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Copyright of Japanese Journal of Learning Disabilities / LD Kenkyu is the property of Japan Academy of Learning Disabilities and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of the Japanese Society of Pediatric Surgery is the property of Japanese Society of Pediatric Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Home Economics of Japan is the property of Japan Society of Home Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Home Economics of Japan is the property of Japan Society of Home Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Tangney et al.'s (2004) Brief Self-Control Scale has been widely used in many languages, including Japanese. We developed and validated the Brief Self-Control Scale for Children (BSCS-C). Data came from 1,289 Japanese students in public elementary and junior high schools (691 boys and 598 girls; 633 students in grades 3-6 and 656 students in grades 7-8). Using a cross-validation procedure, exploratory and confirmatory factor analyses supported the one-factor structure of the BSCS-C. Multi-group confirmatory factor analyses indicated configural, metric, and scalar invariance of the BSCS-C across gender and grade groups. Latent mean differences of the BSCS-C across the groups were small. The BSCS-C demonstrated the internal consistency, seven-month test-retest reliability, and correlations with conscientiousness, extraversion, and the number of behavioral problems. [ABSTRACT FROM AUTHOR]

Acute low-pressure hydrocephalus (ALPH) is a rare form of hydrocephalus that presents with decreased intracranial pressure (ICP) despite symptoms of increased ICP and ventricular enlargement. We report a case of ALPH complicated by Listeria meningitis, with a review of the literature on pathophysiology, drainage management and treatment options for ALPH. The patient is a 1-year and 10-month-old boy. He was referred to a local doctor because of fever, diarrhea, and vomiting for 5 days, and was found to have impaired consciousness and stiff neck. The cerebrospinal fluid (CSF) examination revealed elevated cell counts and low CSF glucose. However, head computed tomography (CT) showed no obvious abnormality. The patient was diagnosed with bacterial meningitis and started on antibiotic treatment. The next day, he was referred to our hospital due to status epilepticus. After admission, anisocoria was observed, and hydrocephalus was diagnosed by head CT. Consequently, emergency ventricular drainage (EVD) was performed. Intraoperative findings revealed the decompression of dura matter in burr hole and low ICP of 5 cmH2O. Postoperatively, the patient was followed up at a pressure setting of 5 cmH2O, but drained CSF was little and the ventricle size indicated no recovery. The protocol was changed to lower the pressure setting to promote spinal fluid drainage. The size of the ventricles gradually decreased, and the patient’s consciousness improved. On the 29th day after the operation, ventriculoperitoneal shunting (VPS) was performed and the patient was discharged home with good progress. He was followed up in the outpatient clinic, and a magnetic resonance imaging (MRI) scan of the head showed ballooning of the floor of the third ventricle. He is scheduled to undergo endoscopic third ventriculostomy (ETV) soon. ALPH is a rare condition; however, there are no clear treatment guidelines. In the literature, EVD is used as initial treatment, and VPS and ETV are used as curative treatment. In the present case, spinal fluid drainage was aggressively performed from day 10, but the duration of treatment could have been shortened by promoting drainage immediately after surgery. Although VPS was effective in this case, ETV may be considered as an initial curative treatment after EVD. In the future, ETV may be used for shunt release in the long term. [ABSTRACT FROM AUTHOR]

I described 4 categories of sexually victimized children (① in family assaulted by adult, ② out of family assaulted by adult, ③ in family assaulted by child, ④ out of family assaulted by child) with model cases in terms of occurring factors and treatment techniques. There is limited research or empirical evidence in this area because those supporters hesitate to consult with a specialist, especially when the victim is a child. For the child psychiatrist and allied professional, the main role is evaluating, with standard developmental and emotional assessments, children who conducted the assault or were victimized. Professionals also need to decide the kind of care and degree of urgency of care that is needed for the victim, and the advice for the actual supporter, if continuous care is required. As in all cases of child abuse, the child who conducted the assault or the victimized child needs access to psychiatric services to address concerns about their situation, to determine appropriate levels of care, and to construct a healthy support system. [ABSTRACT FROM AUTHOR]

Objective: The ribbon procedure, which was established at Okayama University, is the indirect revascularization of the anterior cerebral artery (ACA) territory in patients with moyamoya disease (MMD). The aim of this study is to evaluate the surgical and long-term outcomes of the ribbon procedure for pediatric patients with MMD. Materials and methods: The records of 36 consecutive pediatric patients (＜16 years of age) who were surgically treated were reviewed. Operation time, bleeding volume, perioperative complication, angiographical collateral formation 6 months after the procedure, change in frequency of lower limb weakness, and most recent modified Rankin Scale (mRS) score were evaluated. Results: Seven patients (19%) underwent the ribbon procedure. The mean age was 6.6 ± 3.0 years and the mean follow-up period was 55 ± 29 months. Four patients underwent the ribbon procedure as an initial treatment and three underwent it as a secondary treatment. The mean operation time was 160 min and the mean bleeding volume was 16.6 ml. Perioperative complications occurred in 2 patients: one had wound infection, and the other had asymptomatic cerebral infarction in the ACA territory and chronic subdural hematoma. The transient lower limb weakness disappeared in six patients postoperatively. Six patients exhibited excellent or good collateral formation in the ACA territory on angiography 6 months after the ribbon procedure. No patients experienced stroke during the follow-up period. Most recent mRS scores was 0 in 5 patients, 2 in one patient, and 4 in one patient. Conclusion: The ribbon procedure is a safe and effective treatment for pediatric patients with MMD. [ABSTRACT FROM AUTHOR]

