Endovascular treatment of acute atherothrombotic internal carotid artery occlusion associated with persistent primitive hypoglossal artery.

Persistent primitive hypoglossal artery is a relatively rare anatomical variation and a type of persistent carotid-basilar anastomosis. Acute internal carotid artery occlusion associated with persistent primitive hypoglossal artery is rare, and atherothrombotic occlusion is extremely rare. We present a case of acute atherothrombotic internal carotid artery occlusion associated with persistent primitive hypoglossal artery that was successfully treated by endovascular treatment. A 70-year-old male with a history of left internal carotid artery stenosis was transferred to our hospital by ambulance because of abnormal behaviors and aphasia. He was diagnosed with cerebral infarction and left internal carotid artery occlusion. Left carotid angiography revealed the persistent primitive hypoglossal artery arising from the cervical internal carotid artery and complete internal carotid artery occlusion distal to the origin of the persistent primitive hypoglossal artery. Therefore, we performed endovascular treatment. Mechanical thrombectomy was performed under minimal flow arrest with consideration of brain ischemia causing coma. After additional balloon angioplasty, recanalization was achieved, and the patient's symptoms improved. During the 1.5-year follow-up period, no recurrence or restenosis was observed. This report provides evidence that atherosclerotic internal carotid artery stenosis associated with persistent primitive hypoglossal artery can occur even distal to the origin of the persistent primitive hypoglossal artery and that the lesion may become acutely occluded, leading to acute stroke. Endovascular treatment considering brain ischemia was effective in this case.

Internal carotid artery-persistent primitive anterior choroidal artery aneurysms: report of two cases and literature review.

PURPOSE: Persistent primitive anterior choroidal artery (PPAChA) is a rare vascular anomaly. The clinical course of internal carotid artery (ICA)-PPAChA aneurysms has not been well described. CASE REPORTS: We report two patients with an ICA-PPChA aneurysm and summarize previously reported cases. RESULTS: Including our two, a total of 10 patients with an ICA-PPAChA aneurysm have been reported. Data were not described for one. Among the remaining nine, five patients (56%) experienced aneurysmal rupture. Five patients underwent surgical clipping and four underwent endovascular coiling. The procedure was completed in all but one patient who had a tiny branch artery adherent to the aneurysm; this patient was converted from clipping to aneurysm coating with a cotton sheet. Among the other eight patients, one who underwent coiling experienced an internal capsule infarction. The remaining seven had a satisfactory postoperative course; however, an asymptomatic occlusion of the PPAChA at its origin was noted on postoperative angiography in one. CONCLUSION: PPChA is associated with a high incidence of aneurysm formation and rupture. During treatment of ICA-PPAChA aneurysms, obstruction of the PPAChA and any surrounding perforating arteries should be avoided to prevent ischemic stroke.

Rescue retrieval of a trapped embolic protection device using a JB2-type balloon catheter.

Carotid artery stenting is a treatment option for patients with significant symptomatic or asymptomatic carotid artery stenosis. Although use of an embolic protection device during carotid artery stenting can prevent distal embolization, device retrieval after stenting can be difficult. In this report, during an embolic protection device retrieval, it was not possible to advance recapture catheters through the distal flare segment of the stent because the device wire would catch on the flare or become jammed between the flare and vessel wall. Then, an extension wire was connected to the end of the device and a 5.2-Fr JB2-type balloon catheter was advanced over the wire, which was able to pass through the stent. The use of a 5.2-Fr JB2-type balloon catheter to retrieve a trapped embolic protection device is feasible and effective if standard maneuvers fail.

Acute middle cerebral artery occlusion caused by spontaneous thrombosis of a small internal carotid artery aneurysm: illustrative case.

