (average age 61.5 years) compared with normothermia (53.6 years) and hypothermia (46.9 years). ICP monitoring was significantly decreased in 85.1% of patients with hypothermia, 42.6% with normothermia, and 14.7% in no temperature management group. Favorable outcome rate was significantly higher with hypothermia (52.4%) compared with normothermia (26.9%) and no temperature management (20.7%) with evacuated mass lesions in contrast to diffuse injury. Multivariate analysis in patients with evacuated mass lesions showed that GCS (≥6 pts), and hypothermia were independent factors related to a favorable outcome. Appropriate thermoregulation of the brain for individual patients with various types of TBI are important.

Ultrasound analysis of gray-scale median value of carotid plaques is a useful reference index for cerebro-cardiovascular events in patients with type 2 diabetes

Aims/Introduction

Measurements of plaque echogenicity, the gray-scale median (GSM), were shown to correlate inversely with risk factors for cerebro-cardiovascular disease (CVD). The eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio is a potential predictor of CVD risk. In the present study, we assessed the usefulness of carotid plaque GSM values and EPA/AA ratios in atherosclerotic diabetics.

Materials and Methods

A total of 84 type 2 diabetics with carotid artery plaques were enrolled. On admission, platelet aggregation and lipid profiles, including EPA and AA, were examined. Using ultrasound, mean intima media thickness and plaque score were measured in carotid arteries. Plaque echogenicity was evaluated using computer-assisted quantification of GSM. The patients were then further observed for approximately 3 years.

Results

Gray-scale median was found to be a good marker of CVD events. On multivariate logistic regression analysis, GSM <32 and plaque score ≥5 were significantly associated with past history and onset of CVD during the follow-up period, the odds ratios being 7.730 (P = 0.014) and 4.601 (P = 0.046), respectively. EPA/AA showed a significant correlation with GSM (P = 0.012) and high-density lipoprotein cholesterol (P = 0.039), and an inverse correlation with platelet aggregation (P = 0.046) and triglyceride (P = 0.020). Although most patients with CVD had both low GSM and low EPA/AA values, an association of EPA/AA with CVD events could not be statistically confirmed.

Conclusions

The present results suggest the GSM value to be useful as a reference index for CVD events in high-risk atherosclerotic diabetics. Associations of the EPA/AA ratio with known CVD risk factors warrant a larger and more extensive study to show the usefulness of this parameter.

Seasonal variation in the incidence of aneurysmal subarachnoid hemorrhage associated with age and gender: 20-year results from the Yamaguchi cerebral aneurysm registry

BACKGROUND

This study was a cerebral aneurysm registry study conducted in a region with few climatic differences. Based on data collected for over 20 years, seasonal variations and characteristics of subarachnoid hemorrhage (SAH) due to ruptured aneurysms were analyzed.

METHODS

This study included 5,007 patients in the Yamaguchi Prefecture with aneurysmal SAH between 1986 and 2005. Incidence rates by month, sex, age, severity, and aneurysm site were analyzed.

RESULTS

In women, seasonal variation was observed, in particular among those aged ≥50 years. Among those aged 50-69 years, the highest incidence was in October, and the nadir was in June (peak-to-trough ratio = 1.72). At age ≥70 years, this was slightly different, with the highest incidence in December and the nadir in July (peak-to-trough ratio = 1.48). However, there was no seasonal variation in men overall; it was limited to elderly men at age ≥70 years, with the highest incidence in January and the nadir in July (peak-to-trough ratio = 2.9). Aneurysm site and severity showed no relationship with seasonal variation.

CONCLUSION

The present study shows seasonal variations in the onset of SAH. Seasonal variations in SAH differed depending on age and sex.

Initial 'TTP Map-Defect' of Computed Tomography Perfusion as a Predictor of Hemorrhagic Transformation of Acute Ischemic Stroke

Background

Hemorrhagic transformation (HT) following acute ischemic stroke is a major problem, especially for the indication of reperfusion therapy including intravenous administration of recombinant tissue plasminogen activator (IV rt-PA). The specific predictive factors of HT have not yet been established. The present study evaluated the findings of computed tomography perfusion (CTP) images as predictors of subsequent HT to identify patients with low HT risk for reperfusion therapy such as IV rt-PA.

Methods

We retrospectively reviewed 68 consecutive stroke patients (41 males; mean age 72.9 years) with steno-occlusive lesions in the major trunk, including 10 patients who underwent IV rt-PA. Each HT was detected on a follow-up T2*-weighted magnetic resonance image until 2 weeks after stroke onset and categorized into four groups [hemorrhagic infarction (HI) type 1 and 2, and parenchymal hematoma (PH) type 1 and 2] according to the European Cooperative Acute Stroke Study (ECASS) classification. We assessed clinical features and radiological findings between the HT and non-HT groups or the PH2 and non-PH2 groups. The efficacy of initial time to peak (TTP) mapping of CTP for predicting HT or PH2 was evaluated.

