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Anaphylaxis is a common condition observed in emergency departments and is sometimes associated with a fatal outcome. This may be a good way to prevent I Anisakis i allergy.[[4]] Although previous studies conducted in Spain reported I Anisakis i allergy incidences of 10.8%-11.1%,[[6]] I Anisakis i -related anaphylaxis has rarely been reported in other areas.[[1], [8]] The consumption of a raw fish diet in Japan may have contributed to this epidemiological difference. [Extracted from the article]

We describe a patient with sporadic amyotrophic lateral sclerosis (ALS) who showed progressive deterioration of sensory cortex excitability at the advanced stage, while using invasive ventilation. At the time of diagnosis, the patient showed enlarged N20 of the median nerve somatosensory evoked potential (SEP). Following ventilator use through tracheostomy, the patient gradually fell into a totally locked-in state for four years and the N20 showed progressive deterioration in the amplitude, which finally led to its loss. Magnetic resonance imaging (MRI) showed frontotemporal and mild parietal cortex atrophy, subcortical white matter hyperintensity and brainstem atrophy suggesting the involvement of the central sensory pathways. MRI and flash visual evoked potentials revealed that the occipital lobe was well-preserved throughout the course of the disease. This is the first case report of a physiological demonstration of multisystem neurodegeneration involving the central sensory pathway in a patient with advanced ALS and invasive ventilation use. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsTo investigate the impact of different ventilatory support options on opioid use among patients with amyotrophic lateral sclerosis (ALS).We retrospectively reviewed 889 consecutive patients with ALS and enrolled 399 eligible patients. All patients were followed until death or tracheostomy. Clinical characteristics of patients and the timing of initial opioid administration were evaluated. Patients were categorized into four subgroups: (1) 160 patients who never used a ventilator, (2) 120 patients who used only noninvasive ventilation (NIV), (3) 61 patients who transitioned from NIV to tracheostomy and invasive ventilation (TIV), and (4) 58 patients who underwent TIV without prior NIV. We compared the prevalence of opioid use across these groups and assessed its relationship with ventilatory support options using multivariate logistic analysis.A total of 130 patients (32.6%) used opioids. The number of patients who used opioids in each group was as follows: 55 (34.4%) in Group 1, 69 (57.5%) in Group 2, 5 (8.2%) in Group 3, and 1 (1.7%) in Group 4 (p < 0.0001). Multivariate logistic analysis revealed that, compared to Group 1, the use of NIV only was positively associated with opioid use (p = 0.002). In contrast, transitioning from NIV to TIV (Group 3) and using TIV only (Group 4) were negatively associated with opioid use (p = 0.0001 and 0.001, respectively).The choice of ventilatory support significantly influences opioid use in patients with ALS. Patients who opted against TIV required opioids to relieve distress more commonly than those who chose TIV. [ABSTRACT FROM AUTHOR]

Background: Chronic subdural hematoma (CSDH) is a condition that tends to recur frequently. Although middle meningeal artery embolization (MMAE) is an effective CSDH treatment, there is currently no consensus regarding the optimal timing for embolization., Methods: In this single-center and retrospective study, we reviewed 72 cases with 1 st -time recurrent CSDH from January 2018 to July 2023 and identified those treated with MMAE to examine its effect and the impact of differences in the timing of treatment., Results: Of the 72 cases with CSDH recurrence for the 1 st time (mean age: 80.4 ± 9.7 years; men: 62 [86.1%]; mean first recurrence interval: 33 ± 24 days), 27 (37.5%) experienced a second recurrence. The mean first recurrence interval was shorter in cases with a second recurrence compared to cured cases: 24.3 ± 18.6 versus 38.3 ± 25.6 days, respectively ( P = 0.005). MMAE was performed in 17 (23.6%) cases (mean age: 82 ± 6.2 years; men: 14 [82.4%]). The mean time from initial surgical treatment to embolization was 52.4 ± 35.4 days, and the mean recurrence interval before MMAE was 24.9 ± 19.6 days. Six cases (35.3%) experienced post-embolization recurrence and required surgical treatment. The mean recurrence interval before MMAE was shorter in cases with recurrence after MMAE (15 ± 6.4 vs. 30 ± 22.1 days, P = 0.023). The time from initial surgical treatment to embolization was significantly shorter: 31.3 ± 12.8 versus 63.9 ± 38.9 days ( P = 0.039)., Conclusion: Cases with a short first recurrence interval were more likely to experience a second recurrence. Repeated recurrences within a short time increased the likelihood of post-embolization recurrence. MMAE performed early following the initial surgical treatment increased the recurrence risk., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Surgical Neurology International.)