BACKGROUND: Spontaneous thrombosis of a saccular, unruptured, intracranial aneurysm is rare in nongiant aneurysms. Herein, the authors present a case of acute middle cerebral artery occlusion (MCO) caused by spontaneous thrombus of a small internal carotid artery (ICA) aneurysm. OBSERVATIONS: A 68-year-old woman presented with increased somnolence, right-sided hemiplegia, hemispatial neglect, and total aphagia. Left MCO and a small left ICA aneurysm were suspected based on magnetic resonance angiography (MRA). The authors detected early ischemic lesions from diffusion-weighted imaging (DWI). The DWI-Alberta Stroke Program Early Computed Tomography Score was 6. T2*-weighted imaging (T2*WI) showed a thrombus, the so-called susceptibility vessel sign, at the left MCO site. Another suspected thrombus was also found in the ipsilateral ICA aneurysm. The authors treated acute phase MCO with mechanical thrombectomy (MT), after which secondary stroke prophylaxis consisting of warfarin potassium was started. Since follow-up T2*WI showed the thrombus had disappeared from the left ICA aneurysm and the whole aneurysm was clarified by MRA, coil embolization was performed. After coil embolization, there was no ischemic recurrence. LESSONS: Aneurysms are infrequently found proximal to occlusion sites during MT. If the proximal aneurysm is a potential embolic source, treatment of the said aneurysm may prevent stroke.

Mechanical Thrombectomy Making Practical Use of an Aspiration Catheter While Selecting the Retrieval Technique during the Procedure.

Objective: To report the outcomes of thrombectomy for arterial occlusion involving the major arteries of the cerebral anterior circulation when an aspiration catheter (AC) was used in all cases, with the retrieval technique chosen during the procedure. Methods: Of the 126 patients who underwent endovascular thrombectomy during the 2-year period of 2018-2019, the study subjects were 102 patients with arterial occlusion involving the major arteries of the cerebral anterior circulation. Patients were divided into two groups depending on when the procedure was performed. In the earlier group (January 2018-March 2019), treatment was performed using only a stent retriever (SR), whereas an AC was used for all cases in the later group (April-December 2019). Outcomes between groups were retrospectively compared. In the later group, the treatment strategy was to use the SR in combination with the AC (combined technique) for retrieval if the microcatheter reached the distal side of the occlusion site without difficulty. If the microcatheter did not easily reach the distal side, we did not stick to penetrating the occlusion site, and contact aspiration was performed. Results: Thrombolysis in cerebral infarction (TICI) grade 2b-3 was achieved in 85% of patients in the earlier group and 95% in the later group. TICI grade 3 was achieved in 52% of the earlier group and 54% of the later group, showing no significant difference. TICI grade 2b-3 was achieved at first pass in 46% of patients in the earlier group, significantly lower than the 71% in the later group (P = 0.013). The mean number of passes decreased significantly from 1.84 in the earlier group to 1.32 in the later group (P = 0.002). Conclusion: Using an AC from the start, and using a combined technique when the microcatheter reached the distal side of the occlusion site, the frequency of first-pass TICI grade 2b-3 increased, and the mean number of passes decreased in comparison with the SR-alone group.

Predictors of a Good Outcome in Endovascular Treatment for Basilar Artery Occlusion with a Direct Aspiration First-Pass Technique.

Objective: There is limited evidence for mechanical thrombectomy in patients with basilar artery occlusion. Despite recanalization, there are several reports on poor outcomes. Therefore, we retrospectively evaluated the outcomes and examined the predictors of mechanical thrombectomy in patients with basilar artery occlusion. Methods: We recruited 22 consecutive patients who had received mechanical thrombectomy for basilar artery occlusion with a direct aspiration first-pass technique at our hospital between January 2016 and April 2020. The subjects were divided into good (modified Rankin Scale [mRS] ≤2) and poor outcome groups (mRS ≥3) and compared with one another. We conducted ROC analysis to identify the cut-off value that revealed a statistically significant difference in the univariate analysis. Results: Of the 22 patients, the average age ± standard deviation (SD), median pretreatment NIHSS (interquartile range [IQR]), and median pretreatment posterior circulation acute stroke progression early CT score (pc-ASPECTS) (IQR) were 76 ± 10 years, 21 (8-31), and 8 (5-9), respectively. The predictors that showed statistically significant differences in the univariate analysis were age, pretreatment NIHSS score, and pretreatment pc-ASPECTS. Based on the ROC analysis, age (area under the curve [AUC] of 0.782, cutoff <74, and P = 0.028), pretreatment pc-ASPECTS (AUC of 0.850, cutoff ≥7, and P = 0.006), and pretreatment NIHSS (AUC of 0.803, cutoff <19, and P = 0.018) were significant prognostic factors. Conclusion: In this study, aged <74 years, pc-ASPECTS ≥7, and NIHSS <19 were significant prognostic factors in endovascular treatment for basilar artery occlusion with a direct aspiration first-pass technique.