Poor medication compliance in children can affect treatment efficacy. We examined the impact of a picture book created by pharmacists to improve medication compliance in children. Our study aim was to assess the effects of the pharmacist-created picture book on medication compliance in children and their parents in collaboration with an outpatient pharmacy. This study included 74 children [recovery rate 28/74 (37.8%)] aged 3-6 years and their parents between March 2023 and March 2024. In the item "Have you experienced any difficulties in giving medication to your child?" the proportion of respondents answering, "Always" or "Sometimes" decreased from 78.3% (18/23) to 34.7% (8/23) after reading the picture book (p<0.01). When answering the question "What specific situations have you found challenging when giving medication?" the number of responses decreased from (an average/mean) of 1.5 situations before reading the picture book to 1 situation. Regarding whether guardians felt a greater appreciation for the importance of giving medication to their children after reading the book, 64.3% answered "Yes," the highest response. A positive correlation (correlation coefficient=0.77, p<0.01) was observed between "Is the child interested in taking the medication?" and "Is the child able to take the medicine? Pharmacists need to raise public awareness of the importance of medication adherence. Since picture books are likely to be repeatedly read aloud, they are considered effective. The results of this study suggest that pharmacist-created picture books may contribute to improving medication compliance in children.

Objectives　Resilience is the ability to navigate adversity and recover from challenging situations. Developing resilience at a young age promotes mental health and provides benefits throughout one's lifespan. Validated measures for assessing resilience at a young age are required in both clinical practice and epidemiological studies. The Child and Youth Resilience Measure-Revised (CYRM-R) is a tool used worldwide to assess resilience in children and young people. The objective of this study was to develop a Japanese version of the CYRM-R and investigate its psychometric properties.Methods　Children in grades 5-9 were recruited via a two-stage cluster random sampling taken from the Japan Adolescent and Youth (JAY) Longitudinal Cohort Study. The participants completed the Japanese version of the CYRM-R . The CYRM-R consists of two subscales, personal resilience and caregiver resilience, with a total of 17 items. The linguistic validity of the Japanese version of the CYRM-R was ensured through translation and back-translation.Cronbach's alpha coefficients were examined for the total score and the two subscales to assess the internal consistency of the Japanese version of the CYRM-R scale. In addition, correlation coefficients of the subscales were calculated. For factorial validity, a confirmatory factor analysis was conducted on the same two-factor structure as in the original version to assess the model's goodness of fit. Results　A total of 2,266 children (50.0% male) were included in the study. The overall Cronbach's alpha of the Japanese version of the CYRM-R obtained from this sample was 0.956; For the personal resilience subscale, Cronbach's alpha was 0.932; for the caregiver resilience subscale, it was 0.919. Significant positive correlations were also found between subscales (r = 0.827, p < 0.001). A confirmatory factor analysis was conducted using a two-factor structure for validity. The model fit was good (RMSEA = 0.085, SRMR = 0.041, CFI = 0.934).Conclusion　The Japanese version of the CYRM-R maintained the same two-factor structure as the original version. The study findings showed that the Japanese version of the CYRM-R had adequate internal consistency and factorial validity for assessing resilience in children and youth. Therefore, this scale is a valuable tool for identifying individuals or groups at risk in terms of children's resilience and for evaluating the effectiveness of support and interventions.

Adjustment disorder is one of the most frequently used diagnoses in child psychiatric practice in Japan. However, conventional diagnostic criteria, such as the 10th edition of the International Classification of Diseases （ICD-10）, focused on the presence of stressors and the duration between stressors and symptom onset, and the clinical symptoms of adjustment disorders have not been clearly defined. The 11th edition of the International Classification of Diseases （ICD-11）, which came into force in Japan in January 2022, provides a clear framework for the diagnosis of adjustment disorder. For the diagnosis of adjustment disorder, it is necessary to focus on the differences in the subjective experience of stress, such as the presence of rumination about stressors and excessive anxiety. Although there is insufficient evidence for the treatment of adjustment disorder due to the unclear definition of the previous diagnostic criteria. However, some young patients with adjustment disorder are comorbid with suicide risk. Clinicians should carefully monitor the course of patients and offer psychosocial support, or psychological treatment. In this article, we review the historical development of adjustment disorders and discuss their diagnosis, assessment, and treatment. [ABSTRACT FROM AUTHOR]