Results

Thirty-four patients (50%) developed subsequent HT: 18 (52.9%) had HI and 16 (47.1%) had PH, including 9 PH2 patients (13.2%). IV rt-PA was not significantly associated with HT or PH2 occurrence. Forty of the 68 patients (59%) revealed defect areas on the initial TTP mapping (TTP map-defect), and 34 of these 40 patients (85%) developed secondary HT and 9 patients (22.5%) developed PH2. Initial ‘TTP map-defect’ was significantly associated with the occurrence of HT (p < 0.0001) and PH2 (p = 0.0070). Thirty of the 34 patients (88.2%) in the HT group experienced delayed recanalization of the occluded vessels, in contrast to only 8 of the 34 patients (23.6%) in the non-HT group. All patients of the PH2 group showed recanalization (p = 0.0042). In 40 ‘TTP map-defect’-positive patients, delayed recanalization was associated with the occurrence of HT (p < 0.0001) and PH2 (p = 0.0491). All 28 patients without ‘TTP map-defect’ did not develop HT, including 8 patients (28.6%) with delayed recanalization.

Conclusions

Initial ‘TTP map-defect’ of CTP could accurately predict HT risk including PH2 risk and identify low-risk patients even in the delayed period.

Age limit for surgical treatment of poor-grade patients with subarachnoid hemorrhage: A project of the Chugoku-Shikoku division of the Japan neurosurgical society

Objective:

Management of elderly patients with poor-grade subarachnoid hemorrhage (SAH) remains controversial. The objective of this study was to investigate whether there is an age-dependent difference in the outcome of poor-grade SAH after surgical obliteration of the aneurysm.

Methods:

Data were reviewed retrospectively for 156 patients with poor-grade aneurysmal SAH at multiple centers in Chugoku and Shikoku, Japan. Patients were divided into age groups of 65-74 and ≥75 years old. Factors influencing a favorable outcome at discharge (Glasgow Outcome Scale, good recovery or moderately disabled) were determined using multivariate logistic regression analyses.

Results:

A favorable outcome at discharge was achieved in 37 of the 156 patients (23.7%). Advanced age (≥75 years old, P < 0.01), improvement of World Federation of Neurosurgical Societies (WFNS) Grade after admission (P = 0.02), Fisher grade (P < 0.001), and a low density area (LDA) associated with vasospasm on computed tomography (CT) (P < 0.01) were significantly associated with outcome. Multivariate analysis identified advanced age (≥75 years old, P = 0.01), Fisher group 4 (P = 0.002), and a new LDA associated with vasospasm on CT (P = 0.007) as predictors of a poor outcome in elderly patients with poor-grade SAH after surgical obliteration of the aneurysm. WFNS Grade V at admission (P = 0.052) was weakly associated with a poor outcome.

Conclusions:

Advanced age (≥75 years old), Fisher group 4, and LDA associated with vasospasm on CT were independent predictors of clinical outcome in elderly patients with poor-grade SAH. A favorable outcome in these patients occurred more frequently after Guglielmi detachable coil embolization than after surgical clipping, but without a significant difference.

Psychosocial functioning and self-rated health in Japanese school-aged children: A cross-sectional study

Emotional and behavioral disorders in children are school-health concerns; however, Japanese screening tools for such disorders are not yet available. We examined the association between psychosocial functioning as measured by the Pediatric Symptom Checklist (PSC) and self-rated health within school settings. A cross-sectional study was conducted for 2513 fifth and eighth graders from all of the primary and secondary schools in Shunan City, Japan. The Japanese PSC had high internal consistency (Cronbach's α = 0.90) and a factor structure similar to that of the English PSC. When the cut-off values were set to ≥ 28 and ≥ 17, 4-9% and 20-39% of our respondents, respectively, reported high PSC scores. A multiple ordinal logistic regression analysis showed that the odds ratio of a positive PSC score (≥ 28) for poorer self-rated health among ratings of "very good," "good," "fair," and "poor" was 3.5 (95% confidence interval = 2.6-4.8). There was a clear association between psychosocial dysfunction identified by a PSC score ≥ 28 and poor self-rated health. We offer directions for further research on appropriate PSC cut-off values with Japanese samples.

Validity of self-reported body mass index of Japanese children and adolescents

BACKGROUND

Self-reported body mass index (BMI) has been widely used in epidemiological studies, but no study thus far has validated the self-reported BMI of Japanese children and adolescents. The aim of the present study was to assess the accuracy of self-reported BMI and its use for classification into weight categories.

METHODS

Fifth- and eighth-grade students (n= 358) from all schools in Shunan City, Japan, from 2006 to 2010 were included. BMI was calculated from both self-reported and measured data. Pearson's correlation, Kappa statistics and the number of overweight children, and Bland-Altman plots with 95% limits of agreement were calculated to assess the agreement.

RESULTS

Pearson's correlation between self-reported and measured data ranged between 0.946 and 0.987 for height, 0.978 and 0.992 for weight, and 0.930 and 0.964 for BMI, depending on gender or age. Kappa was excellent: 0.949 for boys, 0.867 for girls, 0.897 for 10-11-year-old children, 0.928 for 13-14-year-old adolescents. The number of overweight children based on self-reported BMI was not significantly different from that based on measured BMI. The 95% limits of agreement were -3.62 and 2.90 cm for height, -2.80 and 2.38 kg for weight, and -1.42 and 1.44 kg/m(2) for BMI.

