Association between house renovation during pregnancy and wheezing in the first year of life: The Japan environment and children's study.

BACKGROUND: Wheezing is a common symptom in infants, which may occasionally develop into asthma. There are many factors related to infant wheezing, including anatomical features, viral infections, and passive smoking. There are only a few reports on the association between renovation and pregnancy worldwide, and reports on this association are inadequate in Japan. This study aimed to examine the association between house renovation and new construction during pregnancy and wheezing in infants during the first year of life using data from the Japan Environment and Children's Study (JECS). METHODS: Data of pregnant women registered in JECS were collected using self-administered questionnaires during the second/third trimester and 1 month after delivery. Childbirth records were completed by the doctors. Similarly, wheezing in infants was evaluated using self-administered questionnaires 1 year after birth. Logistic regression analysis was used to determine the primary outcome. RESULTS: In total, 75,731 infants, excluding those with unknown gender, who were not singleton infants, and who relocated during pregnancy and the first month of life, were examined in this study. Renovation during pregnancy increased the prevalence of wheezing (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.20-1.48) and recurrent wheezing (OR: 1.22, 95% CI: 1.00-1.48) in the first year of life. The relationship between new construction during pregnancy and wheezing in infants was insignificant (OR: 0.98, 95% CI: 0.90-1.06). CONCLUSIONS: Renovation during pregnancy may be a risk factor for wheezing in infants, and should be avoided.

Corrigendum to "Relationship between growth and food avoidance with food allergy at age 3 years: The Japan Environment and Children's Study (JECS)" [World Allergy Organ J (2023) 100826].

[This corrects the article DOI: 10.1016/j.waojou.2023.100826.].

Relationship between growth and food avoidance with food allergy at age 3 years: The Japan Environment and Children's Study (JECS).

Background: Basic management for food allergy (FA) is eliminating causative food from the diet, which can impact normal growth. This study examined the association between food avoidance and growth failure among children with FA aged 0-3 years using the Japan Environment and Children's Study (JECS) data. Methods: Data on height, weight, and FA history registered were collected using self-administered questionnaires at age 1, 1.5, 2, and 3 years. A general linear model was used to examine whether dietary restriction affected body size. Height, weight, and body mass index (BMI) were adjusted for age in months using standard deviation (SD) scores for each age group by month of measurement. Presence of FA or dietary restriction was used as a binary variable. Results: Of the 38 477 participants included in this analysis, 4070 with FAs had significantly lower SD scores for height and weight at age 3 years. With milk avoidance, significantly lower SD scores for height (male: ß = -0.097 [95%CI: 0.175, -0.019], female: ß = -0.103 [95%CI: 0.204, -0.002]), a significantly lower SD score for weight (male: ß = -0.115[95%CI: 0.187, -0.043], female ß = -0.114[95%CI: 0.203, -0.026]) were observed. Soy avoidance in males marked a lower SD score for height (ß = -0.307 [95%CI: 0.474, -0.140]). Continued food avoidance until age 3 resulted in significantly lower SD score for height and weight regardless of gender. Conclusion: Growth impairment was observed with food avoidance at age 3 years. Growth impairment were more obvious in males than in females. With regards food items, the impact of milk and soy was more significant.

Efficacy and safety of pemafibrate in patients with chronic kidney disease: A retrospective study.

