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New Findings: What is the central question of this study?Maximal sniff nasal inspiratory and reverse sniff nasal expiratory pressures are measured as inspiratory and expiratory muscle strength, respectively. Is the genioglossus muscle activated during short maximal inspiratory and expiratory efforts through the nose?What is the main finding and its importance?Genioglossus muscle activity occurred with inspiratory muscle activity during a maximal sniff and with expiratory muscle activity during a maximal reverse sniff. These results indicate that genioglossus muscle activity is closely related to the generation of maximal sniff nasal inspiratory and reverse sniff nasal expiratory pressures. Maximal sniff nasal inspiratory pressure (SNIPmax) is widely used to assess inspiratory muscle strength. The sniff nasal inspiratory pressure (SNIP) is lower in patients with neuromuscular disease with bulbar involvement compared with those without, possibly owing to impaired upper airway muscle function. However, the degree to which the genioglossus (GG) muscle, one of the upper airway muscles, is activated during inspiratory and expiratory efforts through the nose remains unclear. Therefore, we examined GG activity during short and sharp inspiratory and expiratory efforts through the nose, i.e. sniff and reverse sniff manoeuvres. In eight normal young subjects, we inserted fine wire electrodes into the GG muscle, parasternal intercostal and scalene (inspiratory) muscles and transversus abdominis (expiratory) muscle. We assessed EMG activity of each muscle and measured SNIP and reverse sniff nasal expiratory pressure (RSNEP) during sniffs and reverse sniffs from low to high intensities in the sitting position. The highest SNIP and RSNEP were analysed as SNIPmax and maximal RSNEP (RSNEPmax), respectively. In each subject, GG EMG activity increased linearly with increasing SNIP and RSNEP. The SNIPmax and RSNEPmax were −85.1 ± 15.9 and 83.2 ± 24.2 cmH2O, respectively. Genioglossus EMG activity varied with EMG activity of the parasternal intercostal and scalene muscles during generation of SNIPmax and with EMG activity of the transversus abdominis muscle during RSNEPmax. Genioglossus EMG activity during generation of SNIPmax was higher than during RSNEPmax (62.9 ± 31.1% EMG of SNIPmax, P = 0.012). These results suggested that GG activity was closely related to the generation of both SNIPmax and RSNEPmax. [ABSTRACT FROM AUTHOR]

Abstract: Background: Anemia in infancy is still prevalent in developing countries. Commercial iron‐fortified complementary foods or iron drops are not available in Japan, and breast‐fed infants have a higher risk of anemia. We studied anemia screening in 10‐month‐old infants to determine whether breast‐feeding is a risk factor for anemia. Methods: Anemia screening was performed during regular health check for 10‐month‐old children at four local pediatric clinics in Shimane Prefecture, Japan. Venous blood was obtained for complete blood count. The clinical characteristics of each child were obtained via questionnaire. Anemia was defined as hemoglobin <11.0 g/dL. Children were categorized into anemia and no‐anemia groups, and univariate analysis was conducted on comparison of the clinical variables. Multivariate logistic regression analysis for anemia was performed to adjust for several clinical variables. Results: We analyzed data in 325 children. On univariate analysis, anemia was associated with breast‐feeding, monthly bodyweight gain and gestational week. On multivariate logistic regression analysis, anemia was associated with feeding type and gestational week (OR of partial breast‐feeding and formula feeding, 0.446; 95%CI: 0.208–0.957; and 0.223; 95%CI: 0.075–0.660, respectively, compared with exclusive breast‐feeding, OR, 1.0; and gestational week, OR, 0.753; 95%CI: 0583–0.972). Conclusion: Breast‐feeding is an important factor for anemia in 10‐month‐old Japanese infants. Breast‐fed infants after 6 months of age may need iron supplements or iron‐fortified complimentary foods. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To analyze the quality of infection control activities, bacteriological data relevant to infection control was evaluated through the microbiological data warehouse networking hospitals in two medical regions. Methods: Data regarding bacterial test results of 19 hospitals were extracted from two microbiological laboratory information data bases. The rate of MRSA among total S. aureus was used as a general indicator of infection control activities. The occupancy rate of nasal or pharyngeal swabs among MRSA‐positive bacteriological samples was used as an indicator of attention paid for infection control in intensive care wards. The number of blood culture sets per examined patient was utilized as an indicator for life‐long vocational education on updated medical practice relevant to infectious diseases. Results: The rate of MRSA was significantly higher in secondary private hospitals. The occupancy rate of nasal or pharyngeal swabs was significantly higher in tertiary hospitals. The average number of blood culture set per examined patient were 1.55, 1.54 and 1.39 in tertiary, secondary public and secondary private hospitals, respectively; however, there were no statistical differences between groups. Conclusions: Data bases of microbiological test results shared by hospital laboratories are useful for evaluating regional infection control activities. [ABSTRACT FROM AUTHOR]