CONCLUSIONS

Self-reported BMI was generally reliable for predicting the number of overweight Japanese children and adolescents. There is slight discrepancy, however, between self-reported BMI and measured BMI, and self-reported BMI should be used with caution, keeping the variance and concordance rate in mind.

Self-reported seafood intake and atopy in Japanese school-aged children

BACKGROUND

The effects of fish consumption and n-3 poly-unsaturated fatty acid (PUFA) levels on atopic disorders are inconsistent in previous reports, but few studies have investigated the effects of both fish and n-3 PUFA. The aim of the present study was to investigate whether erythrocyte fatty acids and the consumption of fish are associated with atopic diseases in pre- and early adolescents.

METHODS

A total of 135 students with eczema, 136 students with asthma, and 137 healthy control students were selected from fifth and eighth grades in Shunan, Japan. Atopic disorders and dietary intake were evaluated with questionnaires, and total serum IgE was measured using an enzyme-linked immunosorbent assay. In addition, erythrocyte membrane levels of PUFA were assessed via gas chromatography.

RESULTS

Total IgE was significantly elevated in the atopic subjects (P < 0.001). The intake of fatty and dried fish or seafood was significantly associated with eczema (odds ratios of the highest quartiles: 0.46, 95% confidence interval (95%CI): 0.22-0.94; 0.34, 95%CI: 0.16-0.71, respectively). Additionally, only erythrocyte eicosapentaenoic acid (EPA) level had a negative association with eczema (P= 0.048). For asthma, the effect of fish consumption was not significant.

CONCLUSIONS

Fish consumption was related to a low prevalence of eczema, but not asthma in Japanese pre- and early adolescents. EPA may be involved in this mechanism.

Meat intake frequency and anemia in Japanese children and adolescents

The consumption of meat products is considered to be a feasible solution to prevent anemia, which is a critical health problem. The present study assessed hematological parameters and the prevalence of anemia in Japanese children and adolescents, and examined the association with the frequency of meat intake. Data from the Shunan Children Health Cohort Study were analyzed. The participants included male and female residents, 3373 children (aged 10-11 years), and 3085 adolescents (aged 13-14 years). The frequency of meat intake was determined with a questionnaire, and blood samples were analyzed. Anemia was defined according to the criteria of the World Health Organization. The prevalence of anemia in children was 3.6% and 2.5% in girls and boys, respectively, and in adolescents, it was 4.5% in girls and 0.8% in boys. The frequency of meat intake did not show a positive association with the hematological indices or the prevalence of anemia. These results suggest that the promotion of meat consumption is not an effective strategy to decrease anemia, and that other approaches are necessary to prevent anemia in this population.

Breakfast habits among adolescents and their association with daily energy and fish, vegetable, and fruit intake: a community-based cross-sectional study

OBJECTIVES

To investigate breakfast eating habits on daily energy and fish, vegetable, and fruit intake in Japanese adolescents.

METHODS

This study was completed as part of the Shunan Child Health Cohort Study. Two types of questionnaires, one on lifestyle habits and the other a brief-type, self-administered questionnaire on diet history, were administered to second-year junior high school students (1,876 boys and 1,759 girls) in Shunan City, Yamaguchi, Japan. The different breakfast habits were compared using the general linear model and the estimated means and P value for trend were calculated, with energy-adjusted food intake as the dependent variable and body mass index, gender, age, residential areas, and living status as covariates.

RESULTS

In both males and females, the proportion of those who ate breakfast irregularly was about 10%. The daily intake of fish, vegetables, and fruit was significantly higher in those who ate breakfast with their guardians than in those who ate breakfast alone (P for trend <0.01). The daily intake of fish, seafood, and vegetables was significantly higher in those who less frequently ate cooked foods for breakfast (P for trend <0.01). Those who ate rice more frequently than bread at breakfast had a higher daily intake of fish, seafood, and vegetables (P for trend <0.01).

CONCLUSIONS

Eating breakfast with the family, reducing the intake of cooked foods at breakfast, and eating breakfast with rice as a main staple food are suggested to contribute to an improved quality of diet in adolescents.

Cooling of the epileptic focus suppresses seizures with minimal influence on neurologic functions

PURPOSE

Focal brain cooling is effective for suppression of epileptic seizures, but it is unclear if seizures can be suppressed without a substantial influence on normal neurologic function. To address the issue, a thermoelectrically driven cooling system was developed and applied in free-moving rat models of focal seizure and epilepsy.

METHODS

Focal seizures limited to the unilateral forelimb were induced by local application of a penicillin G solution or cobalt powder to the unilateral sensorimotor cortex. A proportional integration and differentiation (PID)-controlled, thermoelectrically driven cooling device (weight of 11 g) and bipolar electrodes were chronically implanted on the eloquent area (on the epileptic focus) and the effects of cooling (20, 15, and 10°C) on electrocorticography, seizure frequency, and neurologic changes were investigated.

KEY FINDINGS

Cooling was associated with a distinct reduction of the epileptic discharges. In both models, cooling of epileptic foci significantly improved both seizure frequency and neurologic functions from 20°C down to 15°C. Cooling to 10°C also suppressed seizures, but with no further improvement in neurologic function. Subsequent investigation of sensorimotor function revealed significant deterioration in foot-fault tests and the receptive field size at 15°C.

