Factors Associated with Low Albumin in Community-Dwelling Older Adults Aged 75 Years and Above.

This study aimed to clarify the factors associated with low albumin in Japanese older adults aged ≥75 years. The data utilized were the health checkup data of older adults aged ≥75 years from 42 municipalities in Gifu Prefecture, which were provided by the National Health Insurance database system. After excluding the data of individuals with incomplete information on serum albumin, BMI, lifestyle habits, or weight at previous year, the data from 18,674 individuals' health checkup were analyzed. A logistic regression showed that low albumin was associated with smoking, not walking at least 1 h/day, slow walking speed, difficulty in chewing, slow eating speed, weight loss in the previous year, and underweight. Furthermore, an analysis conducted for older adults aged ≥85 years showed that low albumin was associated with not walking at least 1 h/day, difficulty in chewing, slow eating speed, weight loss in the previous year, and underweight. In the future, the number of older adults will increase in Japan; therefore, a strategic approach to promote the health of these aged individuals will become even more necessary. An early approach to maintaining an active physical life, an appropriate weight, and good oral function will lead to improved health in older adults.

Developmental changes in visual-cognitive and attentional functions in infancy.

BACKGROUND: Identifying developmental changes in visual-cognitive and attentional functions during infancy may lead to early diagnosis of neurodevelopmental disorders such as ASD and ADHD. AIMS: To clarify the developmental changes in visual-cognitive and attentional functions during infancy (3-36 months of age). STUDY DESIGN: Cross-sectional study. SUBJECTS: We included 23, 24, 31, and 26 participants aged 3, 9, 18, and 36 months, respectively (full-term births). Fifteen children who cried intensely or whose data could not be accurately recorded were excluded. OUTCOME MEASURES: Three activities were given to each child while they were seated in front of a gaze-tracking device to evaluate re-gaze, motion transparency, and color-motion integration. We analyzed whether the child's attention shifted to the new stimulus in their peripheral vision in the re-gaze task. In the motion transparency and color-motion integration tasks, two images were presented simultaneously on the screen. In the motion transparency task, participants preferred random dots moving in opposite directions; in the color-motion task, they preferred subjective contours from apparent motion stimuli consisting of random red and green dots with different luminance. RESULTS: In the re-gaze task, fewer 3-month-olds gazed at the new target than other age groups participants. All ages showed preference for target stimuli in the motion transparency task, but 3-month-olds showed significantly lower preference in the color-motion integration task. CONCLUSION: These tasks may be useful for measuring visual-cognitive and attentional functions in infants.

The Trajectory of Expressed Colostrum Volume in the First 48 Hours Postpartum: An Observational Study.

Objective: Colostrum, the first form of human milk, is strongly encouraged for infants due to its benefits. During the early postpartum (PP) period, the secreted colostrum volume can be minimal, causing concerns among mothers about sufficient milk supply. Few studies have examined temporal changes in the colostrum. This study aimed to elucidate the trajectory of expressed colostrum volume in the first 48 hours after delivery. Materials and Methods: This was a cross-sectional observational study performed at Kagawa National Children's Hospital. One hundred five mothers who did not directly breastfeed in the first 48 hours after delivery were enrolled in the study. Well-trained midwives instructed the mothers on how to express human milk, and mothers started to express as soon as possible after delivery. Mothers were advised to express human milk every 3 hours, and the milk volume was measured. Results: Within 3 hours PP, 60% of mothers expressed milk, and the median frequency of expression was 14 (interquartile range, 11-16) times in the first 48 hours. At 0-3 and 3-6 hours PP, the volume of initially expressed milk was 0.4 (0.0-2.0) mL and 1.0 (0.0-6.0) mL, respectively. Subsequently, milk volume decreased. The volume remained low until 30 hours PP and increased dramatically; this phenomenon is termed secretory activation, which began later in primiparous women than in multiparous women. Conclusion: The decline in expressed milk volume during the early PP period caused concern among mothers. Therefore, mothers should be informed of the PP trajectory of human milk volume.

Chiral Octapalladium Chains Supported by Enantiopure P-Stereogenic Linear Tetraphosphines, (R,R)- and (S,S)-Ph2PCH2P(Ph)CH2P(Ph)CH2PPh2.