Objective　This scoping review aimed to provide an overview of collaborative practices for children with medical complexities and their families by life stage.Methods　This scoping review was conducted based on the JBI scoping review manual using the PubMed, CINAHL, and Medical Journal databases. Search terms included "collaboration," "intersectoral collaboration," "children with medical complexity," and "children with special healthcare needs," whereas control words included "children with special healthcare needs," "children with medical care," "children with severe mental and physical disabilities," and "children with severe mental and physical disabilities." The inclusion criteria were articles in Japan that reported on practices for children (aged 0-18 years) with medical care needs and collaboration among other multiple professions, research articles, excluding review and protocol articles, and English or Japanese articles. For the analysis, collaboration-related practices were extracted from selected papers, categorized based on similarities in content, and further summarized according to the life stage. Three researchers discussed the selection of papers, data extraction, and analysis until a consensus was reached.Results　The analysis included 30 papers (27 Japanese and three English papers). Regarding publication year, 14 papers were published within the last 3 years. Additionally, 19 case and 26 practice reports and 11 studies (quantitative research; one, qualitative research; 10) were published by professionals. Regarding collaborative practices, 160 cases were extracted and classified into nine. In "discharge support," practices in all subcategories were reported for preschoolers, whereas only two of the five subcategories were reported for school-aged children. Contrastingly, in the "maintenance phase in preschool, daycare, and school," preschoolers reported practices in two of the seven subcategories. Additionally, various professionals from the fields of medicine, welfare, education, and administration were involved in the collaboration.Conclusion　There were differences in the reporting of collaborative practices at each life stage. Although numerous professionals were involved, reports of collaborative practices among them were unevenly distributed. Eventually, it will be necessary to investigate the nature of collaborative practices among various professionals, focusing on children and their families.

A workshop of the Special Committee on Measures for Transition from Pediatric to Adult Health Care, the Japanese Society of Neurology was held to discuss various issues and practices involved in healthcare transition. The following points were addressed: (1) the history of, and issues involved in, promoting support for patients requiring medical care, (2) cooperation between pediatric medical centers and university hospitals, (3) collaboration between pediatrics and neurology in medical and rehabilitation facilities, and (4) a questionnaire survey of members of the Japanese Society of Neurology. The reasons for extreme difficulties in pediatric-adult healthcare transition for patients with neurological diseases, especially those who require continuous intensive medical care over a long period of time, include the difference in the operating systems of pediatric and adult departments, in addition to the difference in the diseases treated during childhood and adulthood. For holistic transition support, it is necessary to strengthen cooperation not only among medical professionals, but also among multiple professions, as well as between local communities and government.

This study aimed to develop the Japanese version of the parent report of the School Liking and Avoidance Questionnaire (SLAQ) and investigate its reliability and validity. Factor analysis revealed two structures similar to the original scale, with higher internal consistency. Significant relationships were found in the revised edition between enjoyment of school lives and school refusal to a similar degree as in a previous study. In conclusion, the results indicated the validity and reliability of the Japanese version of the parent report of the SLAQ. [ABSTRACT FROM AUTHOR]

The effects of the sleep environment in the summer on sleep and bed climate of the foot area in preschoolaged children (PC) and their mothers were investigated. The subjects included 10 pairs of PC and their mothers. The study was conducted during the summer and fall. Wrist actigraphy, bed climate of the foot area, temperature and relative humidity outside and within the bedroom, subjective sleep, and thermal and comfort sensations were measured. The bedroom temperature was significantly higher in the summer (27.1 ± 0.25 ℃ ) than that in the fall (23.1 ± 0.69 ℃ ). In multiple comparisons, in PC, the sleep time and sleep efficiency index significantly decreased and wakefulness increased in the summer compared to those in the fall, while there were no significant differences in the mothers. PC’s sleep as observed by their mothers was significantly worse in the summer compared to that in the fall. The bed climate temperature of the foot area was significantly lower in PC than in mothers, regardless of the season. These results suggest that adverse effect of high ambient temperature on sleep may be greater in PC than that in mothers. [ABSTRACT FROM AUTHOR]

Leber's hereditary optic atrophy (LHON) is a genetic optic neuropathy that is more prevalent in young males but can occur from childhood to old age. The primary cause is mitochondrial genetic mutations, which are associated with dysfunction of mitochondrial electron transport chain complex I. It manifests as acute to subacute visual impairment, often starting unilaterally but progressing to involve both eyes within weeks to months. Visual loss is severe, with many patients having corrected visual acuity below 0.1. The differential diagnosis of optic neuritis is essential, and assessments such as pupillary light reflex, fluorescein fundus angiography, and magnetic resonance imaging can be useful for differentiation. LHON should be considered as one of the differential diagnoses for optic neuritis, and collaboration between neurologists and ophthalmologists is crucial for accurate diagnosis and appropriate treatment.

We established a transition program from hospital to home administration of blinatumomab using the CADD-Legacy® pump and evaluated its safety and feasibility in 2 pediatric patients. The program recommended that repeated overnight stays with continued hospitalization would help patients safely transition to home administration of blinatumomab. Pediatric patients who do not attend school, such as preschoolers, or who return to their original school, can be transited to an outpatient setting if people caring for pediatric patients, including teachers in the school, are educated.

In accordance with the Basic Plan to Promote Cancer Control Programs, a medical setting for providing patients with pediatric cancers sufficient medical treatments and supports has been assigned as one of the central issues in Japan. The Japanese Ministry of Health, Labour and Welfare designated 15 Pediatric Cancer Core Hospitals, and National Center for Child Health and Development as a central center in February 2013. A medical setting for pediatric cancers has been progressed to achieve the consolidation of patients who need specialized therapies and equalization of patients who need standard therapies for cure. Pediatric cancers are typical rare cancers in terms of the disease frequency. Therefore, there is a limitation to conduct systemic clinical studies in a few centers. To overcome this situation, JCCG(Japanese Children's Cancer Group)and JPLSG(Japanese Pediatric Leukemia/Lymphoma Study Group)were organized to conduct more than 30 clinical studies nationwide in each disease of pediatric solid tumors and hematological malignancies, respectively. They contributed to better outcome achieving more than 80% overall survival rates. While clinical trials to reduce therapeutic intensity in patients with better prognosis, molecular targeted therapies based on comprehensive genetic analysis and CAR-T therapy have been provided as effective therapeutic options in patients with refractory diseases. However, we still have limitations to provide patients such new therapeutic agents without delay covered by health insurance. Comprehensive supportive care for the patients and their family members by multi-disciplinary medical stuffs are required for their better quality of life. Long-term follow-ups for cancer survivors, learning supporting system for high school students, cares for their siblings, supports for the generation of adolescent and young adults (AYA) and fertility preservation have been provided in each hospital. In this paper, I summarized these current status and future perspective for medical settings of pediatric cancers in Japan.