SIGNIFICANCE

Despite the beneficial effects in ictal rats, sensorimotor functions deteriorated at 15°C, thereby suggesting a lower limit for the therapeutic temperature. These results provide important evidence of a therapeutic effect of temperatures from 20 to 15°C using an implantable, hypothermal device for focal epilepsy.

Validity and reliability of physical activity questionnaire for Japanese students

BACKGROUND

Self-administered questionnaires about physical activity are useful for collecting data to develop public health policies. There is currently no validated physical activity questionnaire, however, for Japanese children and adolescents. The purpose of the present study was to evaluate the validity and reliability of self-administered, physical activity questionnaires for Japanese students.

METHODS

Fifth- and eighth-grade students were asked to complete two questionnaires that estimated the intensity and time of moderate-to-vigorous physical activities in which they participated, and the frequency and duration spent performing sports activities. Students also wore triaxial accelerometers to compare their actual activity levels to their estimates, to investigate the validity and reliability of the questionnaires.

RESULTS

The intensity and time spent performing moderate-to-vigorous physical activity that were estimated from the questionnaire were higher than those measured by accelerometry (9-161% of accelerometry). Questionnaire data were highly correlated with accelerometer data for eighth graders (Spearman correlation, 0.642-0.754), but the correlations were lower for fifth graders (≤ 0.331). Furthermore, there was higher repeatability in the data collected from eighth graders (intraclass correlation, 0.625-0.645) than from fifth graders (0.136-0.194).

CONCLUSIONS

Questionnaires may be useful in epidemiological studies for ranking physical activity levels of adolescents, such as a confounding factor for other lifestyle surveys, but these surveys are less accurate for younger children.

Association between the FTO gene and overweight in Japanese children and adolescents

BACKGROUND

The association between the fat mass- and obesity-associated (FTO) gene and a predisposition to obesity is inconsistent in adult Asian populations. We investigated the association of the FTO gene with weight status in Japanese children and adolescents.

DESIGN/SETTING

Nested case-control study and 3-yr longitudinal study - In the Shunan Child Cohort Study, fifth and eighth grade students attending all schools of Shunan completed the questionnaires. Overweight, including obesity, was defined as a percentage of overweight of 20% or in accordance with the International Obesity Task Force. We recruited 133 obese subjects and randomly selected controls from the 2006 cohort. We genotyped three FTO single nucleotide polymorphisms (SNPs): rs3751812, rs9939609, and rs1558902.

RESULTS

The three genotyped SNPs were in tight linkage disequilibrium, with the exception of one case. The minor SNP allele of rs3751812 conferred a predisposition to obesity, and its odds ratio was 2.2 [95% confidence interval (CI), 1.5-3.4] in the additive model and 2.7 (95% CI, 1.6-4.4) in the dominant model (p < 0.001). Although blood parameters and some lifestyle behaviors were significantly different between the cases and controls (p < 0.01), these traits were not significantly different among the genotypes. In addition, we did not find an association between the genotypes and body mass index change during the 3 yr.

CONCLUSION

The FTO gene is associated with the early onset of overweight in the Japanese population as well as in European populations. The results suggest that obesity-related risk factors in fifth and eighth graders appear because of their overweight status.

Preoperative prediction of outcome in 283 poor-grade patients with subarachnoid hemorrhage: a project of the Chugoku-Shikoku Division of the Japan Neurosurgical Society

BACKGROUND

The management of patients with poor-grade subarachnoid hemorrhage (SAH) continues to be controversial. The objective of this study was to examine predictors of outcome of poor-grade SAH after surgical obliteration of the aneurysm.

METHODS

The study was performed as a retrospective review of 283 patients with poor-grade SAH who underwent surgical obliteration of the aneurysm at multiple centers in Chugoku and Shikoku, Japan.

RESULTS

A favorable outcome at discharge was achieved in 97 of the 283 patients (34.3%). Age (p < 0.001), World Federation of Neurosurgical Societies (WFNS) grade V at admission (p = 0.002), improvement in WFNS grade after admission (p = 0.002), Fisher grade (p = 0.039) and a low-density area (LDA) associated with vasospasm on computed tomography (CT; p < 0.001) showed a significant association with outcome. Further analysis of WFNS grades indicated that most patients who only improved to preoperative grade IV from grade V at admission did not have a favorable outcome. Multivariate analysis identified age (especially of > or =65 years; p < 0.001), WFNS grade V (p < 0.001) and LDA associated with vasospasm on CT (p < 0.001) as predictors of a poor outcome, and improvement in WFNS grade (p = 0.001) as a predictor of a favorable outcome after surgical obliteration of the aneurysm.

CONCLUSIONS

Advanced age, WFNS grade V, improvement in WFNS grade, and LDA associated with vasospasm on CT were found to be independent predictors of clinical outcome, whereas rebleeding, early aneurysm surgery and treatment modality (surgical clipping or Guglielmi detachable coil embolization) were not independently associated with outcome in patients with poor-grade aneurysm.