Binuclear Pd(II) and Pt(II) complexes supported by rac-dpmppm (bis[(diphenylphosphinomethyl)phenylphosphino]methane) in a triply-bridged Z-form, [M2Cl4(rac-dpmppm)] (M = Pd (3a), Pt (3b)), readily reacted with 2,6-xylyl isocyanide (XylNC) in the presence of NH4PF6 to afford [M2Cl2(rac-dpmppm)(XylNC)2](PF6)2 (M = Pd (4a), Pt (4b)), in which each metal center accommodates one isocyanide ligand at the trans position to the inner P atom of dpmppm. Similarly, treatment of 3a and 3b with axially chiral (R/S)-1,1'-binaphthyl-2,2'-bisisocyanide (rac-Binac) in the presence of NH4OTf gave cyclic tetranuclear complexes, [{M2Cl2(rac-dpmppm)(rac-Binac)}2](OTf)4 (M = Pd (5), Pt (8)), where two {M2Cl2(rac-dpmppm)}2+ fragments are connected by two rac-Binac ligands through chirality sorting of (R*,R*)-dpmppm and (R*)-Binac. Complex 5 could be transformed into the halide exchanged tetranuclear complexes, [{Pd2X2(rac-dpmppm)(rac-Binac)}2](OTf)4 (X = Br (6), I (7)), to show that the rectangular arrangement of four Pd(II) ions is elongated by repulsive interaction between halide ligands. By using (R)- and (S)-Binac, enantiopure Pd4 complexes, [{Pd2Cl2((R*,R*)-dpmppm)((R*)-Binac)}2](OTf)4 (5RR/R and 5SS/S), were successfully isolated as pure crystalline forms, from which enantiopure (R,R)- and (S,S)-dpmppm were obtained by treatment with NaCN aqueous solution. Namely, optical resolution of rac-dpmppm was established through the tetranuclear Pd complexes, which is the first example for methylene-bridged polyphosphines, R2P(CH2PR)nCH2PR2 (n > 0). Furthermore, chiral octapalladium chains, [Pd8((R*,R*)-dpmppm)4(N≡CCH3)2](BF4)4 (2RR and 2SS), were synthesized by reacting enantiopure P-chiral dpmppm with [Pd2(CH3CN)6](BF4)2 and [Pd2(dba)3]·C6H6 and were characterized by spectroscopic and X-ray crystallographic analyses, to determine the absolute configurational structures. The Pd8 chains are the longest enantiopure chiral single-metal-atom chains structurally characterized, thus far, and the electronic structures were examined on the basis of DFT calculations of 2RR.

Association between swallowing function and oral bacterial flora in independent community-dwelling elderly.

BACKGROUND: Increasing incidences of swallowing dysfunction, or dysphagia, a risk factor for aspiration pneumonia, are being reported in aging populations. AIMS: To investigate the relationship between swallowing function and oral bacteria in independent, community-dwelling elderly. METHODS: This study recruited 139 community-dwelling individuals aged ≥ 70 years with poor swallowing function. The presence of anaerobic (Prevotella spp. and Fusobacterium spp.) and aerobic bacteria was examined in the participants' oral cavity flora. Swallowing function was evaluated using a 30 mL water swallowing test. Multivariate logistic regression analyses were performed to examine the association between oral bacteria and swallowing function. RESULTS: Swallowing function was assessed as abnormal in 2.9% and as abnormal in 47.5% of the subjects. The colony-forming units (CFUs/ml) of Prevotella spp. were associated with the swallowing dysfunction (odds ratio [OR] 3.45, 95% confidence interval [CI] 1.49-8.11). Further, CFUs/ml of Fusobacterium spp. and aerobes did not correlate with the swallowing dysfunction but were related with the number of teeth (OR 2.71; 95% CI 1.28-5.74, and OR 0.40; 95% CI, 0.18-0.91, respectively) CONCLUSIONS: Swallowing dysfunction in community-dwelling elderly is associated with increased abundance of Prevotella spp., which indirectly may be an increased risk factor for aspiration pneumonia.

