BACKGROUND: Limited evidence exists regarding the relationship between central-to-peripheral fat ratio measured by dual-energy X-ray absorptiometry (DXA) and subsequent cardiometabolic risk in both pediatric and adult populations. METHODS: The present cohort study investigated the relationship between DXA-measured body fat distribution and cardiometabolic parameters. The source population was 275 4th-6th graders (aged 9.6-12.6 years) in the northeast region of Japan (Shiokawa area in Kitakata). A 3-year follow-up was conducted to obtain complete information from 155 normal-weight children (87 boys and 68 girls). Normal-weight children were identified using sex- and age-specific international cut-offs for body mass index (BMI) based on adult BMI values of 25 kg/m and 18.5 kg/m, respectively. Body fat distribution was assessed using the trunk-to-appendicular fat ratio (TAR) and trunk-to-leg fat ratio (TLR) measured by DXA. RESULTS: In boys, systolic blood pressure (SBP) at follow-up showed a significant relationship with TAR at baseline after adjusting for age, height, pubic hair appearance, SBP, and whole body fat at baseline (β = 0.24, P < 0.05), and SBP also showed a significant relationship with TLR after adjusting for confounding factors including whole body fat (β = 0.25, P < 0.05). In girls, there were no significant relationships between blood pressure and TAR/TLR. CONCLUSION Body fat distribution in normal-weight boys predicted subsequent blood pressure levels in adolescence. The relationship between fat distribution and blood pressure was independent of fat volume.
Absorptiometry, Photon ; Adolescent ; Blood Pressure ; Body Fat Distribution ; Child ; Cohort Studies ; Humans ; Japan ; Male

Objectives: This study aimed to clarify the present system of palliative care at general hospitals, and to examine the factors contributing to the opioid consumption. Methods: We surveyed the palliative care system using a self-administered questionnaire, which was mailed to 37 general hospitals in Southern and Southwestern wards, Tokyo. Multiple regression analyses were used to identify the associations between explanatory variables and the opioid consumption. Results: Valid responses were obtained from 18 hospitals (response rate: 48.6%). 35% of the general hospitals didn’t have a palliative care team and most hospitals had no specialists. In multivariate analyses, factors associated with the opioid consumption were pharmacists with speciality of pharmaceutical palliative care, physicians joined the palliative care education program based on the Cancer Control Act of Japan, and the number of physicians’ correct answers of questions regarding palliative care. Conclusion: The survey showed that the higher consumption of opioids is significantly associated with the number of health care workers who have knowledge of palliative care. Our study suggested that the arrangement of palliative care experts might decrease the differences in the opioid consumption between general hospitals.

[Objective] For six consecutive years, we investigated 83 cases of the effect of acupuncture therapy on children with night terrors.[Subjects and Methods] The number of subjects was 83 (38 boys and 45 girls, mean age: 2.2 ± 2.8 years old). Acupuncture therapy for infants was defined as pattern identification/syndrome differentiation and treatment. The acupuncture therapy used spoon needles and moxibustion; skin stimulation was applied to the acupuncture point. Infant needles in the Daishi style and moxibustion of the incense stick were used as a method to approach the hole. Therapeutic effect was judged by a self-written evaluation form certified by the Japan Society of Pediatric Acupuncture. One major item, "sleep disorder (broad sense of night terrors)," three minor items ('night terror' in a narrower sense), 'difficulty in falling asleep,' 'nocturnal awakening,' number of nocturnal awakenings at night, and satisfaction with acupuncture therapy in infants were investigated. Evaluations were made at the time of the first treatment and before the fifth treatment. In the statistical analysis, the change in the score of the evaluation slip and the number of partial awakenings were tested by the Wilcoxon signed-rank-sum test. The level of significance was set at 5%.[Results] Significant improvement was observed in the score for the major item, minor items, and number of partial awakenings. The degree of satisfaction was 90.4%.[Conclusion] It was suggested that acupuncture therapy in infants is effective for ameliorating symptoms of "sleep disorder."