Objectives　The relationship between household income and dietary intake among older children and adults in Japan has been studied. However, few studies have examined the relationship in younger children, and we believe that this should be taken into consideration from early childhood to correct health disparities. In this study, we examined the relationship between family income and dietary food group intake, and investigated the adequacy of food intake based on the Japanese Food Guide Spinning Top for young children aged 3 to 6 years attending nursery school. The goal of this study was to obtain trends in food intake that can be used to improve poor dietary intake of young children caused by socioeconomic factors.Methods　A dietary survey using the food weighing or recording method and a self-administered questionnaire on dietary status were conducted on two non-consecutive days, including weekdays and weekends, from October to December 2019 or 2020. The participants were 761 young children (423 boys and 338 girls) attending nursery schools in seven cities in Japan. Equivalent income was calculated from household income and the number of family members indicated in the dietary status survey. Intake of each food group and consistency with the Japanese Food Guide Spinning Top were compared in five quintiles.Results　Compared to the low equivalent income group, the high equivalent income group showed a decreasing trend in cereal intake and an increasing trend in the intake of sugar and sweeteners, green and yellow vegetables, and dairy products. The percentage of the low-income group who did not meet the definition of adequate intake using the Japanese Food Guide Spinning Top was lower for meals that include cereals and grain products, and higher for meals that include meat and fish, vegetable, milk and dairy products, and fruits.Conclusion　The lower income group had higher intake of cereals and lower intake of vegetables and fruits compared to the higher income group. This finding is similar to the results of studies in adults and older children. However, based on the Japanese Food Guide Spinning Top, >90% of young children have a diet that fall below the adequate intake of meals, including vegetable dishes and even on weekdays, which suggests a general vegetable deficiency in young children. Multifaceted support is required to address this concern, including measures to correct disparities of income and to ensure desirable nutrient intake in early childhood.

汎性拒絶症候群（PRS）は，長期間にわたる，飲食，歩行，会話，セルフケアの拒絶と，援助 への拒否による重篤な病態と定義づけられた稀な症候群で，前思春期の女児を中心に発症し，身体 的な重篤さと治療抵抗からしばしば長期の入院治療を要するとされる。 今回我々は長期間にわたって食事，歩行，会話，セルフケアを拒絶し，PRS と診断した11歳女 児の入院治療を経験した。まじめで完璧主義，対人的に受身であった女児が，前思春期における母 子分離をめぐる葛藤の高まりと学習面での行き詰まりから無力感を抱き，PRS に至ったと推測さ れた。児童精神科病棟において受容し，看護ケア，半強制的なリハビリテーション，個人・家族面 接など多職種間で連携し，女児自身の回復ペースを支持する治療が奏効し，徐々に拒絶は改善し自 発性を取り戻して退院した。その後食事量低下により再入院したが，拒絶は見られず最低限の体重 を保ち，母子分離，仲間関係の確立といった思春期の課題に取り組んでいる。 PRS は重度のストレスへの反応や，病前性格と成長に伴う内的変化による環境への不適応など に因るものと考えられ，独立した疾患というよりも，摂食障害，変換症，うつ病，カタトニアなど 様々な精神疾患と連続性のある，特殊な病態の一つと推測される。 「長期間にわたる，複数の領域における，意志を含んだ拒絶症状，治療抵抗」 という特異的な病 態をもつ PRS の概念と，適切な治療的介入について，児童精神医療の臨床家が理解しておくこと は有用と考えられる。 [ABSTRACT FROM AUTHOR]

Copyright of Japanese Journal of Physical Fitness & Sports Medicine / Tairyoku kagak is the property of Japanese Society of Physical Fitness & Sports Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The cumulative incidence of secondary cancers in childhood cancer survivors at 20 years after treatment is 2-5%, which is 3-20 times higher than in the general population. Risk factors include radiation therapy, alkylating agents, platinum drugs, and topoisomerase Ⅱ inhibitors. A retrospective cohort study of 15 pediatric oncology hospitals in Japan revealed that the time to development of a second cancer varies from 5 years or less for hematologic tumors, 10 years or less for bone/soft tissue tumors, approximately 10 years for brain tumors, and 15-20 years for thyroid and adult-type cancers. Some secondary cancers have a poor prognosis. Primary prevention of secondary cancers is the same as in the general population, and early detection and treatment are important. The key points of consensus on secondary cancers by the North American Children's Oncology Group guidelines and the International Guideline Harmonization Group were presented. In the future, it will be important to share information on the benefits and risks of cancer screening with childhood cancer survivors and their families.