Variance in the transaminase levels over the body mass index spectrum in 10- and 13-year-olds

BACKGROUND

Transaminase levels increase with body mass index (BMI) and also with an extreme drop in the BMI, as in the case of patients with anorexia nervosa. We examined these levels over the BMI spectrum in Japanese 10- and 13-year-olds.

METHODS

Fifth- and eighth-grade students (n= 3747) from all schools in Shunan City, Japan, between 2006 and 2008 were included in the study. BMI z-score and serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT) were measured.

RESULTS

The ALT and GGT levels increased with z-BMI values in the boys and 10-year-old girls (P≤ 0.001). In the 13-year-old girls, only the ALT levels increased with the z-BMI values (P= 0.018). Similarly, the proportion of subjects with elevated ALT and GGT levels increased with the z-BMI values (p(trend) < 0.05). The AST levels were negatively associated with BMI in the girls (P < 0.001). Among the boys, these levels were elevated at the highest z-BMI values and slightly elevated at lower values, but not significantly. These associations did not change after adjustments for confounders. Generalized additive model analyses revealed that transaminase had non-linear relationships with z-BMI, except for the AST levels in the girls.

CONCLUSION

The elevated ALT and GGT levels were associated with high BMI in both sexes. In the same study population, however, AST increased in the girls with low BMI and in the boys with high BMI.

Association of serum carotenoids and tocopherols with atopic diseases in Japanese children and adolescents

The present study assessed whether serum carotenoids and tocopherols are associated with atopic diseases (eczema and asthma) in 10- and 13-yr-olds in a Japanese community. Of 2796 students attending schools in Shunan, Japan, in 2006, 396 students were randomly selected for this study using nested case-control design. Atopic diseases and dietary food intake were assessed using self-administered questionnaires, and serum antioxidants were analyzed using high-performance liquid chromatography. We found no associations between serum carotenoids and atopic diseases. However, odds ratios (OR)s for the third and fourth quartiles of serum alpha-tocopherol with atopic eczema were 0.33 (95% confidence interval: 0.15-0.73) and 0.36 (0.14-0.89), respectively, and the trend was negatively significant (P(trend) = 0.048). We did not find a significant association for asthma. In conclusion, serum alpha-tocopherol was negatively associated with the prevalence of eczema. Serum carotenoids did not show definitive protective effects in Japanese youth.

Measuring methods for functional reach test: comparison of 1-arm reach and 2-arm reach

Kage H, Okuda M, Nakamura I, Kunitsugu I, Sugiyama S, Hobara T. Measuring methods for functional reach test: comparison of 1-arm reach and 2-arm reach.

OBJECTIVES

To investigate which functional reach test better reflects the center of pressure excursion, a 1-arm reach or a 2-arm reach, and to investigate the effect of trunk rotation on the reach distance in a 1-arm reach. In addition, we considered the influence of the individual variation at the starting position.

DESIGN

Descriptive study using a force platform and a 3-dimensional (3D) motion capture system.

SETTING

Motion analysis laboratory in a college setting.

PARTICIPANTS

Elderly volunteers (N=41; 15 men, 26 women; 71.8+/-5.2y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

3D coordinate data and the movement of the center of pressure.

RESULTS

The correlation between the reach distance and the center of pressure excursion was significantly higher (P<.05) for the 1-arm reach (r=.60, .72) compared with a 2-arm reach (r=.41, .55). In the case of the 1-arm reach, center of pressure excursion was a significant factor affecting reach distance (beta=.319, .470) in multivariate regression analysis, but trunk rotation was not (beta=.162, .095). When the reach distance was measured using the heel as a reference, the correlation was stronger.

CONCLUSIONS

To evaluate dynamic balance, a 1-arm reach, which better reflects center of pressure excursion, is more valid. It is meaningful to reduce the individual variation of the acromion at the starting position.

Use of body mass index and percentage overweight cutoffs to screen Japanese children and adolescents for obesity-related risk factors

BACKGROUND

Cutoffs based on percentage overweight (POW) are used for screening students in Japan; however, body mass index (BMI) is more common in the rest of the world. To screen for risk factors related to obesity among Japanese primary and secondary school students, we compared fasting and postprandial values, and the receiver operating characteristic (ROC) curves for the POW and BMI criteria.

METHODS

The subjects were students aged 10 and 13 years living in Shunan City, Japan between 2006 and 2008 (n = 6566). POW and International Obesity Taskforce (IOTF) BMI criteria were used to screen for obesity-related risk factors. The lower (20%, 18-year-old equivalent: 25 kg/m(2)) and higher (50%, 18-year-old equivalent: 30 kg/m(2)) cutoffs were examined, and ROC curves were drawn.

RESULTS

Fasting cholesterol levels were higher than postprandial levels. The prevalences of overweight/obesity were 6.6% to 10.0% using the lower cutoff and 0.6% to 5.0% using the higher cutoff. Among overweight subjects under fasting conditions, dyslipidemia was present in 12% to 52%, hypertriglyceridemia in 29% to 54%, hyperglycemia in 11% to 21%, and hypertension in 15% to 40%. Although the use of the lower and higher POW cutoffs resulted in lower sensitivity and the higher specificity, the POW and BMI ROC curves largely overlapped. However, for girls aged 10 years, the POW curve for >or=3 risks factors was lower than that of the latter (P = 0.013).