Aim: This study sought to determine the incidence of annular ligament displacement (ALD), also known as nursemaid's elbow, in the first 3 years of life.Methods: A questionnaire was sent to 1098 families between August 2014 and July 2015 before their child attended a routine health check at 3 years of age in Izumo, Shimane prefecture, Japan. The questionnaire included a brief description about ALD, the age when ALD occurred and how the condition was managed.Results: We received 784 (71.4%) responses and these showed that 61 (7.8%) children had a history of ALD and 31 (51%) were girls. The incidence was 2.6%, calculated by multiplying the number of children by the 3-year observation period. The mean and median ages of the first ALD occurrence were both 25 months. In addition, 28 (46%) children with ALD had a recurrence and the mean number of ALD episodes was 1.8 (range 1-5). The total number of ALD episodes was 108, and of these, 33 (30%) were seen at the hospital emergency department and 17 (16%) spontaneously resolved.Conclusion: This study confirmed that ALD was a common occurrence in 3-year-old children and that there was a high rate of recurrence. [ABSTRACT FROM AUTHOR]

Aim The aim of the study was to determine clinical and genetic characteristics of Japanese patients with hyperekplexia. Method Clinical courses, responses to antiepileptic drugs, outcomes, and genetic testing were investigated in 17 Japanese patients (nine males, eight females, median age 1y, range birth-45y) with hyperekplexia. Results In all patients, muscle stiffness and startle responses appeared soon after birth. Only seven patients were diagnosed with hyperekplexia before 1 year of age. Seven patients had been misdiagnosed with other disorders such as epilepsy and adult-onset anxiety neurosis. Umbilical/inguinal hernias were seen in 10 patients. Life-threatening events were noted in four patients. Clonazepam was the most effective drug. Muscle stiffness completely disappeared in 12 patients before 5 years of age, whereas startle responses resolved in only three patients. Mutations in the GLRA1 and GLRB genes were identified in 16 patients and one patient respectively. In 14 patients, the mutation showed autosomal dominant inheritance; in the other three, inheritance was autosomal recessive. p.R271Q of GLRA1 was the most frequent mutation, found in 10 patients. Novel mutations, p.A272P and p.A384P of GLRA1, were detected. Clinical severity and outcome varied even in the same family. Interpretation Early correct diagnosis is essential for prevention of accidental injuries and to provide appropriate treatments for hyperekplexia. Clonazepam is effective, although the time taken for startle responses to resolve varied. [ABSTRACT FROM AUTHOR]

Tailoring the crystallographic orientation in piezoelectric ceramics is very useful for improving their properties. Orientation in ceramics can be controlled by templated grain growth, hot forging, etc. We have focused on using a strong magnetic field for the crystallographic orientation even in diamagnetic ceramics. In a previous study, although only a one-directional orientation could be controlled by these methods, it was difficult to control the multi-axis orientation in the ceramics. In this study, we demonstrated that alignments of the c-axis and the <100> axis in Bi4 Ti3 O12 piezoelectric ceramics were controlled by using a strong magnetic field as well as platelet particles. We also estimated the degree of orientation by an electron back scattering diffraction analysis. When the magnetic field was applied to the platelet particles, appropriately 80% of the grains were aligned with the tilt angle made by the c-axis and the vertical direction less than 10° and 73% of grains were oriented with the angle between the <100> axis and the magnetic field less than 10°. [ABSTRACT FROM AUTHOR]

Textured CaBi4Ti4O15 (CBT) ceramics were fabricated by slip casting in a high magnetic field of 12 T, and a layer structure was obtained by co-firing with the textured CBT ceramics and a metal internal electrode. The crystalline a( b)-axis of CBT was aligned parallel to the magnetic field, and highly a( b)-axis textured ceramics were obtained. The orientation degree of the textured ceramics was 0.82, and the electromechanical coupling coefficient of thickness extensional (TE) vibration was about 1.5 times larger than that of the randomly oriented ceramics. The second harmonic TE vibration was successfully generated in the layer structure specimens, which contained two layers of the textured ceramics and an internal electrode. Therefore, it was recognized that the layer structure was satisfactorily fabricated. [ABSTRACT FROM AUTHOR]