Hypertriglyceridemia and chronic kidney disease (CKD) are known risk factors for cardiovascular disease. However, treatment with statins, which control low-density lipoprotein cholesterol levels, increases the risk of estimated glomerular filtration rate (eGFR) reduction. Although conventional fibrates, such as bezafibrate (Beza-F) and fenofibrate (Feno-F), are the mainstay for hypertriglyceridemia treatment, they may be associated with a risk of increased serum creatinine level and renal dysfunction. Pemafibrate (Pema) is pharmacologically defined as a selective peroxisomal proliferator-activated receptor α modulator which is excreted in bile and not likely to cause renal dysfunction. We evaluated the efficacy and safety of switching from Beza-F or Feno-F to Pema in CKD patients with hypertriglyceridemia. We recruited 47 CKD patients with hypertriglyceridemia who were receiving Beza-F, Feno-F, or eicosapentaenoic acid (EPA) but were switched to Pema from 2018 to 2021. A retrospective analysis of renal function and lipid profiles was performed before and 24 weeks after switching. CKD patients switching from EPA to Pema were used as study control. The effect of Pema on hypertriglyceridemia was equivalent to that of Beza-F or Feno-F. However, after switching to Pema, eGFR showed a marked average improvement of 10.2 mL/min/1.73 m2 (P < .001). Improvement in eGFR and levels of n-acetyl-ß-d-glucosaminidase and ß-2-microglobulin was observed only in cases of switching from Beza-F or Feno-F but not from EPA. Although Beza-F and Feno-F are useful medications for the treatment of hypertriglyceridemia, these are associated with a high risk of renal dysfunction. We also found that the deterioration in eGFR due to Beza-F or Feno-F is reversible with drug withdrawal and may not increase the risk for long-term renal dysfunction. We suggest that Pema may be an effective and safe treatment for hypertriglyceridemia in CKD patients.

Dataset dependency of low-density lipoprotein-cholesterol estimation by machine learning.

OBJECTIVES: We evaluated the applicability of a machine learning-based low-density lipoprotein-cholesterol (LDL-C) estimation method and the influence of the characteristics of the training datasets. METHODS: Three training datasets were chosen from training datasets: health check-up participants at the Resource Center for Health Science (N = 2664), clinical patients at Gifu University Hospital (N = 7409), and clinical patients at Fujita Health University Hospital (N = 14,842). Nine different machine learning models were constructed through hyperparameter tuning and 10-fold cross-validation. Another test dataset of another 3711 clinical patients at Fujita Health University Hospital was selected as the test set used for comparing and validating the model against the Friedewald formula and the Martin method. RESULTS: The coefficients of determination of the models trained on the health check-up dataset produced coefficients of determination that were equal to or inferior to those of the Martin method. In contrast, the coefficients of determination of several models trained on clinical patients exceeded those of the Martin method. The means of the differences and the convergences to the direct method were higher for the models trained on the clinical patients' dataset than for those trained on the health check-up participants' dataset. The models trained on the latter dataset tended to overestimate the 2019 ESC/EAS Guideline for LDL-cholesterol classification. CONCLUSION: Although machine learning models provide valuable method for LDL-C estimates, they should be trained on datasets with matched characteristics. The versatility of machine learning methods is another important consideration.

Comparison of the Serial Humoral Immune Response according to the Immunosuppressive Treatment after SARS-CoV-2 mRNA Vaccination.

Objective The objective of this study was to estimate the humoral immune response evaluated by immunoglobulin G (IgG) against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike receptor-binding domain (RBD-IgG) following the third mRNA coronavirus disease 2019 (COVID-19) vaccination in patients with kidney disease who received immunosuppressive treatment. Methods The primary outcome was RBD-IgG levels after the third SARS-CoV-2 vaccination. The primary comparison was the RBD-IgG levels between patients with kidney disease who received immunosuppressive treatment (n=124) and those who did not (n=33). Results The RBD-IgG levels were significantly lower in the patients with kidney disease who received immunosuppressive treatment than in those who did not receive immunosuppressive treatment. The RBD-IgG levels were lower in patients treated with glucocorticoid monotherapy than in those who did not receive immunosuppressive treatment. Even in patients who received ≤5 mg prednisolone, the RBD-IgG levels were significantly lower. Nine of the 10 patients who received rituximab within one year before the first vaccination did not experience seroconversion after the third vaccination. Meanwhile, all nine patients who received rituximab only after the second vaccination experienced seroconversion, even if B cell recovery was insufficient. Patients treated with mycophenolate mofetil plus glucocorticoid plus belimumab had significantly lower RBD-IgG levels than those treated with mycophenolate mofetil plus glucocorticoid. Conclusion The RBD-IgG levels were lower in patients with kidney disease who received immunosuppressive treatment than in those who did not receive immunosuppressive treatment. Low-dose glucocorticoid monotherapy affected the humoral immune response following the third mRNA COVID-19 vaccination.