Multiple system atrophy (MSA) is an adult-onset, progressive neurodegenerative disorder. Patients with MSA show various phenotypes during the course of their illness, including parkinsonism, cerebellar ataxia, autonomic failure, and pyramidal signs. Patients with MSA sometimes present with isolated autonomic failure or motor symptoms/signs. The median duration from onset to the concomitant appearance of motor and autonomic symptoms is approximately 2 years but can range up to 14 years. As the presence of both motor and autonomic symptoms is essential for the current diagnostic criteria, early diagnosis is difficult when patients present with isolated autonomic failure or motor symptoms/signs. In contrast, patients with MSA may show severe autonomic failure and die before the presentation of motor symptoms/signs, which are currently required for the diagnosis of MSA. Recent studies have also revealed that patients with MSA may show nonsupporting features of MSA such as dementia, hallucinations, and vertical gaze palsy. To establish early diagnostic criteria and clinically definitive categorization for the successful development of disease-modifying therapy or symptomatic interventions for MSA, research should focus on the isolated phase and atypical symptoms to develop specific clinical, imaging, and fluid biomarkers that satisfy the requirements for objectivity, for semi- or quantitative measurements, and for uncomplicated, worldwide availability. Several novel techniques, such as automated compartmentalization of the brain into multiple parcels for the quantification of gray and white matter volumes on an individual basis and the visualization of α-synuclein and other candidate serum and cerebrospinal fluid biomarkers, may be promising for the early and clinically definitive diagnosis of MSA.
Biomarkers ; Brain ; Cerebellar Ataxia ; Cerebrospinal Fluid ; Dementia ; Diagnosis ; Early Diagnosis ; Hallucinations ; Humans ; Multiple System Atrophy ; Neurodegenerative Diseases ; Paralysis ; Parkinsonian Disorders ; Phenotype ; White Matter

[Objective]Menstrual disorders are generic symptoms that appear during a menstrual cycle. In this study we examined three years of medical records retrospectively in order to investigate the effects of acupuncture treatment on menstrual disorders. We compared a group of women with diseases 'D'with to no diseases 'N'with respect to the effects of short-term acupuncture treatment.
[Methodology]Subjects for this research were 203women with menstrual disorders who came to our office during the period January 2009 -March 2012. The only treatment they were given was traditional Chinese medicine. We used BL 32, BL 35, GV 2, GV 4, and SP 6 as acupuncture points. We inserted stainless steel acupuncture needles (40 mm long, 1.8 mm in diameter) to a depth of 20 mm at BL 32 and 10 mm at SP 6. Other points were treated three times with kyubu-moxibution (burnt 90%). Treatment was provided once every 1-2 weeks. A Menstrual Distress Questionnaire (MDQ) was used to judge treatment effectiveness. We classified the 203women into two groups;one was 'D'group (n = 46) and the other was 'N'group (n = 157). Concerning the eight items from the MDQ we compared each woman's condition before the first treatment after one menstrual cycle. This time we paid attention to premenstrual and menstrual periods. 'D'group was observed through three menstrual cycles.
[Results]The average number of treatments during one menstrual cycle was 2.2. Both groups had reduced scores for 6 prementstrual symptoms (p < 0.05). During menstrual period, 'D'had reduced scores for 3items, 'N'had reduced scores for 5 items;(p < 0.05). 'D'confirmed continuous effects of treatment. The effects on premenstrual symptoms were confirmed, "Pain"during all three menstrual cycles, "Water retention"during the second and third menstrual cycles, and "Concentration"during the third menstrual cycle. The effects during the menstrual period were also confirmed, "Pain"for all three menstrual cycles, and "Water retention"and "Behavioral change"during the third menstrual period (p < 0.05).
[Discussion]Concerning the effects of acupuncture treatment for menstrual disorders, 'D'had higher MDQ scores than 'N'. After one menstrual cycle, 'D'showed less improvement of MDQ items than 'N'. But continuous acupuncture treatments reduced menstrual disorder symptoms for 'D'.
[Conclusion]We have confirmed the effects of acupuncture treatment on menstrual cycle symptoms. In one menstrual cycle, 'N'showed more improvement than 'D'. But during three menstrual cycles 'N'experienced continuous effects of treatment.