Double-layered piezoelectric ceramic resonators were fabricated using layer stacking with lead–titanate-based ceramics and strontium–bismuth–niobate (SBN)-based ceramics, which are extremely stable against temperature changes or high-temperature retention. Single-mode resonant characteristics of the second harmonic thickness-extensional (TE2) mode vibration can easily be obtained in those resonators. The dispersion curves of the TE2 vibrations were calculated and the results can explain the single-mode resonant phenomenon in the TE2 mode. SBN-based ceramic materials are quite adequate for the fine-tolerance resonator applications, because their electromechanical coupling coefficients are sufficiently small. Strontium site substitutions for SBN improved the temperature coefficient of frequency. [ABSTRACT FROM AUTHOR]

Abstract The case of a 1-year-8-month-old-boy with cerebral infarction after varicella infection is reported here. Brain magnetic resonance (MR) angiography revealed segmental narrowing of the left middle cerebral artery which became normal 8 months later. The MR angiography well demonstrated the time course of the vascular involvement in the present patient. In cerebral infarction after varicella infection, the proximal portion of the main cerebral arteries were frequently damaged therefore MR angiography is useful for diagnosis and therapeutic decision-making. Moreover, serial MR angiographic studies can clarify the natural course of vascular changes in varicella virus-related cerebral infarction. [ABSTRACT FROM AUTHOR]

AbstractA prospective study of antiepileptic drug (AED) reduction in patients with unprovoked seizures and severe neurological abnormalities after a seizure-free period of more than 5 years was performed. From a hospital for severely handicapped children (150 patients) and an institution for mentally handicapped people (89 persons), 13 patients were enrolled to this study after informed consent was obtained. All patients had experienced a seizure-free period of more than 7 years (median, 10 years). The patients had IQs of less than 50 and were almost dependent in their life. Five patients had additional motor deficits. The patients had been taking one to three AED (mean, 1.9) before reduction and only one AED was withdrawn. During the following 2 years, four of the 13 patients (31%) showed a recurrence of seizures. The age at the time of the last seizure was lower in the seizure-free patients. As to the 10 patients with onset ages of 10 or less, a significant factor as to seizure recurrence was whether or not seizures were controlled before the age of 11 years (P < 0.05, Fisher’s exact probability test). It is suggested that a patient with severe neurological abnormalities, in whom epilepsy or unprovoked seizures are controlled before the age of 11 years (i.e. before adolescence) could be a candidate for the reduction of AED. [ABSTRACT FROM AUTHOR]

Aims We investigated the effect of angiotensin converting enzyme inhibitors (ACEIs) on postsynaptic adrenoceptor sensitivity and compared the effect of the lipophilic ACEI, quinapril, and that of hydrophilic agent, enalapril in human vessels. Methods α-adrenoceptor sensitivity was evaluated using the dorsal hand vein compliance technique. The dose–response curves of vasoconstriction to phenylephrine and prostaglandin F2α were obtained in healthy male volunteers. Results The ACEIs shifted the dose–response curve of phenylephrine to the right and raised the median effective dose (ED50; 189.3 (57.6 ng min-1 ) of phenylephrine. Following quinapril administration, ED50 increased to 481.1 (101.8 ng min-1 compared with 266.8 (55.8 ng min-1 after enalapril (95% CI for differences; 31.1–397.5 ng min-1 ). Quinapril administration had no effect on the dose–response curve of PGF2α. Conclusions ACE inhibition attenuates α-adrenoceptor sensitivity in human vessels. The effect of quinapril, a lipophilic ACEI, was greater than that of enalapril, a hydrophilic ACEI. Lipophilic ACEIs may be more potent in vasodilating effect than hydrophilic ACEIs. Angiotensin II concentration in tissue rather than that in plasma may contribute to the α-adrenoceptor sensitivity of the vessels. [ABSTRACT FROM AUTHOR]