Do low birth weight infants not see eyes? Face recognition in infancy.

BACKGROUND: Progress in neonatal medicine has dramatically improved the survival rate of preterm births, but the evidence suggests that these low-birth weight infants (LBWIs) go on to develop pervasive development disorders and attention deficit hyperactivity disorder (ADHD) at greater rates than the general population. Children with neurodevelopmental disorders are known to suffer from deficits in visual cognition, such as in face perception and attentional functions, the characteristics of which already manifest in early infancy. PURPOSE: This study aimed to investigate visual cognition in LBWIs during infancy. SUBJECTS: 20 LBWIs and 20 normal-birth-weight infants (NBWIs: control) of age 9-10 months (corrected age was used for LBWIs). METHOD: Children were held seated in front of an eye tracking system by a parent, and presented with facial photos as visual stimuli. During the familiarization phase, the child was presented with two images of the same human face (familiarization stimulus) on the left and right side of a display screen (5 × 10 s trials). Next, during the test phase, the child was presented with the same image on one side of the screen, and a photo of a different person's face (novel stimulus) on the other (2 × 5 s trials). Gaze behavior was assessed in terms of the total time spent looking at either facial stimulus, and specifically at the eyes of the stimuli, as well as the number of attentional shifts between stimuli, and novelty preference. RESULTS/DISCUSSION: LBWIs spent significant less time looking at facial stimuli overall, and less time at the eye region, than NBWIs. These findings seem to evidence developmental differences in functions related to visual cognition.

Factors Influencing Gait Velocity Improvement Following Botulinum Toxin Injection for Spasticity of the Plantar Flexors in Patients with Stroke.

OBJECTIVE: In patients with hemiplegia, botulinum toxin type A injection for ankle spasticity of the plantar flexors reportedly improves walking speed. This improvement may be affected by background factors and patient baseline physical performance. This study aimed to clarify the factors affecting gait velocity improvement after botulinum toxin type A injection. METHODS: Background and evaluation data were collected for 60 patients with stroke who received botulinum toxin type A injection for spasticity of the plantar flexors. The patients were divided into improvement (n=27) and non-improvement (n=33) groups based on the gait velocity change from before injection to 2 weeks after injection. Logistic regression analysis was performed with the improvement and non-improvement groups as response variables and background data and evaluation data at baseline as explanatory variables. RESULTS: The presence or absence of physical therapy following botulinum toxin type A injection (odds ratio: 7.82) was the only significant explanatory variable for gait velocity change. CONCLUSION: Background factors and physical performance at baseline did not affect gait velocity improvement after botulinum toxin type A injection. If botulinum treatment of the ankle plantar flexors in patients with stroke is targeted at walking performance improvement, then physical therapy following botulinum toxin type A injection should be an essential part of the treatment strategy.

Pedaling improves gait ability of hemiparetic patients with stiff-knee gait: fall prevention during gait.

BACKGROUND AND PURPOSE: Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective. METHODS: Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention. RESULTS: In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity. CONCLUSIONS: Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability.

Factors associated with medication adherence among people with diabetes mellitus in poor urban areas of Cambodia: A cross-sectional study.

BACKGROUND: In Cambodia, the age-standardized prevalence of diabetes mellitus has increased in both men and women. The main objective of this study was to identify factors associated with diabetes medication adherence among people with diabetes mellitus in poor urban areas of Phnom Penh, Cambodia. METHODS: A cross-sectional study was conducted in 2017 using a structured questionnaire for face-to-face interviews by trained interviewers. The participants were people with diabetes mellitus who were the active members of a peer educator network, lived in poor urban areas of Phnom Penh, and attended weekly educational sessions during the survey period. Diabetes medication adherence was measured using four items of modified Morisky Medication Adherence Scale. Participants were classified into two groups based on their adherence score: 0 (high adherence) and from 1 to 4 (medium or low adherence). Sociodemographic characteristics; medical history; accessibility to health services; and knowledge, attitude, and practices related to diabetes mellitus were examined. A multiple logistic regression analysis was conducted adjusting for sex, age, marital status, and education levels. RESULTS: Data from 773 people with diabetes were included in the analyses. Of the total, 49.3% had a high level of diabetes medication adherence. A high level of adherence was associated with higher family income (≥50 USD per month) (adjusted odds ratio [AOR] = 5.00, 95% confidence interval [CI] = 2.25-11.08), absence of diabetes mellitus-related complications (AOR = 1.66, 95% CI = 1.19-2.32), use of health services more than once per month (AOR = 2.87, 95% CI = 1.64-5.04), following special diet for diabetes mellitus (AOR = 1.81, 95% CI = 1.17-2.81), and absence of alcohol consumption (AOR = 13.67, 95% CI = 2.86-65.34). CONCLUSIONS: High diabetes medication adherence was associated with better family economic conditions, absence of diabetes mellitus-related complications, and healthy behaviors. It would be crucial to improve affordable access to regular follow-ups including promotion of healthy behaviors through health education and control of diabetes mellitus-related complications.