A Case of Internal Carotid Artery Occlusion Caused by En Bloc Distal Embolization of Carotid Free-Floating Thrombus Treated by Mechanical Thrombectomy.

Objective: We report a case of internal carotid artery (ICA) occlusion caused by en bloc distal embolization of carotid free-floating thrombus (FFT) treated by mechanical thrombectomy. Case Presentation: A 57-year-old woman was brought to our hospital with dysarthria, right hemiparesis, and motor aphasia. MRI and MRA revealed acute infarction due to middle cerebral artery occlusion. Carotid ultrasonography demonstrated a pedunculated mobile plaque in the left ICA. We diagnosed embolic infarction due to the carotid FFT and started medical treatment. However, on the second hospital day, the carotid FFT detached from the arterial wall en bloc, resulting in left ICA occlusion. The occluded ICA was successfully recanalized by mechanical thrombectomy. Conclusion: FFT is associated with a high risk of embolic ischemic stroke and the primary treatment strategy must be carefully considered.

Target Embolization of Dilated Post-PICA Segment for Ruptured PICA-Involved Type Vertebral Artery Dissecting Aneurysm.

Objective: In parent artery occlusion (PAO) for ruptured vertebral artery dissecting aneurysms (RVADA), target embolization using coils in a short segment to occlude only the vasodilated area containing the rupture point is selected as a first-choice procedure at our institute. We focused on RVADA involving the posterior inferior cerebellar artery (PICA) and evaluated the treatment results. Methods: This study consisted of eight cases with RVADA involving the PICA which were treated between October 2007 and January 2020. Based on radiological findings such as the bleb, the rupture points were located at the affected vertebral artery (VA) distal to PICA in all cases. Target embolization, by which only coiling at the dilated segment distal to the VA was performed. We aimed to preserve blood flow to the PICA. The incidence and extent of medullary infarctions, and neurological outcome were retrospectively assessed. Results: Regarding the diameter of bilateral VA, there were no differences in six cases while the affected VA with RVADA were larger in the remaining two cases. PICA was preserved in all cases but one in which occlusion of complementary PICA was observed. Postoperative medullary infarction was not noted. There was no rebleeding during the follow-up period. However, recanalization of the VA was observed in four cases and additional coil embolization was performed. All patients were discharged with a good outcome (modified Rankin Scale [mRS] 0; seven patients, mRS 2; one patient). Conclusion: Target embolization preserving the PICA in PICA-involved type RVADA was considered to be an effective treatment method for cases whose rupture point was located in the VA distal to PICA orifice.

Children with autism spectrum disorder comorbid with attention-deficit/hyperactivity disorder examined by the Wisconsin card sorting test: Analysis by age-related differences.

The DSM-5 confirmed that autism spectrum disorder (ASD) might be comorbid with attention-deficit/hyperactivity disorder (ADHD). This study investigated the executive function of ASD comorbid with ADHD (ASD + ADHD), ASD, and typically developed (TD) children using the Keio version of the modified Wisconsin card sorting test (KWCST). Children with ASD + ADHD (n = 43), ASD (n = 69), and TD (n = 69) were examined in two age groups: 5-9 years and 10-15 years. Both of the younger clinical groups showed significantly unfavorable scores for many indices in the second step compared to the TD group. As for the older groups, the ASD children showed significantly unfavorable scores in total errors in the second step, while the ASD + ADHD children did not show significant differences in either step. However, some index scores of the two older clinical groups were comparable to the older TD group in the second step. For the cognitive differences between clinical groups, the younger ASD + ADHD showed unfavorable scores in numbers of response cards until the first category achieved in the second step, while the older ASD showed unfavorable scores in categories achieved and perseverative errors of Nelson in the first step. For the degree of improvements in the second step, the older groups did not show significant group differences, while the younger ASD group showed significantly fewer improvements compared to the TD group. Based on these results, it is presumed that younger ASD + ADHD individuals are not sufficiently able to sustain attention and/or memory, and that the older ASD patients have difficulty in terms of flexibility.