A 19-year-old man had been aware of dysuria and urinary incontinence since childhood but did not seek medical attention. He was diagnosed with acute pyelonephritis due to lower urinary tract dysfunction associated with spina bifida occulta and tethered cord syndrome (TCS) due to spinal cord lipoma. After placement of a urethral catheter and antibacterial chemotherapy, the patient was cured of acute pyelonephritis. He was treated with solifenacin and started clean self-intermittent catheterization (CIC). Shortly after the start of CIC, the acute pyelonephritis flared up again, and he was managed with a reinserted urethral catheter until an untethering operation. Preoperative video urodynamics showed that the bladder morphology was Ogawa classification grade III with vesicoureteral reflux (VUR) at 92 ml infusion. With the combination of an untethering operation and additional mirabegron, the functional bladder capacity was increased to 353 ml and VUR improved, allowing for safe urinary management of the CIC. TCS can be diagnosed at any age and requires appropriate urinary management and therapeutic intervention as early as possible after diagnosis.

A ganglioneuroma is a rare, benign, neurogenic tumor originating from the sympathetic ganglion. Mediastinal ganglioneuroma are mostly detected in children, typically around 10 years of age, and are rarely identified in adults. Herein, we report two surgically resected cases of mediastinal ganglioneuroma in adults. In Case 1, a 53-year-old man, without any symptom, underwent a computed tomography, revealing a 3.2 cm well-defined paravertebral superior mediastinal tumor with long craniocaudal axis. In case 2, a 29-year-old woman presented with newly-developed ptosis and a history of left-sided facial hypohidrosis since the age of 10. Chest computed tomography (CT) revealed a 7.8 cm well-defined paravertebral superior mediastinal tumor with long craniocaudal axis. Both patients were initially suspected to have neurogenic tumors, particularly schwannomas. They underwent mediastinal tumor resections, requiring sympathetic nerve trunk dissection. Pathological examination confirmed the diagnosis of ganglioneuromas in both cases. Mediastinal ganglioneuroma must be differentiated from schwannoma, the most common neurogenic tumor in adults. Unlike schwannoma, ganglioneuroma cannot be enucleated, therefore attention should be focused on complications associated with sympathetic nerve trunk dissection, such as Horner's syndrome, hyperhidrosis, and arrhythmia. Identifying this rare entity and its characteristic imaging aids in preoperative differentiation, strategizing surgical approaches, and predicting complications.

Objectives　We aimed to clarify the relationship between economic insecurity and the psychological profiles of mothers raising infants by analyzing data from three-month health check-ups in relation to the birth population in order to generate basic data that can be used to consider support for families facing economic insecurity.Methods　The study area was a neighborhood in a major Japanese city. The survey focused on 1013 mothers who had received health check-ups for children aged 18 months between November 2017 and October 2019. The data included in the analysis were data from the children's three-month health check-ups and survey data from 908 mothers who responded to the questionnaire and consented to the use of their health check-up data. After excluding data from potential participants who were not mothers or had multiple births, data from 847 participants were analyzed (valid response rate: 93.3%).　The objective variables were mothers' mood and thoughts about life with their children at the time of the three-month check-up as the mothers' psychological profiles. The explanatory variable was the presence or absence of maternal economic insecurity, and logistic regression analysis was conducted, adjusted for the children's sex and birth order, presence or absence of maternal counselors, and the mothers' educational attainment.Results　A total of 60 (7.1%) mothers were economically insecure. Of the mothers' moods, 122 (14.4%) reported feeling anxious, followed by 36 (4.3%) who reported feeling lonely. Of their thoughts on life with their children, 776 (91.6%) mothers reported that they enjoyed it, and 567 (66.9%) reported that they were happy to be parents. On the other hand, 157 (18.5%) reported feeling frustrated, and 75 (8.9%) reported that the lack of time for themselves was painful. Economically insecure mothers had an odds ratio of 5.59 (95% confidence interval, 2.49-12.55) for feeling lonely, 4.77 (2.67-8.54) for feeling anxious, and 2.70 (1.50-4.86) for feeling frustrated, all significantly higher than in mothers not facing economic insecurity.Conclusion　Economic insecurity among mothers at the time of the three-month check-up was associated with the psychological states of loneliness, anxiety, and frustration about living with their children. It was suggested that to solve economically insecure mothers' problems, they need support, including connecting them with social welfare services, so that they will be able to raise their children in a more stable environment.

Patients with special backgrounds such as organ dysfunction, elderly individuals, children, and pregnant or nursing women in whom the pharmacokinetics of an agent are expected to differ from those observed in the general patient population, are referred to as "special populations." Administration of drug therapy to these patients warrants close attention to and knowledge of altered pharmacokinetics to design appropriate personalized dosing regimens. In this study, we investigated the effects of hypothermia and renal impairment on drug pharmacokinetics, focusing on tissue distribution. Analysis of the effects of hypothermia on local liver kinetics of drugs revealed decreased activity of drug-metabolizing enzymes and transporters. Furthermore, we investigated in vivo drug pharmacokinetics and observed that blood drug concentrations increased with a decrease in the body temperature. However, the tissue concentration of midazolam (MDZ) remained unchanged even with a decrease in body temperature, which indicates reduced tissue transfer of MDZ. With regard to the effect of renal impairment, blood concentration of MDZ decreased in patients with acute renal failure and increased in those with chronic renal failure. However, MDZ clearance was decreased in patients with chronic renal failure owing to decreased expression of hepatic metabolic enzymes and reduced hepatic blood flow. This study highlights that tissue translocation of drugs differs across special populations and that optimization of drug administration based on the prediction of tissue concentrations is important.