Aims Triazolam, a triazolobenzodiazepine hypnotic agent, is metabolized by CYP3A4. Diltiazem is an inhibitor of this isozyme. The aim of this study was to determine if diltiazem affects plasma concentrations of triazolam in humans. Methods We investigated the interaction between triazolam and diltiazem in a randomized, three-phase crossover study. Seven healthy male volunteers received orally either a single 0.25 mg dose of triazolam, a 0.25 mg dose of triazolam after a 3-day treatment of diltiazem (180 mg day−1), or a placebo. Plasma samples were collected to determine triazolam concentration over a 24 h period. The pharmacodynamic effects of triazolam were investigated using the peak saccadic velocity of eye movements (PSV), electroencephalogram (EEG), and visual analogue scale (VAS) through 8 h. Results Diltiazem pretreatment significantly increased the area under the triazolam concentration-time curve (8.0±2.4 to 18.2±3.1 ng ml−1 h; P<0.001; mean±s.d.). Peak triazolam concentration was increased (2.1±0.7 to 3.6±1.0 ng ml−1, P<0.05) and the elimination half-life prolonged (4.1±2.1 to 7.6±1.9 h; P<0.01). The PSV, EEG, and VAS of the triazolam plus diltiazem group revealed significant differences from the triazolam alone group or the control placebo group. Conclusions Diltiazem markedly affects the pharmacokinetics of triazolam and increases the intensity of its sedative effects. Inhibition of CYP3A isozyme by diltiazem may explain the observed pharmacokinetic interaction. Therefore, triazolam should be avoided when patients are using diltiazem. [ABSTRACT FROM AUTHOR]

1 We investigated the pharmacokinetics and pharmacodynamics of (±)-sotalol administered orally to healthy male volunteers in single doses of 40, 80 and 160 mg and in multiple doses of 80 mg twice daily for 7 consecutive days. 2 In the single dose studies, the half-life of (-)-sotalol (7.2-8.5 h) was significantly ( P < 0.01) shorter than that of (+)-sotalol (9.1-11.4 h) while the renal clearance of (-)-sotalol (110.6-126.4 ml min-1) was significantly ( P < 0.01) faster than that of (+)-sotalol (102.2-110.1 ml min-1). In the multiple dose studies, similar differences in the pharmacokinetics of (+)- and (-)-sotalol were observed. In addition, the pharmacokinetics of both (+)- and (-)-sotalol on day 4 were shown to be essentially the same as those on day 7. 3 In pharmacodynamic examinations, (±)-sotalol prolonged QTc intervals on electrocardiograms dose-dependently after single doses of 80 and 160 mg (3.81 ± 2.96%, 13.23 ± 5.66%). The correlation between the plasma concentration of (±)-sotalol and prolongation of QTc intervals was nearly linear, and showed no hysteresis. 4 In conclusion, we demonstrated that QTc interval was prolonged with a linear correlation to the plasma concentration of (±)-sotalol. In addition, our study suggested that differences in the pharmacokinetics of (+)- and (-)-sotalol may be attributable to faster urinary excretion of (-)-sotalol. [ABSTRACT FROM AUTHOR]

The case of a 5-month-old boy with tuberous sclerosis and West syndrome is reported. Tonic spasms were noted from the age of 4 months. High-dose pyridoxal phosphate could not control the seizures completely. Very short and low-dose adrenocorticotropic hormone (ACTH) therapy (i.e. 0.011 mg/kg per dose, 12 times in 20 days) controlled the seizures, while pyridoxal phosphate was on. Early tapering of ACTH was successfully done while abnormal electroencephalogram (EEG) findings remained. Although side effects such as hypertension and brain shrinkage were transiently observed, both the cognitive and seizure prognoses were excellent at the age of 3 years and 2 months. The good response to a small dosage of ACTH might be due to some responsiveness of the high-dose pyridoxal phosphate and the underlying cause of tuberous sclerosis with normal development before onset. The present case illustrates that the duration and dosage of ACTH therapy in West syndrome should be modified according to the individual’s requirements. [ABSTRACT FROM AUTHOR]

A pulled elbow is a common childhood orthopaedic injury that is usually caused by longitudinal traction on the hand. The pathophysiological mechanism of a pulled elbow involves interposition of the annular ligament into the radiohumeral joint. Recent ultrasonographic studies have shown that both the supinator muscle and annular ligament were trapped into the radiohumeral joint. This paper discusses why pulled elbows can occur during pronation and how a pulled elbow can be reduced either by hyperpronation or supination followed by elbow flexion based on the function of the supinator muscle., (© 2021 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)