Results of Therapy Using Oral Anticoagulants in the Acute Phase after Mechanical Thrombectomy.

Objective: The usage of oral anticoagulants (OACs) in the acute phase of cerebral infarction has increased, but the optimal timing for starting OACs after mechanical thrombectomy (MT) is unclear. We report the usage of OACs after MT at our hospital and evaluated the outcomes. Methods: OACs were selected as secondary preventive drugs for 64 patients who underwent MT for anterior circulatory embolism between July 2016 and January 2019. Of the 64 patients, 28 and 36 received direct oral anticoagulants (DOACs) and warfarin (Wf), respectively. We compared the frequency of intracranial hemorrhage in the acute phase and that of recurrent cerebral infarction within 30 days. Results: The median diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Scores + white matter (DWI-ASPECTS + W) score at admission was 7.5 (IQR 6-9)/8 (IQR, 6-9) in the DOACs group/Wf group. The rate of recanalization with modified thrombolysis in cerebral infarction (TICI) ≥2B by MT was 89.3/80.6%. In patients with subarachnoid hemorrhage (SAH) associated with MT and patients with hemorrhagic transformation (HT) on MRI the next day, administration was started after hemostasis. The median timing of the first anticoagulant administration was 3 (IQR, 2-4)/2 (IQR, 1-4) days. In the case of no HT the next day, the rate of new HT after 1 week was 7.1%/29.1%. In the case of HT the next day, the rate of HT deterioration the next day was 7.1%/16.6%. The percentage of symptomatic bleeding was 0%/2.8%. The percentage of recurrent cerebral infarction within 30 days was 0%/2.8%. Conclusion: OACs in the acute phase after MT can be safely used and are expected to be effective at preventing recurrence.

Catch-up growth and behavioral development among preterm, small-for-gestational-age children: A nationwide Japanese population-based study.

OBJECTIVE: To examine the relationship between the catch-up growth of preterm, SGA children and their behavioral development. METHODS: We analyzed data from a large Japanese, nationwide, population-based, longitudinal survey that started in 2001. We restricted the study participants to preterm children with information on height at 2 years of age (n = 1667). Catch-up growth for SGA infants was defined as achieving a height at 2 years of age above -2.0 standard deviations for chronological age. We then used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the associations of SGA/catch-up status with neurobehavioral development both at 5.5 and 8 years of age, adjusting for potential infant- and parent-related confounding factors. RESULTS: Twenty-six percent of preterm SGA infants failed to catch up. SGA children without catch-up growth were more likely to be unable to listen without fidgeting (OR 2.51, 95% CI: 1.06-5.93) and unable to focus on one task (OR 2.66, 95% CI: 1.09-6.48) compared with non-SGA children at 5.5 years of age. Furthermore, SGA children without catch-up growth were at significant risk for inattention at 8 years of age. CONCLUSIONS: SGA infants with poor postnatal growth were at risk for attention problems throughout preschool-age to school-age among preterm infants. Early detection and intervention for attention problems among these infants is warranted.

Intelligence test at preschool-age predicts reading difficulty among school-aged very low birth weight infants in Japan.

OBJECTIVE: To elucidate whether the results of an intelligence test at preschool age are predictive of reading difficulty (RD) at school age among very low birth weight infants (VLBWI). METHODS: Subjects were 48 Japanese children whose birth weight was <1500 g and who regularly visited a follow-up clinic. All subjects completed the Wechsler Intelligence Scale for Children-III (WISC-III) during the last grade of kindergarten, and four reading tasks during the second to fourth grade of elementary school. All participants had a full-scale intelligence quotient score of 85 or higher. Subjects with a standard deviation reading time score greater than 2.0 in two or more tasks were considered to have RD. We evaluated the associations between each WISC-III score and RD using logistic regression analyses. Furthermore, we performed receiver operating characteristic (ROC) analysis to determine a cutoff WISC-III score predictive of RD. RESULTS: In the mutually-adjusted model, the adjusted odds ratio per 1 score increase of freedom from distractibility (FD) was 0.832 (95% confidence interval: 0.720-0.962). In the ROC analysis, an FD score of <95.5 was chosen as the cutoff value for predicting RD (sensitivity, 0.77; specificity, 0.74). CONCLUSION: The present study indicated that a lower FD score at preschool age, which was associated with deficits in verbal working memory and attention, is a risk factor for RD at school age among Japanese VLBWI. Further investigation is desired to clarify the cognitive deficits underlying RD in Japanese-speaking preterm children, and to establish appropriate interventions for these children.