Objectives: The objectives of this study were to develop a Japanese version of the Pediatric Epilepsy Medication Self-Management Questionnaire Caregiver Version (PEMSQ-J) and to examine its reliability and validity., Methods: A quantitative cross-sectional study was conducted among primary caregivers (N=309) of children under the age of 18 taking epilepsy medication. The PEMSQ-J was the main instrument used to collect information such as basic demographics.Cronbach's α was calculated to determine internal consistency, and the intraclass correlation coefficient was calculated to assess reproducibility. In addition, confirmatory factor analysis with covariance structure analysis was performed to confirm the goodness of fit of the model. Finally, criterion-related validity was confirmed., Results: Analysis of responses to items on the PEMSQ-J revealed no ceiling or floor effects, and there was no marked bias in distributions in terms of skewness or kurtosis. Internal consistency assessed with Cronbach's α ranged from 0.847 to 0.935. A test of reproducibility revealed that the intraclass correlation for the total score was 0.730. Exploratory factor analysis identified two factors, which differed from the four factors in the original version. When their details and structure were examined, however, the two were interpreted as having a similar structure. Similarly to those of the original version, the goodness-of-fit indices for the four factors according to confirmatory factor analysis were close to the standard values., Conclusion: The PEMSQ-J, which consists of 27 items with a four-factor structure, was statistically acceptable, and it was found to have a certain degree of reliability and validity.

The new guidelines for pediatric immune thrombocytopenia (ITP) not only include changes to the name and staging of the disease, but also introduce the modified Buchanan's bleeding score for the assessment of bleeding symptoms. Treatments should aim to improve patients' health-related quality of life (HRQoL) based on a multidimensional assessment of not only platelet counts but also bleeding symptoms, as well as activity level, lifestyle, and access to healthcare. First-line therapy includes intravenous immunoglobulin therapy (IVIG) and short-term corticosteroids. Second-line therapy includes thrombopoietin receptor agonists, rituximab, and splenectomy. Many novel agents are also in development, with splenic-derived tyrosine kinase (Syk), Bruton's kinase (BTK), and fetal Fc receptor (FcRn) attracting attention as target molecules. Future developments in the treatment of pediatric ITP are eagerly awaited.

Tisagenlecleucel, a commercially available CD19-targeted CAR-T cell product, has dramatically changed the treatment of relapsed/refractory B-cell acute lymphoblastic leukemia (B-ALL). Tisagenlecleucel infusion has been linked to distinct acute adverse events, including cytokine release syndrome, neurotoxicity, hemophagocytic lymphohistiocytosis and prolonged pancytopenia, which are rare with cytocidal chemotherapy. In addition, recent retrospective studies have revealed pre-infusion prognostic factors including high tumor burden (bone marrow leukemia cell fraction ≥5%) and non-response to blinatumomab, another CD19-targeting agent. Not only physicians providing CAR-T cell therapy but also those referring patients for this therapy should thoroughly understand the indications and limitations, characteristic acute complications, pre-treatment factors affecting prognosis, and late complications. This article outlines the current understanding regarding the use of tisagenlecleucel in children and adolescents with B-ALL.

Acute myeloid leukemia (AML) accounts for approximately 25% of pediatric leukemia cases in Japan, with approximately 150 patients being newly diagnosed with AML annually. Pediatric acute myeloid leukemia is classified into three groups: myeloid leukemia associated with Down syndrome (ML-DS), acute promyelocytic leukemia (APL), and de novo AML. Patients with ML-DS have an event-free survival rate over 80%; however, relapsed patients have dismal outcomes, even if they receive hematopoietic cell transplantation. APL is curable with all-trans retinoic acid and arsenic trioxide. In de novo AML, 10% of patients fail to achieve remission, and approximately 30% of patients who successfully achieve remission subsequently experience AML relapse. This review highlights the therapeutic approach for these three diseases with context from past clinical studies in Japan, and shares promising new therapeutic options for relapsed/refractory de novo AML.

Objective: The purpose of this study was to evaluate the efficacy of sublingual immunotherapy (SLIT) with house dust mite (HDM) on pediatric perennial allergic rhinitis (AR) based on longitudinal assessment of nasal symptoms, laboratory examination, and in vivo biomarkers., Method: The subjects included 40 children with perennial AR who had SLIT with HDM for 2 years. Nasal symptoms, medications, skin prick tests, nasal provocation tests, and peripheral blood tests were evaluated before, 6 months, one year and two years after the onset of SLIT., Results: Total nasal symptom scores, prick test wheal diameter, and peripheral blood eosinophil count decreased in 6 months. Total nasal symptom scores continued to decrease from 6 months to 2 years. Symptom-medication scores and nasal provocation test responses decreased in 1 year. Symptom-medication scores continued to decline from 1 to 2 years. Medication scores and nasal eosinophilia decreased in 2 years. Serum specific IgE to HDM slightly increased transiently and decreased in 2 years. The severity of symptoms and specific IgE to HDM at the baseline, and changes of symptoms and specific IgE to HDM during the first six months and first one year of SLIT were correlated with improvement in symptom scores over two years of SLUT. TNSS at baseline was correlated with that at second year., Conclusion: Longitudinal assessment of symptoms, allergen specific IgE, and in vivo biomarkers showed the effectiveness of SLIT. Symptom scores and allergen specific IgE may also be early predictive factors of SLIT efficacy in children with AR.