Stable deep bite correction with true mandibular incisor intrusion in a late adolescent patient with skeletal deep bite: A case report.

The treatment of skeletal deep bite does not remain stable. The patient was a Japanese woman aged 16 years and 10 months. Her chief complaint was maxillary protrusion. The degree of overjet was + 10.5 mm and overbite was + 5.0 mm; the intermolar relationship was Angle Class II. An excessive curve of Spee was observed in the mandibular arch. A hypodivergent skeletal pattern was indicated by a small mandibular plane angle and gonial angle. The maxillary incisors were proclined and the mandibular incisors were retroclined. Based on the above findings, the patient was diagnosed with Angle Class II maxillary protrusion and deep bite with hypodivergency. Both maxillary first premolars were extracted and orthodontic treatment was performed using multi-bracket appliances. A proper overbite was achieved by 5.0 mm intrusion of the mandibular incisors. The maxillary incisors were retracted by 11.2 mm and a proper overjet was achieved. Good treatment results were obtained without apical root resorption. After 2 years of retention, the occlusion has been well maintained. This report may constitute a remarkable suggestion for treatment of an unstable deep bite.

Behavior problems and dysfunctional parenting: Cross-sectional study in Japan.

BACKGROUND: The Japanese government has established a law encouraging early detection and treatment of developmental disorders in children. Child behavior problems (CBP) tend to be recognized at school as a result of developmental disorders. The aim of this study was to identify factors associated with CBP in Japan. We hypothesized that factors other than developmental disorders are important in explaining CBP. METHODS: The study was conducted between February and March 2015. Parents of 3,515 children aged 2-5 years attending one of 34 public nursery schools in Takamatsu, Kagawa, Japan received self-administered questionnaires addressing parental socioeconomic factors, mental health, parenting style (i.e. hostile, overreactive, or lax), developmental disorders in children, and CBP. A multiple regression analysis was applied to explore associations between CBP and possible factors. RESULTS: Overall, 1,410 mothers were eligible to participate in the study. Children diagnosed with developmental disorders accounted for 7.8% of the sample, while on the Eyberg Child Behavior Inventory 17% of children had behavior problems needing clinical intervention. After adjustment for confounding factors, as well as for the diagnosis of developmental disorders, poor mental status and all three dysfunctional parenting styles had strong associations with CBP, and hostile, overreactive, and lax parenting had standardized ß-values (ß) of 0.29, 0.28, and 0.15, respectively (P < 0.01). A problematic relationship between the parents was also significantly associated with CBP (ß = -0.29, P < 0.01). CONCLUSION: When CBP are identified, parenting skills, mental health status and parental relationships should be considered along with the possibility of developmental disorders in the development of interventions.

The association of smartphone use and depression in Japanese adolescents.