CONCLUSIONS

For Japanese aged 10 and 13 years, both BMI and POW are useful for risk factor screening. However, subjects may be misclassified with dyscholesterolemia if postprandial blood samples are used.

The influence of focal brain cooling on neurophysiopathology: validation for clinical application

Object

Focal brain cooling has been recognized to have a suppressive effect on epileptiform discharges or a protective effect on brain tissue. However, the precise influence of brain cooling on normal brain function and histology has not yet been thoroughly investigated. The aim of this study was to investigate the neurophysiopathological consequences of focal cooling and to detect the threshold temperature that causes irreversible histological change and motor dysfunction.

Methods

The experiments were performed in adult male Sprague-Dawley rats (weighing 250–350 g) after induction of halothane anesthesia. A thermoelectric chip (6 × 6 × 2 mm) was used as a cooling device and was placed on the surface of the sensorimotor cortex after a 10 × 8–mm craniotomy. A thermocouple was placed between the chip and the brain surface. Focal cooling of the cortex was performed at the temperatures of 20, 15, 10, 5, 0, and −5°C for 1 hour (5 rats in each group). Thereafter, the cranial window was repaired. Motor function was evaluated using the beam-walking scale (BWS) every day for 7 days. The rats were killed 7 days after the operation for histological examination with H & E, Klüver-Barrera, glial fibrillary acidic protein, and terminal deoxynucleotidyl transferasemediated deoxyuridine triphosphate nick-end labeling stainings. The authors also euthanized some rats 24 hours after cooling and obtained brain sections by the same methods.

Results

The BWS score was decreased on the day after cooling only in the −5°C group (p < 0.05), whereas the score did not change in the other temperature groups. Histologically, the appearance of cryoinjury such as necrosis, apoptosis, loss of neurons, and marked proliferation of astrocytes at the periphery of the lesion was observed only in the −5°C group, while no apparent changes were observed in the other temperature groups.

Conclusions

The present study confirmed that the focal cooling of the cortex for 1 hour above the temperature of 0°C did not induce any irreversible histological change or motor dysfunction. These results suggest that focal brain cooling above 0°C has the potential to be a minimally invasive and valuable modality for the treatment of severe brain injury or to assist in the examination of brain function.

Inhibitory effects of eicosapentaenoic acid on chronic cerebral vasospasm after subarachnoid hemorrhage: possible involvement of a sphingosylphosphorylcholine-rho-kinase pathway

BACKGROUND AND PURPOSE

Rho-kinase (ROK)-mediated Ca2+ sensitization of vascular smooth muscle (VSM) contraction plays a pivotal role in cerebral vasospasm (CV). We previously demonstrated that sphingosylphosphorylcholine (SPC) induces Ca2+ sensitization through sequential activation of the Src family protein tyrosine kinases (Src-PTKs) and ROK in vitro, and that Ca2+ sensitization is inhibited by eicosapentaenoic acid (EPA) through the selective inactivation of Src-PTK. In this study, we examined whether SPC induced CV in vivo, and, if it did, whether EPA would inhibit CV, as induced by SPC or in an in vivo model of subarachnoid hemorrhage (SAH).

METHODS

Changes in the diameter of the canine basilar artery were investigated by angiography after administering SPC into the cisterna magna. Then, Y27632, a specific Rho-kinase inhibitor, or EPA was injected intracisternally and the effects of both agents were investigated. In another experiment using a single-hemorrhage model, Y27632 or EPA was injected on day 7 after SAH and the changes in the diameter of the canine basilar artery were investigated.

RESULTS

At cerebrospinal fluid concentrations of 100 and 300 micromol/l, SPC induced severe vasoconstriction (maximum vasoconstriction by SPC (100 micromol/l): 61.8 +/- 8.2%), which was markedly reversed by Y27632 (96.3 +/- 4.4%) or EPA (92.6 +/- 12.8%). SAH caused severe vasospasm on day 7 (67.6 +/- 7.8%), which was significantly blocked by Y27632 (95.5 +/- 10.6%) or EPA (90.0 +/- 4.4%).

CONCLUSIONS

SPC is a novel mediator of ROK-induced CV in vivo. The inhibition of CV induced by SPC or after SAH by EPA suggests beneficial roles of EPA in the treatment of CV. Our findings are compatible with the notion that the SPC-ROK pathway may be involved in CV.

Effective suppression of hippocampal seizures in rats by direct hippocampal cooling with a Peltier chip

OBJECT

The use of focal brain cooling to eliminate epileptic discharges (EDs) has attracted increasing attention in the scientific community. In this study, the inhibitory effect of selective hippocampal cooling on experimental hippocampal seizures was investigated using a newly devised cooling system with a thermoelectric (Peltier) chip.

METHODS

A copper needle coated with silicone and attached to the Peltier chip was used for the cooling device. The experiments were performed first in a phantom model with thermography and second in adult male Sprague-Dawley rats in a state of halothane anesthesia. The cooling needle, a thermocouple, and a needle electrode for electroencephalography recording were inserted into the right hippocampus. Kainic acid (KA) was injected into the right hippocampus to provoke the EDs. The animals were divided into hippocampal cooling (10 rats) and noncooling (control, 10 rats) groups.