Many effective new agents for relapsed childhood acute lymphoblastic leukemia (ALL) are now becoming available, and international standard chemotherapy should be developed to optimize use of these agents. Randomized controlled trials (RCTs) are needed to establish a standard treatment, but few have been conducted for relapsed childhood ALL in Japan due to the small patient population. Participation in international RCTs is necessary to access sufficient patients for informative study results, but differences in approved drugs and healthcare systems between countries make this challenging. In 2014, the Japanese Pediatric Leukemia/Lymphoma Study Group (JPLSG) participated in an international study on standard-risk relapsed childhood ALL (IntReALL SR 2010) involving two RCTs and multiple drugs not approved in Japan, which was addressed by replacing the unapproved drugs with alternative approved drugs with the same or similar efficacy. This article discusses the historical background of treatment development for relapsed childhood ALL, our experience in participating in the IntReALL SR 2010 trial, and prospects for treating relapsed childhood ALL.

Gibberellin-regulated protein (GRP) is a newly discovered allergen in systemic fruit allergies. The kind of fruits which cause allergy is extensive as GRP is universally included in plants. Two children with GRP allergy were reported. Case 1: A 6-year-old boy experienced anaphylaxis while running after school lunch, which included canned peaches. A skin prick test (SPT) and blood examination suggested that he had peach GRP allergy. Six months and three years later, he experienced a similar episode after eating apple and citrus flesh, respectively. Case 2: An 11-year-old boy experienced anaphylaxis while running after consuming canned peaches during school lunch. A SPT implied that he had peach GRP allergy. However, a similar episode occurred after eating strawberry flesh 18 months later.Patients with GRP allergy often have one or more allergies to fruits other than peaches, as in these cases, and relevant fruits differ depending on the case. Particularly, clinicians should recognize that apple and citrus fruits are frequently included in school lunches as fruit flesh and as flavoring or seasoning in ready-made sauces or dressings. Therefore, an appropriate removal strategy should be considered in school lunches depending on each case of GRP allergy.

Objective: No questionnaire aimed at evaluating the quality of life (QOL) of children with food allergies has been developed in Japan. Therefore, this study was aimed at developing a Japanese version of a QOL questionnaire for children with food allergies to be responded to by their parents., Methods: A 59-question primary questionnaire was developed for parents of children aged 0 to 15 years who had food allergies. Responses to the primary questionnaire were collected, and question items were reduced using factor analysis. Then, a secondary questionnaire consisting of nine questions was developed. The secondary questionnaire, the Food Allergy Quality of Life Questionnaire - Parent Form (FAQLQ-PF), and the parent-reported questionnaire on health-related quality of life in children and adolescents (KINDL) were administered to parents of children aged 3 to 15 years who had food allergies., Results: Overall, 342 parents completed all questionnaires. The QOL scores of the secondary questionnaire were significantly correlated to those of the FAQLQ-PF (r=0.765) and weakly correlated to those of the KINDL (r=-0.358). In addition, QOL scores were significantly worse in patients with a history of anaphylaxis, who were prescribed an adrenaline auto-injector, and who were allergic to hen's eggs, cow milk, or wheat., Conclusion: We were able to develop a parent-reported validated Japanese version of the QOL questionnaire for children with food allergies.

A 25-year-old woman with a history of B-cell acute lymphoblastic leukemia over ten years ago was referred to our hospital with a chief complaint of leukoblastosis. She was participating in a JPLSG (Japanese Pediatric Leukemia/Lymphoma Study Group) clinical study at that time. We diagnosed ALL relapse by multi-color flow cytometric analysis of bone marrow samples at admission, with reference to previous JPLSG data. Because her leukemic cells were resistant to conventional cytotoxic agents, she proceeded to lymphocyte apheresis for chimeric antigen receptor T-cell (CAR-T, Tisagenlecleucel [Tisa-cel]). She received two cycles of inotuzumab ozogamicin as a bridging therapy to Tisa-cel, resulting in a hematological complete remission (minimal residual disease measured by polymerase chain reaction [PCR-MRD] was positive at 1.0×10 -4 ). She was finally administered Tisa-cel and achieved MRD negativity. She is currently in complete remission with careful MRD monitoring. This strategy of sequential bi-targeted therapy combining antibody conjugates and CAR-T cells provides tumor control in deeper remission and minimal damage to organ function through reduced use of cytotoxic anti-tumor agents. Therefore, we believe that this therapeutic strategy is an effective and rational treatment for adolescent and young adult ALL patients.