We purified a novel angiotensin-I converting enzyme (ACE) inhibitor from fish sauce Ishiru prepared from squid, and identified it as the tripeptide Leu-Ala-Arg (LAR). IC₅₀ of this ACE inhibitor was 2.5 μM, demonstrating high potency among peptides previously purified from fish sauces. Moreover, LAR acted as an antihypertensive peptide, reducing systolic blood pressure in spontaneously hypertensive rats.

Introduction: We described a patient with lung cancer who suffered from severe pain due to pelvic bone metastasis and opioid-induced delirium. Induction of subarachnoid analgesia using implanted intrathecal catheter almost abolished his pain and enable home palliative care. Case description: Seventy-year old man was admitted for intractable leg and hip pain due to pelvic bone metastasis and delirium induced by opioid. Although he was initially administered continuous subcutaneous morphine injection for opioid titration, delirium was deteriorated. Opioid rotation to oxycodone and increase in antipsychotic drugs could not improve his delirium. Epidural analgesia with local anesthetic and small dose of morphine improve his delirium with adequate analgesic effect. Finally, he was received intrathecal catheter implantation and discharged to home palliative care. Conclusion: Neuraxial analgesia may provide not only sufficient analgesia but also lower risk of delirium in patient who was administered high dose of opioids because of intractable cancer pain.

OBJECTIVEClarifying the characteristics of attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood is important for the prevention and management of this disorder. The purpose of this study was to determine the prevalence of ADHD symptoms in Japanese preschool children based on evaluations performed by parents or teachers.

METHODSA questionnaire survey was performed to evaluate the estimated prevalence of ADHD symptoms in preschool children in Niigata City, Japan. The first survey, conducted in 2003, involved an evaluation of ADHD symptoms by their school teachers. The second survey, conducted in 2006, involved an evaluation of the symptoms by parents. The teacher survey included 9,956 children, and the parent survey included 7,566 children. Parents and teachers assessed ADHD symptoms in children using a 14-item questionnaire based on DSM-III-R. Children with a score of 8 or higher were classified as having ADHD symptoms.

RESULTSThe overall prevalence of ADHD symptoms was 2,349/7,566 (31.1%) in the parent survey and 431/9,956 (4.3%) in the teacher survey, with a prevalence ratio of 7.2 (95% CI: 6.5-7.9). Likelihood ratio test indicated that variables significantly associated with the presence of ADHD symptoms were gender, age, school type, interaction between gender and observer, and interaction between school type and observer (each with P < 0.0001).

CONCLUSIONSThe large difference between the estimated prevalence of ADHD symptoms in Japanese preschool children from teacher and parent surveys suggests that compared to teachers, parents consider their children's symptoms much more serious. Thus, parental evaluation of ADHD symptoms using DSM criteria may be inappropriate for ADHD screening.

OBJECTIVESWe investigated psychological well-being and associated factors among elderly Hansen's Disease (HD) patients in three national leprosaria in Japan.

METHODSThree questionnaires on physical and social factors, and psychological well-being based on the 12-item of General Health Questionnaire (GHQ-12) were used to survey all HD patients admitted to three leprosaria in Japan. The number of respondents over 65 years old who completed all 12 items of GHQ-12 was 754 (459 men and 295 women) with a response rate of 80.9%. Data were analyzed by t-test and analysis of covariance (ANCOVA) to determine factors associated with psychological well-being.

RESULTSThe impairment in 8 physical functions, walking, eating, and toileting for both men and women, bathing for men, and vision, dressing and grooming for women, were significantly related to high GHQ-12 scores by t-test and ANCOVA. Having no close friends, less frequent contact with neighbors, and no or less frequent participation in group activities in men, and inactive daily life style in male and female HD patients, were related to high GHQ-12 scores by both analyses.

CONCLUSIONThe present results showed that physical factors and inactive daily life style were related to psychological well-being for both men and women. Social factors were related to psychological well-being among elderly male HD patients in Japan. Further follow-up study is necessary to examine the causal relationships among psychological well-being and associated factors.