Catch-Up Growth and Neurobehavioral Development among Full-Term, Small-for-Gestational-Age Children: A Nationwide Japanese Population-Based Study.

OBJECTIVE: To examine the relationship between catch-up growth of full-term, small for gestational age (SGA) children and their neurobehavioral development. STUDY DESIGN: Data were obtained from a population-based nationwide Japanese longitudinal survey that started in 2001. Study participants were full-term children with information on height at 2 years of age (n = 32 533). Catch-up growth for SGA infants was defined as achieving a height at 2 years of age of more than -2.0 standard deviations for chronological age. Logistic regression analyses were used to estimate ORs and 95% CIs for the associations of SGA and catch-up growth status with neurobehavioral development at 2.5 and 8 years of age, adjusting for potential infant- and parent-related confounding factors. RESULTS: Fifteen percent of term SGA infants failed to catch up in height. At 2.5 years of age, SGA children without catch-up growth were more likely to be unable to climb stairs (OR, 10.42; 95% CI, 5.55-19.56) and unable to compose a 2-word sentence (OR, 3.58; 95% CI, 1.81-7.08) compared with children with normal growth at birth. Furthermore, SGA children without catch-up growth were at increased risk for aggressive behaviors (OR, 3.85; 95% CI, 1.19-12.47) at 8 years of age. CONCLUSIONS: Continuous follow-up for full-term SGA infants with failure of catch-up growth or poor postnatal growth may be beneficial for early detection and intervention for behavioral problems.

[Treatment Strategy and Results of Carotid Endarterectomy in Chronic Renal Failure Patients].

INTRODUCTION: The number of patients receiving chronic dialysis treatment in Japan currently exceeds 300,000 people. Few reports have described carotid endarterectomy(CEA)for chronic renal failure patients because of the unacceptable rate of perioperative stroke and other morbidities. A strategy for and treatment results of CEA for chronic renal failure patients in our hospital are described herein. METHODS: The present study included 6 patients who underwent CEA while receiving dialysis treatment between April 2011 and November 2014. RESULTS: Dialysis treatment was initiated due to diabetes in 4 patients and renal sclerosis in 2 patients. All the patients were men, with a mean age of 74.0 years. Two patients were symptomatic, and four were asymptomatic. In all the patients, heart vascular lesions and arteriosclerosis risk factors were present. Postoperatively, pneumonia transient cranial neuropathy, heart failure, and pneumonia in 1 case required extensive treatment. However, by the time of discharge from hospital, no cases had deteriorated compared with their pre-CEA state. The modified Rankin scale score on discharge was 0-2 for all the patients. CONCLUSION: CEA can be performed safely in patients receiving dialysis, but further operative procedures and careful postoperative management are likely to be needed for patients with CEA who are receiving dialysis.

Behavioral outcomes of school-aged full-term small-for-gestational-age infants: A nationwide Japanese population-based study.

BACKGROUND: Small for gestational age (SGA) birth is linked with neurological deficits among children at pre-school age, but the evidence is still limited on whether such deficits are still observable at school age. We investigated the association between SGA birth and behavioral development at school age among full-term infants. METHODS: We analyzed data from a large, Japanese, nationwide, population-based longitudinal survey that started in 2001. We restricted the study participants to children born at 37-41weeks of gestation with information on birth weight and behavioral outcomes at 8years of age (n=33,795). Behavioral outcomes including three attentional problems and four aggressive behaviors queried at 8years of age by survey questions were used as outcome indicators. We then used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between SGA birth and each outcome, adjusting for potential infant- and parent-related confounding factors. RESULTS: Among full-term children, SGA children were more likely to interrupt people (OR 1.10, 95% CI 1.01, 1.20), unable to wait his/her turn (OR 1.17, 95% CI 1.00, 1.38), and destroy toys and/or books (OR 1.15, 95% CI 1.00, 1.31). CONCLUSIONS: This is the largest study ever conducted on this issue. SGA birth is negatively associated with some attentional problems and aggressive behavior at school age among full-term children. Appropriate long-term developmental follow-up and support may be needed for full-term SGA infants.