Diagnosing neuralgic amyotrophy can be challenging in clinical practice. Here, we report the case of a 37-years old Japanese woman who suddenly developed neuropathic pain in the right upper limb after influenza vaccination. The pain, especially at night, was severe and unrelenting, which disturbed her sleep. However, X-ray and MRI did not reveal any fractures or muscle injuries, and brain MRI did not reveal any abnormalities. During neurological consultation, she was in a posture of flexion at the elbow and adduction at the shoulder. Manual muscle testing suggested weakness of the flexor pollicis longus, pronator quadratus, flexor carpi radialis (FCR), and pronator teres (PT), while the flexor digitorum profundus was intact. Medical history and neurological examination suggested neuralgic amyotrophy, particularly anterior interosseous nerve syndrome (AINS) with PT/FCR involvement. Innervation patterns on muscle MRI were compatible with the clinical findings. Conservative treatment with pain medication and oral corticosteroids relieved the pain to minimum discomfort, whereas weakness remained for approximately 3 months. For surgical exploration, lesions above the elbow and fascicles of the median nerve before branching to the PT/FCR were indicated on neurological examinations; thus, we performed high-resolution imaging to detect possible pathognomonic fascicular constrictions. While fascicular constrictions were not evident on ultrasonography, MR neurography indicated fascicular constriction proximal to the elbow joint line, of which the medial topographical regions of the median nerve were abnormally enlarged and showed marked hyperintensity on short-tau inversion recovery. In patients with AINS, when spontaneous regeneration cannot be expected, timely surgical exploration should be considered for a good outcome. In our case, MR neurography was a useful modality for assessing fascicular constrictions when the imaging protocols were appropriately optimized based on clinical assessment.