RESULTS

In the phantom study, the cooling effects (9 degrees C) occurred in the spherical areas around the needle tip. In the rats the temperature of the cooled hippocampus decreased below 20 degrees C within a 1.6-mm radius and below 25 degrees C within a 2.4-mm radius from the cooling center. The temperature at the needle tip decreased below 20 degrees C within 1 minute and was maintained at the same level until the end of the cooling process. The amplitude of the EDs was suppressed to 68.1 +/- 4.8% of the precooling value and remained low thereafter. No histological damage due to cooling was observed in the rat hippocampus.

CONCLUSIONS

Selective hippocampal cooling effectively suppresses the KA-induced hippocampal EDs. Direct hippocampal cooling with a permanently implantable system is potentially useful as a minimally invasive therapy for temporal lobe epilepsy and therefore could be an alternative to the temporal lobectomy.

Use of a Peltier chip with a newly devised local brain–cooling system for neocortical seizures in the rat

✓ Local cortical cooling for termination of epileptic discharges (EDs) has recently become a focus of research. The authors report on a newly devised cooling system that uses a thermoelectric (Peltier) chip and examine the system’s performance in experimental neocortical seizures. Experiments were performed in adult male Sprague–Dawley rats after induction of halothane anesthesia. The Peltier chip was attached to a heat sink with a water channel. Two silicon tubes were connected to the heat sink, and water at 37°C was circulated in the channel. The newly designed device was placed on the surface of the cortex. Kainic acid (KA) was injected into the cortex to provoke EDs. In the nonepileptic cortex, the temperature of the cortical surface decreased to 14.8 ± 1.5°C and that 2 mm below the surface to 27.1 ± 3.1°C within 30 seconds after the start of cooling. The temperature of the heated side of the chip was maintained at approximately 36.9°C. Without water circulation, the temperature of the cortical surface decreased to 20°C but soon began to increase, peaking at 30°C. The temperature of the heated side of the chip rose to more than 60°C. The EDs, which appeared within 20 minutes after KA injection, began to decrease in amplitude immediately after cooling began and continued to decrease as the temperature of the cortex was lowered. Sufficient miniaturization and good performance of the cooling device was demonstrated. Further efforts to develop implantable cooling systems and improve existing ones should be continued.

Acceleration of murine amyloidosis by implantation of amyloid-containing grafts

We examined the transmissibility of amyloidosis by the implantation of amyloid-containing tissue. If the transmissibility similar to prion diseases is applicable, using amyloid-containing tissue for transplantation in humans might be a risk factor. In this study, AA amyloidosis occurred in mice that underwent implantation of AA amyloid-containing grafts to the liver and subsequent inflammatory stimulation. AApoAII amyloidosis occurred after implantation of AApoAII amyloid-containing grafts to the liver or to the subcutaneous space without inflammatory stimulation. Both types of amyloidoses occurred in the recipient mice sooner than expected. Moreover, AA and AApoAII amyloid deposits were found at 12 weeks after implantation in mice given AApoAII amyloid-containing grafts and inflammatory stimulation. These results suggest that implanted amyloid deposits have an AEF effect and that implanted amyloid-containing tissue can promote and accelerate a different type of amyloidosis. In another experiment, mice received amyloid-containing or normal tissue grafts. The degree of amyloid deposition was compared after 6 days and 5 weeks of inflammatory stimulation and when the mice were killed. There was no obvious difference in the degree of amyloid deposition between each group, indicating that the lag-time is shortened by implantation of amyloid-containing tissue, resulting in severe amyloidosis in the short term.

Chlamydia pneumoniae Infection as a Risk Factor for Subarachnoid Hemorrhage

Many risk factors for subarachnoid hemorrhage (SAH), such as hypertension and recent infection, have already been established. Chlamydia pneumoniae is a common respiratory pathogen that has been implicated as a potential risk factor for hypertension and atherosclerotic diseases. The purpose of the case-control study presented here was to examine the causative relationship between C. pneumoniae infection and SAH. Serum C. pneumoniae IgG and IgA antibodies were measured using an enzyme-linked immunosorbent assay in 52 patients with SAH and in 104 healthy age-matched control subjects. Multivariate analysis revealed a significant association between SAH and both a strong seropositivity for IgG and/or IgA antibodies against C. pneumoniae (odds ratio, OR, 3.62; 95% confidence intervals, CI, 1.06-12.39; p = 0.040), which indicates the presence of acute C. pneumoniae infection, and hypertension (OR, 2.91; 95% CI, 1.42-5.96; p = 0.0035). These results provide evidence that infection with C. pneumoniae may be a risk factor for SAH from a ruptured intracranial aneurysm.

[The efficacy and problems with influenza vaccination among hospital workers]

PURPOSE

The purposes of this study were: (1) to assess the therapeutic and side effects of influenza vaccination during a winter season by comparison of vaccinated and non-vaccinated subjects; and (2) to survey their willingness to receive vaccination in the future based on their experience with the present vaccination.