Efficacy of a coaxial system with a compliant balloon catheter for navigation of the Penumbra reperfusion catheter in tortuous arteries: technique and case experience.

OBJECTIVE The authors describe a method by which they easily and atraumatically navigate a large-bore reperfusion catheter of the Penumbra system to an embolus by using a coaxial system with a compliant balloon catheter in patients with tortuous arteries. METHODS A retrospective review of the prospective endovascular database was performed to identify cases in which a coaxial system with a compliant balloon catheter (Scepter C, MicroVention/Terumo; or TransForm C, Stryker Neurovascular) and a large-bore reperfusion catheter of the Penumbra system (Penumbra, Inc.) was used. The authors achieved a stable guiding sheath position and delivered the coaxial system with a compliant balloon catheter and a large-bore reperfusion catheter. Then, the balloon was inflated somewhat when the distal tip of the balloon was slightly advanced from the tip of the reperfusion catheter, and together the coaxial system was advanced to an embolus over a 0.014-in guidewire, even around the corner. When the distal tip of the balloon catheter reached the embolus, the authors deflated the balloon and navigated the large-bore reperfusion catheter to the embolus. Finally, the aspiration of the embolus with the Penumbra MAX pump was begun. RESULTS Between May 2014 and September 2015, the authors used this technique in 17 cases: 16 cases of middle cerebral artery occlusion (including 5 cases of internal carotid artery occlusion) and 1 case of basilar artery occlusion (age range 36-88 years, mean age 74.7 years, 13 men). For the reperfusion catheter of the Penumbra system, the 5MAX ACE was used in 15 cases, and the 5MAX was used in 2 cases. As a compliant balloon catheter, the Scepter C was used in 16 cases, and the TransForm C was used in 1 case. The technique was successful in 16 cases (94.1%). No parent artery dissections were noted in any cases. Catheter-induced vasospasm was noted in 1 case, but the vasospasm was transient. CONCLUSIONS A coaxial system with a compliant balloon catheter can help safely and easily to navigate the large-bore reperfusion catheter of the Penumbra system to an embolus in patients with tortuous arteries.

Predicting the reading skill of Japanese children.

OBJECTIVE: To clarify cognitive processes underlining the development of reading in children speaking Japanese as their first language, we examined relationships between performances of cognitive tasks in the preschool period and later reading abilities. METHODS: Ninety-one normally developing preschoolers (41 girls and 50 boys; 5years 4months to 6years 4months, mean 5years 10months) participated as subjects. We conducted seven cognitive tasks including phonological awareness tasks, naming tasks, and working memory tasks in the preschool period. In terms of reading tasks, the hiragana naming task was administered in the preschool period; the reading times, which is a composite score of the monomoraic syllable reading task, the word and the non-word reading tasks, and the single sentence reading task, was evaluated in first and second grade; and the kanji reading task (naming task) was tested in second grade. Raven's colored progressive matrices and picture vocabulary test revised were also conducted in first grade. Correlation analyses between task scores and stepwise multiple regression analyses were implemented. RESULTS: Tasks tapping phonological awareness, lexical access, and verbal working memory showed significant correlations with reading tasks. In the multiple regression analyses the performances in the verbal working memory task played a key role in predicting character naming task scores (the hiragana naming task and the kanji reading task) while the digit naming task was an important predictor of reading times. Unexpectedly, the role of phonological (mora) awareness was modest among children speaking Japanese. CONCLUSION: Cognitive functions including phonological awareness, digit naming, and verbal working memory (especially the latter two) were involved in the development of reading skills of children speaking Japanese.