Pain in Spinal Muscular Atrophy: A Questionnaire Study.

OBJECTIVE: This study aimed to reveal the chronic pain prevalence in spinal muscular atrophy (SMA) patients and identify the clinical characteristics of these patients with chronic pain. The pain status was also investigated in SMA patients with chronic pain. METHODS: This cross-sectional study was conducted between July 2018 and December 2018. SMA type II and type III patients in Japan were mailed a survey questionnaire. The survey items were chronic pain prevalence, clinical characteristics, and motor function. Patients with chronic pain also answered questions on various pain status parameters: pain intensity, frequency, duration, location using body map, and factors that exacerbated and relieved pain. RESULTS: The questionnaire recovery rate was 61.1%. Sixty-four type II (mean age 17.3 ± 11.7 years) and 22 type III (mean age 44.9 ± 21.6 years) patients were eligible for inclusion. The prevalence of chronic pain in type II and III patients was 40.6% and 40.9%, respectively. Type II patients with chronic pain were more likely to report the inability to sit without manual support than those without pain (p = 0.03). Pain intensity in SMA patients was mild, but pain usually occurred daily, for prolonged durations, most often in the neck, back, and lower extremities. Sitting and high physical activity exacerbated pain the most. CONCLUSION: The percentage of patients with SMA with chronic pain was high, at above 40%. Moreover, the pain experienced by patients with SMA was low in intensity but frequent and most common in the lower extremities.

Validation of the Martin method to estimate low-density lipoprotein cholesterol concentrations in Japanese populations and a modified method for laboratory information system application.

OBJECTIVES: High concentrations of low-density lipoprotein cholesterol (LDL-C) are a risk factor for cardiovascular disease. We validated the efficacy of the Martin method is useful in the estimation of LDL-C concentrations was validated in Japanese populations and derived a modified Martin method for easy laboratory information system applications. METHODS: We created 3 subject groups, including 2664 health check-up participants registered with the Resource Center for Health Science, 29,806 clinical patients (A) in the Gifu University Hospital, and 113,716 clinical patients (B) in the Fujita Health University Hospital. Each method to estimate serum LDL-C concentrations (Friedewald formula, Martin method and modified Martin method) was validated by correlation analysis with serum LDL-C concentrations measured using a direct method. RESULTS: The correlation coefficients with the direct method in terms of the Friedewald formula, Martin method, and modified Martin method were 0.963, 0.972 and 0.970 in the health check-up participants; 0.946, 0.962 and 0.961 in clinical patients A; and 0.961, 0.979 and 0.978 in clinical patients B, respectively. Concordance ratios with using the direct method in the Friedewald formula, Martin method and modified Martin method were 82.8%, 85.5% and 85.3% in the health check-up participants; 76.4%, 80.5% and 80.2% in clinical patients A; and 76.1%, 82.6% and 82.6% in clinical patients B, respectively. CONCLUSION: Our results show that the Martin and modified Martin methods display good performance in terms of the estimation of LDL-C concentrations among triglyceride concentrations of a wide range, and they may thus be useful for estimating LDL-C concentrations.

Views of the General Population on Newborn Screening for Spinal Muscular Atrophy in Japan.

Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder that results in progressive muscle atrophy and weakness. As new therapies for SMA have been developed, newborn screening for SMA can lead to early diagnosis and treatment. The objective of this study was to gather the general population's view on screening of SMA in newborns in Japan. A questionnaire survey was conducted on two general population groups in Japan. A total of 269 valid responses were obtained. In the general population, about half of the participants had no knowledge about SMA, and more than 90% did not know about new therapies for SMA. Conversely, more than 95% of the general population agreed with screening newborns for SMA because they believed that early diagnosis was important, and treatments were available. This study revealed that the general population in Japan mostly agreed with screening for SMA in newborns even though they did not know much about SMA. Newborn screening for SMA is promising, but it is in very early stages. Therefore, SMA newborn screening should be performed with sufficient preparation and consideration in order to have a positive impact on SMA patients and their families.

Development of a family caregiver needs-assessment scale for end-of-life care for senility at home (FADE).

AIM: This study aimed to develop a "family caregiver needs-assessment scale for end-of-life care for senility at home" (FADE) and examine its reliability and validity. METHOD: A draft item pool was developed based on a literature review, and simplified to 30 items in four domains. Next, the item pool was reviewed by four visiting nurses and four researchers and refined to 15 items. A cross-sectional study was then conducted using a self-reported questionnaire. Questionnaires were sent to 2703 visiting nurses. The survey questions included participants' basic demographic information, the importance of each item according to a modified scale, basic demographics for cases of death by senility at home, satisfaction with each item of the modified scale in an example case, and assessment of the case using the Japanese version of the Support Team Assessment Schedule (STAS-J). Internal consistency was assessed using Cronbach's alpha. Construct validity was confirmed using confirmatory factor analysis, and correlation between the new scale and the STAS-J was used to assess criterion-related validity. RESULTS: In total, 461 visiting nurses provided valid responses. The exploratory and confirmatory factor analyses identified 12 items from two factors: "Needs for adaptation to senility bereavement" and "Needs for essential skills in supporting a dignified death by senility." The final model showed appropriate index values: standardized root mean residual = 0.057, Tucker-Lewis index = 0.920, Akaike information criterion = 191.6, and Bayesian information criterion = 298.2. Cronbach's alpha for the entire scale was 0.908, and was above 0.840 for each factor. The correlation coefficient between STAS-J and the entire scale was 0.259-0.427 (p<0.001). CONCLUSIONS: The FADE scale showed acceptable internal consistency and concurrent validity. The scale can help clarify issues and desires that present themselves at home related to adaptation to senility bereavement and essential skills in supporting a dignified death by senility. Addressing these issues and desires is expected to reduce caregivers' anxiety and burden, and means the older adults under their care may be respected and enabled to live with dignity and peace.

Re-evaluation of body weight as an indicator for contrast material dosage for indirect CT venography.

OBJECTIVE: We evaluated body weight as an accurate indicator for determining contrast load using nonionic monomeric contrast material in indirect CT venography. MATERIALS AND METHODS: One hundred and thirty-two patients (mean age 51 years) underwent indirect CT venography to exclude the possibility of DVT. We used 150 ml of isohexol (iodine, 300 mgI/ml) administered at a rate of 3.0 ml/s. Scanning delay was 180 s from the time of initiation of contrast injection. Scans were obtained in a caudal-to-cranial direction starting from the ankle. Hounsfield unit (HU) measurements were recorded at the common femoral and popliteal veins. Using linear regression analysis, we calculated the correlation the coefficient between the CT attenuation and the iodine dose per body weight of each patient. We also recorded the presence of DVT and measured the CT attenuation of the clots. RESULTS: Average contrast dosage per weight was 765.3 mgI (from 420.5 -1184.2 mgI). Average measurements of HU at the common femoral and popliteal veins were 114.4 ± 17.8 HU and 109.9 ± 21.4 HU, respectively. The regression coefficients were 0.62 and 0.41 for the common femoral and popliteal veins, respectively. DVT was detected in 33 of 132 patients. The average HU of the thrombus was 47.7 ± 13.3 HU. CONCLUSION: Indirect CT venography for detecting DVT initiated 180 s after the start of infusion of contrast material (150 ml) and a contrast injection at a rate of 3 ml/s produced high mean levels of venous enhancement. However, correlation between dose of contrast material per patient weight and CT attenuation of veins was fairly low.