The aim of this study is to assess the association between smartphone usage and depression in each gender of senior high school students. A cross-sectional study with self-administered questionnaires for 295 high school students, aged 15-19 was conducted in Japan. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Female adolescents used smartphones more hours a day than males. Students who used the smartphones for three hours a day accounted for 44.3% of female students and 22.5% of male students. Female students spent longer hours on online chat, social networking sites (SNS), and Internet browsing. The longer hours they spent for online chat (Odds ratio (OR): 1.74; 95% confidence interval (CI): 1.18-2.56), and SNS (OR: 1.41, 95% CI: 1.04-1.92) were associated with depression. On the other hand, male students spent more hours playing games than female students, and their smartphone use was not correlated with depression. There were gender differences in smartphone usage: female students spent more time on social contacts, whereas males were more likely to use them for entertainment. Therefore, if female students overuse online communication, they may be at a higher risk for depression.

Factors associated with patient information sharing among home-visiting nurses in Japan: a cross-sectional study.

BACKGROUND: Home-visiting nurses are expected to enhance their ability to provide adequate nursing care in a relatively isolated work environment. However, the isolated work environment leads to less opportunity to share patient information. We investigated factors relevant to better patient information sharing among home-visiting nurses, which would contribute to the improved care performance of these nurses. METHODS: A cross-sectional study with anonymous self-administered questionnaire was conducted between June 2015 and September 2015 in two districts of Japan. Home-visiting nurses who were working at home health care agencies were recruited. The questionnaires consisted of items on demographic data, job-related variables, communication in the workplace, the current state of patient information sharing, opportunities (or measures) of patient information sharing in the workplace, and job satisfaction. Descriptive analyses were performed on all variables, using the Chi-square test, Fisher's exact test, or Mann-Whitney U-test. Logistic regression analyses were conducted to identify the factors associated with better information sharing, adjusting the years of home-visiting nursing experience as the control variable. RESULTS: Of 762 anonymous self-administered questionnaires were mailed, data from 482 participants who consented to this study and had no missing answer were analyzed. Of the total, 77.2% shared the patients' information. Having a friendly adviser (OR = 2.51, 95% CI = 1.14-5.55, p = 0.023), attending some conferences (OR = 2.32, 95% CI = 1.12-4.82, p = 0.024), joining workshops (OR = 1.89, 95% CI = 1.15-3.10, p = 0.012), and years of home-visiting nursing experience (OR = 1.27, 95% CI = 1.03-1.57, p = 0.025) were significantly associated with sufficient sharing of the information. Nurses sufficiently sharing the information were well satisfied with their job (OR = 5.38, 95% CI =3.19-9.09, p < 0.001) and highly preferred a career in home-visiting nursing care (OR = 5.62, 95% CI =3.41-9.27, p < 0.001). CONCLUSIONS: The results suggested that having opportunities to discuss face-to-face such as at conferences and workshops as well as promoting good relationships among colleagues in the workplace will contribute to better information sharing among home-visiting nurses. Home-visiting nurses with less years of experience need to be supported in order to share the information sufficiently. Additionally, sufficient information sharing was also associated with job satisfaction and preference for home-visiting nursing care, which might lead to job retention for home-visiting nurses.

Prolonged effectiveness of 12-month exercise-plus-diet intervention in Japanese adults at risk of impaired glucose or lipid metabolism.

BACKGROUND AND OBJECTIVES: To investigate the prolonged effects of a 12-month exercise-plus-diet intervention in Japanese adults at risk of impaired glucose or lipid metabolism. METHODS AND STUDY DESIGN: A total of 180 participants were randomly divided into an intervention group (n=94), and a control group (n=86). An exercise-plus- diet intervention was conducted on the intervention group for 12 months. The effects were evaluated by questionnaire, physical examinations, and blood tests at baseline, 3 months, 12 months (the end of intervention), and 24 months (one year after the end of intervention). The control group took only the same examinations as the intervention group. RESULTS: At the end of the 12-month intervention, body weight, waist circumference, fasting glucose, HbA1c, triglycerides, and LDL-cholesterol were improved in the intervention group compared to the control group (all p<0.05). One year after the end of the intervention, body weight, waist circumference, fasting glucose, triglycerides, and LDL-cholesterol were still decreased in the intervention group compared to the control group (all p<0.05), especially among non-overweight participants. Among overweight persons, only body weight in the intervention group was lower than the control group. The personal behaviours of physical activity and diet in the intervention group were also improved. CONCLUSIONS: The 12-month exercise-plus-diet programs were found to be effective in improving glucose and lipid metabolism, as well as personal behaviour one year after completion of the intervention.