Neurodevelopment in full-term small for gestational age infants: A nationwide Japanese population-based study.

OBJECTIVE: To investigate neurological development in small for gestational age (SGA) infants, with a focus on full-term SGA infants. METHODS: We analyzed data from a large, Japanese, nationwide, population-based longitudinal survey started in 2001. We restricted the study to participants born before 42weeks of gestation (n=46,563). Parents were asked questions about motor and language development when the children were 2.5years old, and about behavioral development at 5.5years. We analyzed the relationships between SGA status and development by logistic regression. Odds ratios (ORs) and 95% confidence intervals (95% CI) were calculated for each outcome for full-term and preterm births, adjusting for potential infant- and parent-related confounding factors. We also calculated the population-attributable fractions to estimate the public impact of SGA births. RESULTS: SGA full-term children were more likely to demonstrate developmental delays at 2.5years, e.g., being unable to walk alone (OR 3.0, 95% CI: 1.7, 5.3), compose a two-phrase sentence (OR 1.5, 95% CI: 1.2, 1.8), or use a spoon to eat (OR 1.5, 95% CI: 1.1, 1.9). SGA status also had some degree of negative impacts on behavioral problems at 5.5years among term children, e.g., being unable to listen without fidgeting (OR 1.2, 95% CI: 1.1, 1.3), or remain patient (OR 1.1, 95% CI: 1.0, 1.2). The public health impacts were comparable between full-term and preterm SGA children at 2.5years. CONCLUSION: SGA is a risk factor for developmental delay, even in full-term infants, with non-negligible public health impacts.

Inhibitory function and working memory in attention deficit/hyperactivity disorder and pervasive developmental disorders: does a continuous cognitive gradient explain ADHD and PDD traits?

To clarify the relationship between attention deficit/hyperactivity disorder (AD/HD) and pervasive developmental disorders (PDD), we investigated the common features and differences of these disorders in neuropsychological profiles. The subjects were 4 groups of Japanese boys aged 6 to 15 years, categorized by diagnosis:AD/HD (n＝20), PDD with comorbid AD/HD (PDD＋:n＝16), PDD without comorbid AD/HD (PDD－:n＝8), and typically developing (n＝60). We evaluated executive function (EF) through verbal and visuospatial memory tasks, the Go/NoGo task, and the color-word matching Stroop task. We performed a categorical analysis to estimate the effects of the 3 disorders on EF and a dimensional analysis to estimate the effects of symptom scales on EF. We found that the AD/HD and PDD＋ subjects had negative effects on verbal working memory and intra-individual response variability. The severity of these impairments was positively correlated with the inattentiveness score. The subjects with a PDD＋ or PDD－ diagnosis had poorer scores on interference control;the severity of this impairment was correlated with the PDD symptom score. Impairments in visuospatial working memory were detected in the AD/HD and PDD－ groups but not in the PDD＋ group. Impairments in inhibition of the pre-potent response were noted in all 3 categories. AD/HD and PDD share neuropsychological features, though each disorder has a specific impairment pattern. Our findings partially support the idea that AD/HD and PDD are on a spectrum.

Questionnaire-based assessment of behavioral problems in Japanese children with epilepsy.

Behavioral problems in Japanese children with epilepsy were investigated by means of a questionnaire for parents consisting of three checklists: the Child Behavior Checklist (CBCL)/4-18 Japanese Edition, the High-Functioning Autism Spectrum Screening Questionnaire (ASSQ), and the Attention-Deficit/Hyperactivity Disorder (ADHD) Rating Scale-IV (ADHD-RS) for parents. The participants were the parents of 108 children aged 6-18 years with apparently normal intelligence. The CBCL indicated abnormal behavior in 10.5 to 35.6% of the children, and T scores on both the internalizing and externalizing scales had a significant positive relation with scores on the ASSQ and ADHD-RS. It was revealed through multivariate logistic regression analysis that the persistence of seizures was significantly related with abnormality on the externalizing scale of the CBCL (p=0.010, odds ratio: 3.48, 95% confidence interval: 1.34-9.02). Future studies are needed to determine whether seizure freedom improves behavior in children with epilepsy.