Visualization of the azygos arch valves on multidetector-row computed tomography.

To evaluate the frequency and appearance of the azygos arch valves on chest examinations using multidetector-row computed tomography (MDCT), we retrospectively reviewed findings from 194 contrast-enhanced MDCT examinations of the chest. Rate of injection of 300 mgI/ml contrast materials was low (2.0 ml/s) and high (3.0 ml/s). Scanning delay was 80 s on examination on low-rate injection of contrast material and 20 s on high-rate injection of contrast material. The presence of residual contrast material in the azygos arch valves and reflux of contrast material into the azygos arch were recorded. The Cochran-Armitage trend test was used to compare the frequency of residual contrast material in the azygos arch valves and reflux of contrast material into the azygos arch in both groups. Of 92 examinations of high-rate injection of contrast material, 63 (68.5%) demonstrated residual contrast material in the azygos arch valves and 71 (77.2%) demonstrated reflux of contrast material into the azygos arch. A significantly higher frequency of reflux of contrast material into the azygos arch and residual contrast material in the azygos arch valves was seen in the high-rate injection group than in the low-rate injection group (P < 0.05). Residual contrast material in the azygos arch valves was demonstrated more frequently when contrast material was administered in the right side of the arm than in the left side of the arm (P < 0.05). Reflux of contrast material into the azygos arch was common in the high-injection-rate group and residual contrast material in the azygos arch valves was far more frequently seen in the high-injection-rate group than in the low-injection-rate group on MDCT.

Visualization of azygos arch valves using computed tomography: comparison of scanning delay times.

OBJECTIVE: To evaluate the frequency and appearance of azygos arch valves after short and long scanning delays and high injection rates of contrast material (CM) using a 64-slice multi-detector-row computed tomography (MDCT). METHODS: We retrospectively reviewed the findings from 264 contrast-enhanced MDCT chest examinations. The rate of injection for 300 mg I/ml CM was 3.0 ml/sec; the short and long scanning delays were 20 and 180 sec, respectively. The presence of residual CM in the azygos arch valves and reflux of CM into the azygos arch were recorded. A chi-square test was used to compare the frequency of residual CM in azygos arch valves and reflux of CM into the azygos arch in both groups. RESULTS: Of the 132 examinations with short scanning delays, 91 (68.9%) demonstrated residual CM in azygos arch valves and 103 (78.0%) demonstrated reflux of CM into the azygos arch. A significantly higher frequency of reflux of CM into the azygos arch and residual CM in azygos arch valves was seen with short scanning delays than with long scanning delays (P<0.05). However, no reflux of CM into azygos arch was seen with long scanning delays. CONCLUSIONS: Both reflux of CM into azygos arch valve and residual CM in the azygos arch were frequently seen using short scanning delays.

Radiological reporting that combine continuous speech recognition with error correction by transcriptionists.

OBJECTIVE: We evaluated the usefulness of radiological reporting that combines continuous speech recognition (CSR) and error correction by transcriptionists. MATERIALS AND METHODS: Four transcriptionists (two with more than 10 years' and two with less than 3 months' transcription experience) listened to the same 100 dictation files and created radiological reports using conventional transcription and a method that combined CSR with manual error correction by the transcriptionists. We compared the 2 groups using the 2 methods for accuracy and report creation time and evaluated the transcriptionists' inter-personal dependence on accuracy rate and report creation time. We used a CSR system that did not require the training of the system to recognize the user's voice. RESULTS: We observed no significant difference in accuracy between the 2 groups and 2 methods that we tested, though transcriptionists with greater experience transcribed faster than those with less experience using conventional transcription. Using the combined method, error correction speed was not significantly different between two groups of transcriptionists with different levels of experience. CONCLUSION: Combining CSR and manual error correction by transcriptionists enabled convenient and accurate radiological reporting.