Aim: The 22q11.2 deletion syndrome (22q11DS) is associated with a high prevalence of mental health comorbidities. However, not enough attention has been paid to the elevated prevalence of high trait anxiety that begins early in life and may be enduring. We sought to identify specific medical, welfare, or educational difficulties associated with high trait anxiety in 22q11DS., Methods: A questionnaire-based survey was conducted for the parents of 22q11DS individuals ( N  = 125). First, a multiple regression analysis was conducted to confirm the hypothesis that high trait anxiety in individuals with 22q11DS would be associated with parents' psychological distress. This was based on 19 questionnaire options regarding what difficulties the parents currently face about their child's disease, characteristics, and traits. Next, we explored what challenges faced in medical, welfare, and educational services would be associated with the trait anxiety in their child., Results: The multiple regression analysis confirmed that the high trait anxiety was significantly associated with parental psychological distress ( β  = 0.265, p  = 0.018) among the 19 clinical/personal characteristics of 22q11DS. Furthermore, this characteristic was associated with various difficulties faced in the medical care, welfare, and education services, and the parent-child relationship., Conclusion: To our knowledge, this is the first study to clarify quantitatively how the characteristic of high anxiety level in 22q11DS individuals is related to the caregivers' perceived difficulties in medical, welfare, and educational services. These results suggest the necessity of designing service structures informed of the fact that high trait anxiety is an important clinical feature of the syndrome., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Aim: Young carers (YCs) refer to children under the age of 18 who assume responsibilities that would normally be assumed by adults, such as caring for family members in need of care. In recent years, the concept of YCs has been expanding in Japan, and the government has been rapidly implementing strategies to support them. There is a need for a survey scale for YCs that uses standardized methods that can be compared internationally., Method: The BBC/University of Nottingham Survey for estimating the prevalence of YCs and caring activities of United Kingdom adolescents was translated into Japanese, and its reliability and validity were tested with 313 adolescents. Moreover, the prevalence of YCs was estimated in a school-based survey among 5000 adolescents., Results: The Young Carers Scale Japanese version (YCS-J) was acceptably reliable and valid. The original six-factor model for caring activity in the Multidimensional Assessment of Caring Activities Checklist for Young Carers (MACA-YC18) was supported by confirmatory factor analysis. The prevalence of YCs among 5000 adolescents in the Tokyo metropolitan area was estimated to be 7.4%, comparable to that reported in Western countries and in recent surveys in Japan using nonstandardized methods. YCs exhibited significantly higher scores for prosocial behavior and emotional symptoms than non-YCs., Conclusions: The YCS-J, as an internationally comparable instrument, will be useful for understanding the actual situation of YCs in Japan, and to disseminate and implement support through cooperation among education, welfare, and healthcare sectors., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Aim: Online classes were implemented in numerous schools during the school closure due to COVID-19. The present study examined the relationship between online classes during national school closure and mental health symptoms after the reopening of schools., Methods: We conducted a cross-sectional survey from October 1 to November 7, 2020 using an anonymous self-reported questionnaire to evaluate 21 junior and senior high schools in the Saitama prefecture of Japan. Out of the 5538 students who were recruited, 5000 agreed to participate. The relationship between the implementation of online classes and mental health symptoms (emotional symptoms, psychotic experience [PE], and smartphone addiction) was evaluated using mixed-effect logistic regression models, while controlling for individual and class-level covariates (e.g., gender, grades)., Results: Implementation of online classes was reported by 78.2% of classroom teachers, and it was associated with lower rates of emotional symptoms (OR = 0.79, 95% CI = 0.63-0.99, p  = 0.040) and smartphone addiction (OR = 0.79, 95% CI = 0.65-0.96, p  = 0.020), but not related to PE (OR = 0.91, 95% CI = 0.61-1.36, p  = 0.637)., Conclusions: Implementing online classes during the national school closure might have had a potential protective effect for adolescents' mental health symptoms (especially emotional symptoms and smartphone addiction) after the reopening of schools during the ongoing COVID-19 pandemic., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Objective: The vessel compression at the root entry zone (REZ) of trigeminal nerve is a common cause of trigeminal neuralgia (TN). We report a rare case of TN caused by dural arteriovenous fistula (DAVF) of the transverse-sigmoid sinus without vessel compression at REZ., Case Presentation: A 45-year-old woman presented with right side tinnitus and was diagnosed as a DAVF of the right transverse-sigmoid sinus (Borden Type I). After that, the facial pain in the right maxillary nerve area appeared and was getting worse. DSA revealed an enlargement of the artery of foramen rotundum (AFR) as one of the feeding arteries. MRI revealed no evidence of vascular compression at REZ. The patient was treated with transarterial embolization (TAE) with Onyx via the branches of the middle meningeal artery (MMA) and occipital artery (OA). The AFR decreased in size and the facial pain was improved. However, the DAVF and the facial pain were recurred. Finally, the DAVF was completely embolized with transvenous embolization (TVE). During 1-year follow-up period, the patient remained free of pain without recurrence., Conclusion: The compression of the maxillary nerve by the AFR might result in TN, because the pain diminished after shrinkage of the AFR by the endovascular treatment., Competing Interests: The authors declare that they have no conflicts of interest., (©2022 The Japanese Society for Neuroendovascular Therapy.)

Immersion pulmonary oedema (IPE) is particularly associated with an excessive reaction to exercise and/or cold stress. IPE usually resolves without recompression therapy within a day or two. Herein we report a diver diagnosed with IPE, in whom symptoms persisted for five days. A 58-year-old man presented with sudden onset of dyspnoea, cough and haemoptysis after surfacing. He was an experienced diving instructor with a history of moderate mitral valve regurgitation. While IPE was diagnosed and oxygen administered, respiratory symptoms deteriorated, and serum C-reactive protein elevated. No evidence of infection was seen. Three hyperbaric oxygen treatments were given on the basis of suspected decompression sickness, and symptoms subsequently resolved. The recently diagnosed mitral valve regurgitation and inflammatory response were considered to have contributed to the prolongation of symptoms., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)