Difference in Response to a Motor Imagery Task: A Comparison between Individuals with and without Painful Temporomandibular Disorders.

The aim of the study was to investigate the difference in response to a motor imagery task between individuals with and without painful temporomandibular disorders (TMDs). The participants were 24 adults with and without TMD (TMD and control group, resp.). A set of photographic images of the profile view of a person's head and neck and a hand and a foot were presented in a random order. The set consisted of six different orientations with rotations of each image at 0, 60, 120, 180, 240, and 300 degrees and included left and right representations. The participants were required to view the image and make a decision as to whether it was a left or a right side presented, that is, mental rotation (MR) task. Data were collected on 48 tasks (including left and right) at each orientation for each body part. Reaction times (RTs) for correct answers and accuracy in making the left or right judgements were recorded. The RT was slower in the TMD group than in the control group. The RT for the profile image was slower than those for the hand and foot images. For images that were 180 degrees, the RT was slower and the accuracy was lower than those for five of the other image orientations. The judgements made about the 180-degree rotated image were more inaccurate compared to images of all other orientations among all types of stimuli.

Factors Associated with Quality of Life Among Mothers Rearing 4- and 18-Month Old Infants in Japan.

Objective The purpose of the present study was to investigate factors associated with quality of life (QOL) among mothers raising 4 and 18-month-old infants. Methods A cross-sectional study was conducted using self-report questionnaires. Participants included 400 women who took their infants for health checkups at a city in Aichi Prefecture, Japan (4-month-olds: n = 197, 18-month-olds: n = 203). Study variables included the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale, mother's lifestyle, support from family, and other factors potentially related to QOL. Results For mothers of 4-month-old infants, total QOL was associated with emotional support from families (OR 6.09, 95% CI 2.13-17.43) and having enough sleep (7 h or more; OR 4.18, 95% CI 1.86-9.36). These mothers had shorter sleeping hours than mothers of 18-month-old infants. QOL of mothers of 18-month-old infants was associated with emotional support from families (OR 3.06, 95% CI 1.14-8.22) and using childrearing support facilities (OR 2.02, 95% CI 1.01-4.01). Conclusion Different factors contributed to mothers' QOL as a function of infant age. Emotional support from families was associated with better QOL in both mother groups. Differences were that for mothers of 4-month-old infants, enough sleep was relevant to QOL, while in mothers of 18-month-old infants, childcare services helped improving their QOL.

Association between Excessive Use of Mobile Phone and Insomnia and Depression among Japanese Adolescents.

The aim of this study was to investigate the relationship between mobile phone use and insomnia and depression in adolescents. A cross-sectional study was conducted on 295 high school students aged 15-19 in Japan. Insomnia and depression were assessed using Athene Insomnia Scales (AIS) and the Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Mobile phones were owned by 98.6% of students; 58.6% used mobile phones for over 2 h per day and 10.5% used them for over 5 h per day. Overall mobile phone use of over 5 h per day was associated with shorter sleep duration and insomnia (OR: 3.89 [[95% CI: 1.21-12.49]), but not with depression. Mobile phone use of 2 h or more per day for social network services (OR: 3.63 [[1.20-10.98]) and online chats (OR: 3.14 [[1.42-6.95]), respectively, was associated with a higher risk of depression. Mobile phone overuse can be linked to unhealthy sleep habits and insomnia. Moreover, mobile phone overuse for social network services and online chats may contribute more to depression than the use for internet searching, playing games or viewing videos.

Evans syndrome after autologous peripheral blood stem cell transplantation for recurrent Hodgkin lymphoma.

There have been a number of recent reports on the occurrence of autoimmune conditions after autologous hematopoietic stem cell transplantation. We describe a rare case of Evans syndrome (ES) that developed in a 16-year-old patient >1 year after autologous peripheral blood stem cell transplantation for recurrent Hodgkin lymphoma. ES is a rare and frequently refractory condition. No therapy for the condition has been established, and it can often be fatal. In the present case, i.v. cyclosporine A injection was significantly effective against the ES, which has not recurred.