Objective: Quality of life (QOL) questionnaires for parents of children with food allergies have been developed in the United States and Europe. However, no original Japanese QOL questionnaire has been developed till date. We aimed to develop an original questionnaire to evaluate the QOL in parents of children with food allergies in Japan., Methods: We collected QOL-related questions from parents of children with food allergies aged 0-15 years, and created a primary questionnaire. Responses to the primary questionnaire were obtained from the parents again, and question items were reduced using factor analysis to create a secondary questionnaire comprising eight items. In addition to the secondary questionnaire, responses to the Food Allergy QOL Questionnaire-Parent Form (FAQLQ-PF) Japanese version, Parent reported Health-Related QOL in children and adolescents (KINDL) and Health-related QOL (SF-8) were obtained from parents to assess the validity of the secondary questionnaire., Results: A total of 407 parents completed all questionnaires. The secondary questionnaire scores were positively correlated with those of FAQLQ-PF and weakly negatively correlated with the KINDL and SF-8 mental component summary scores. Parents of children with food allergies with ≥3 culprit foods or severe reactions to daily foods, a history of anaphylaxis, and those carrying adrenaline autoinjectors scored higher and had lower QOL., Conclusion: The developed original questionnaire is a valid QOL questionnaire for Parents of children with food allergies.

We report a case of testicular torsion in an 8-year-old who was referred to our hospital for right groin pain. He was diagnosed with right retractile testis during a 12-month check-up. However, instead of performing orchiopexy, he was placed under observation until the age of 5, after which he did not seek medical attention. Physical examination revealed swelling and tenderness in the right inguinal region and no palpable testis in the right scrotum. Ultrasound and computed tomography revealed right testicular torsion, and emergency surgery was performed. Intraoperative findings revealed a dark and ischemic testis that was twisted at 180°in the right inguinal region. There was no improvement in blood flow even after the testicular torsion was released; therefore, right orchidectomy with left orchiopexy was performed. Although the incidence of testicular torsion is higher in patients with an undescended testis than in those with a normally positioned scrotal position testis, reports of testicular torsion associated with a retractile testis are rare.

Cedar pollen is known as a typical allergen that causes various allergic symptoms in the nasal mucosa, conjunctiva, and skin. However, inflammation of the vulvar mucosa due to sensitization to cedar pollen is not well-known. We experienced two cases in which the detection of cedar pollen during microscopic urine sediment examination led to the diagnosis of allergic vulvovaginitis caused by cedar pollen. The cases involved a 4-year-old girl and a 10-year-old girl. In both cases, the patients presented with chief complaints of pruritis in the vulva and insomnia due to frequent urination during the season of cedar pollen dissemination. Both patients were afebrile. No inflammatory skin changes such as erythema, swelling, or non-purulent discharge from mucous membranes of the vulva were observed. Microscopic urine sediment examination revealed large amounts of shed cedar pollen. The patients' conditions improved after treatment with oral antihistamines and instruction to dry their underwear indoors. Follow-up blood tests revealed high levels of specific anti-IgE antibodies to cedar pollen, thus confirming a diagnosis of allergic vulvovaginitis due to cedar pollen. Cedar pollen can cause allergic vulvovaginitis. Microscopic urine sediment examination is useful, and when combined with specific IgE antibody testing, leads to an appropriate diagnosis. This disease should also be considered in patients with complaints of vulvar discomfort during the season of cedar pollen dissemination.

Herein, we report the case of a 7-year-old girl with a history of atopic dermatitis because of infancy. Her grandfather grew Egoma (Perilla frutescens), and her family frequently consumed food items prepared using Egoma; however, she never consumed them because she did not enjoy these food items; she experienced vomiting, facial swelling, and oral discomfort upon ingesting Egoma during school lunch for the first time. Her food oral challenge test was positive, as well as a skin-prick test with sesame powder. Egoma antigen protein was extracted and reacted with patient serum by immunoblotting, which detected a positive band of approximately 26kDa. She was brought up in an environment with high exposure to Egoma; hence, she most likely developed an allergy to Egoma because of percutaneous sensitization. This is the first time an Egoma allergen analysis has been conducted in Japan, and we consider it to be a valuable case.

The pathogenesis of juvenile myasthenia gravis is similar to that of adult-onset cases, but does differ significantly in that it is predominantly ocular type, has a low antibody-positive rate, a low thymoma complication rate, and a high remission rate. The evidence for the adult treatment strategy of low-dose steroids and fast-acting treatment is insufficient in children, and the safety of immunosuppressive drugs has not been established. Steroid use in children in particular requires caution due to the risk of growth retardation, and while lower doses are desirable, the efficacy of lower doses has not been as fully investigated as in adults. Conversely, experience has shown that the use of adequate doses of steroids results in high remission rates, and there is currently no rationale for recommending lower doses.

Background: The number of students with food allergies is on the increase, while the problems and burdens of school teachers and staff are not yet clear. Our study was designed to identify the unmet needs of school teachers and staff dealing with food allergy in school lunches., Methods: A written questionnaire was sent by mail to 600 elementary and junior high schools in Miyagi Prefecture., Results: Responses were received from 169 schools. The prevalence of food allergy was 5.6% and the EpiPen possession rate was 0.36%. The most common problems perceived by teachers and staff were the "increase in the number of students with food allergies" and the "diversification of causative foods". Other problems included "uncertainty of foods to be removed" and "insufficient collaboration among teachers, guardians, and doctors," which could be improved by the medical providers. In the free descriptions, many respondents complained of an excessive workload and the mental burden of never making a mistake or missing anything., Conclusion: Our survey revealed that while there is a public demand for safe school lunches, the teachers and staff dealing with this demand are under considerable strain. It is necessary to consider reducing the burden, and a sustainable system needs to be established.