METHOD

The subjects were 185 vaccinated hospital workers and 450 unvaccinated city office workers. We explained to the first group the desirability of receiving vaccination for the purpose of preventing in-hospital infections and received informed consent before administering influenza vaccinations. There were five subjects who did not receive any vaccination due to strong side effects from previous vaccinations or who did not give consent. We then examined the therapeutic and side effects of the vaccination with the vaccinated subjects. A questionnaire was also filled out by both groups of subjects regarding their physical condition and whether they wished to receive vaccination in the future. In this study, the criterion for influenza was a fever of 38.5 degrees C or higher while common cold was concluded with a fever under 38.5 degrees C.

RESULTS AND DISCUSSION

The percentage of subjects who subsequently developed influenza symptoms was 13.2% for the vaccinated group whereas that for the unvaccinated group was 33.2%. The difference was significant (P < 0.01). There was no significant difference in the frequency of common cold symptoms between the two groups. According to the vaccinated group's self-report (through the questionnaire; n = 159), 16 subjects (10%) suffered some kind of side effects after the vaccination. In terms of their desire to receive vaccination the following year, in the vaccinated group, 25% of those who reported side effects wanted vaccination the following year whereas 86% of those who did not report side effects wanted vaccination. The difference was significant (P < 0.01).

CONCLUSION

The significantly lower percentage of vaccinated subjects with influenza symptoms may have been due to the vaccination effect. The prevalence of side effects (10%) was rather low. Although a relatively high percentage of the vaccinated subjects wished to receive vaccination in the following year, the breakdown indicated that only a small number of those with side effects wanted furture vaccination. Even among those with no side effect, there were some (9.1%) who did not desire vaccination in the future. Thus, there seems to be a need for further education regarding the importance of preventing influenza through vaccination.

[Comparison of serum concentrations of trace elements in healthy free-living and hospitalized oldest-old]

PURPOSE

The aim of this study was to examine differences in concentration of trace elements in serum between healthy free-living and hospitalized oldest-old people aged > or = 85 years.

SUBJECTS AND METHODS

Subjects were 33 healthy free-living oldest-olds (18 men, 15 women, aged 85-91 years, mean age: 87.3 +/- 1.7 years) selected at annual health examination and 40 hospitalized oldest-olds (14 men, 26 women, aged 85-92 years, mean age: 87.8 +/- 2.2 years). The serum concentrations of managanese (Mn), zinc (Zn), copper (Cu), iron (Fe), calcium (Ca), magnesium (Mg) and phosphorus (P) (microgram/ml) were measured using atomic absorption spectrophotometry and colorimetric method. Differences between groups for serum concentration of trace elements were assessed with the Wilcoxon rank sum test. Spearman's rank correlation coefficients were calculated with reference to clinical examination data in the two groups.

RESULTS

1) The concentrations of Ca, Mg, P and Zn were significantly higher in the healthy free-living than in the hospitalized, especially in the P and Zn case. The Cu/Zn ratio was significantly lower in the healthy free-living. 2) The Zn concentration was positively correlated with the Ca concentration, and the P concentration with the total cholesterol level in both groups. Zn was one of the elements demonstrating good correlations with other parameter. Especially in the healthy free-living, the Zn concentration was high positively associated with the Fe concentration.

CONCLUSION

These results suggest that the serum concentrations of trace elements in the healthy free-living are higher than in the hospitalized oldest-old, especially in the P and Zn case.

Inhibitory effect of 1,1,1-trichloroethane on calcium channels of neurons

Peripheral neuropathy may remain for some time after 1,1,1-trichloroethane exposure. A variety of Ca2+ channels gives sensory neurons many kinds of transmitting sensory information. We measured calcium currents in sensory neurons from neonatal rat dorsal root ganglion using whole-cell patch-clamp recordings. Trichloroethane reversibly reduced the low-voltage-activated (LVA) and high-voltage-activated (HVA) calcium. The half-inhibitory concentration (IC50) of the HVA and LVA currents was 5.76 x 10(-3) M and 3.99 x 10(-3) M, respectively. The Hill coefficient of the HVA and LVA currents was 0.61 and 1.04, respectively. In assessing voltage dependence for activation and inactivation of calcium currents, only the HVA calcium current was inactivated at greater negative potentials. This may be one of the mechanisms to reduce HVA current. However, activation and inactivation of the LVA currents were not affected by trichlorothane, so inhibition of the LVA currents may have other mechanisms. Calcium currents are thought to be involved in the control of neuronal excitability and neurotransmitter release. The inhibitory effect of trichloroethane on calcium currents may be involved in trichloroethane-induced sensory discomfort.

Estimation of the lethal toluene concentration from the accidental death of painting workers

To determine the potentially lethal level of thinner concentration in the air, we measured the concentration of toluene in the blood and others of three patients who suffered severe acute thinner intoxication between 4 January 1996 and 21 April 1997 in Ube city. The concentration of toluene in blood were 30.2 mg/L in died patient, and 13.7 mg/L and 17.5 mg/L in recovered patients, respectively. By extrapolation from the results of our previous toxicokinetic research on toluene poisoning in anesthetized dogs, the fatal concentration of toluene was estimated to be approximately 1800 to 2000 ppm for 1-hour exposure.