Nonsurgical Creation of an Auriculocephalic Sulcus in Children With Congenital Auricular Deformities.

Nonsurgical correction of congenital auricular deformity is known to be effective in newborns. In this study, the authors investigated factors influencing the outcome of nonsurgical or surgical correction of the auriculocephalic sulcus, an important auricular structure and one that is necessary for wearing glasses or a mask. A total of 80 ears (63 children) were splinted using a metallic paper clip and thermoplastic resin in our outpatient clinic between October 2010 and September 2019. The ears were divided into a group, in which the auriculocephalic sulcus was formed nonsurgically (n =5 6) and a group, in which surgery was needed (n = 24). The authors compared the clinical characteristics of the deformities, whether cryptotia affected the superior or inferior crus, and whether constricted ears were Tanzer group IIA or IIB between the two study groups by retrospective chart review. There was a significant correlation between the age, at which ear-molding treatment was initiated and outcome ( P < 0.001). The optimal cutoff value for age, before which ear-molding treatment should be initiated was 7 months. Inferior crus-type cryptotia was corrected adequately by splinting, but all Tanzer group IIB constricted ears needed surgical treatment. Earlier initiation of ear-molding treatment is recommended, preferably before 6 months of age. Nonsurgical treatment is an effective intervention for the creation of the auriculocephalic sulcus in ears with cryptotia and Tanzer group IIA constricted ears but cannot correct for an inadequate amount of skin over the auricular margin or a defect in the antihelix.

Bone Flap Preservation in Subcutaneous Abdominal Pocket for Decompressive Craniectomy.

We report our experiences of two pediatric cases in which a bone flap was preserved in the subcutaneous abdominal pocket for decompressive craniectomy. In one case, the bone flap was divided and preserved for cranioplasty without complications; in the other case, the bone flap was left intact as one piece. In pediatric patients, the storage space for a bone flap is sometimes difficult to achieve, and the technique described herein is useful in such situations. Notably, because the bone resorption rate with cryopreservation is higher in pediatric patients, in vivo preservation may be more useful in this population.

Influence of Living Alone or with a Spouse Only on the Short-Term Prognosis in Patients after an Acute Ischemic Stroke.

Background-This study aimed to explore whether living alone or with a spouse only affects the short-term prognosis of acute ischemic stroke patients. Methods-We conducted a retrospective cohort study of patients with a diagnosis of acute ischemic stroke from April 2014 to February 2019 in Japan. The primary outcome was defined as worsening by at least one grade on the modified Rankin Scale (mRS). The secondary outcome was set as the degree of worsening on the mRS. The outcomes were compared between three groups of patients: (1) those living alone (ALONE), (2) those living with their spouse only (SPOUSE), and (3) OTHERs. Results-In total, 365 patients were included in this study: 111 (30%) ALONE, 133 (36%) SPOUSE, and 121 (33%) OTHERs. Cardiogenic embolisms were observed more frequently in ALONE than in OTHERs. The primary outcome occurred in 88 (79.3%) patients in ALONE and in 96 (72.2%) patients in SPOUSE, both of which were higher than the 72 (59.5%) in OTHERs. After adjusting with 19 variables, the risk of worsening was higher in ALONE (odds ratio (OR): 2.90, 95% confidence interval (CI): 1.50-5.58) and SPOUSE (OR: 1.83, 95% CI: 1.00-3.33) compared with OTHERs. Conclusions-In patients with acute ischemic stroke, not only living alone but also living with a spouse only may be associated with a worse short-term prognosis, independent of other cardiovascular risks.

Relationship Between the Number of Patients Visiting Emergency Department and Tokyo Health System's Capacity During Early Stages of the First Wave of COVID-19.

The first coronavirus 2019 (COVID-19) patients were reported in China on December 12, 2019, and the first COVID-19 patients were reported in Japan on January 16, 2020. Here, we investigated the number of patients in Emergency Departments (EDs) in three major hospitals in Tokyo, and also briefly discussed about the relationship between the number of patients in EDs and health system's capacity. We compared the number of patients in 2020 to the average number of patients from 2016 to 2019. Numbers were compared in three periods: before the first COVID-19 patient was reported in Japan (January 1 to January 16), after the government encouraged social distancing (February 26 to March 10), and the interval between them (January 17 to February 25). The average number of daily patients in 2020 (n = 122) decreased by 17% compared to the average number of patients from 2016 to 2019 (n = 144) (Mann-Whitney test, p < 0.001). This phenomenon might be due to a fear of contracting the virus at hospitals, companies having their employees work remotely and postponing events, people following the Japanese Ministry of Health, Labour and Welfare's instructional guidelines for going to the hospital, prevention awareness becoming widespread, and a decreased number of tourists. The number of patients visiting Emergency Departments in Tokyo was decreased and the number of COVID-19 infections has remained within the health system's capacity during the early phase of COVID-19 first wave.

Critical Care Medical Centers May Play an Important Role in Reducing the Risk of COVID-19 Death in Japan.

Marked differences in COVID-19 mortalities have been observed among 47 prefectures in Japan. Here, we explored associations between COVID-19 mortalities and medical and public health capacities in individual prefectures. The following data by prefecture were abstracted from open resources provided by the Ministry of Health, Labour and Welfare in Japan as of May 24, 2020: total number of COVID-19 deaths; polymerase chain reaction (PCR)-positive ratio (i.e., number of patients with PCR-positive results/number of patients aiming diagnosis of COVID-19 or individuals in close contacted with COVID-19 patients); number of call centers, outpatient centers, and hospital beds specifically for patients diagnosed with COVID-19; and others. The primary outcome was COVID-19 mortality per million population. Multiple and simple linear regression models were applied. Two variables were significantly associated with COVID-19 mortality: PCR-positive ratio (P < 0.001) and number of critical care medical centers per million population (P = 0.001). PCR-positive ratio was positively associated with COVID-19 mortality (aR-sqr = 0.522). Low PCR-positive ratio, especially ≤ 4%, was associated with low COVID-19 mortality. Critical care medical centers may also play an important role in reducing the risk of COVID-19 death.

Tokyo and New York: A Study in the Contrasting Effects of Socioeconomic Status on Coronavirus Disease 2019 Outcomes.

OBJECTIVES: It is still not known why cases of coronavirus disease 2019 during the first wave in Tokyo have fallen without lockdown restrictions. People with low socioeconomic status are not dominant among coronavirus disease 2019 patients in Tokyo in contrast with New York, where the opposite demographics have been in play. Thus, we set out to examine the association between socioeconomic status and the rate of coronavirus disease 2019 infections using public data from Tokyo. DESIGN: We obtained data from each of the 23 wards of Tokyo, showing population size, density, age, sex, number of graduates, income, and hospital attendance numbers. Coronavirus disease 2019 infections were gathered for 2 separate days: April 9, 2020, when new daily coronavirus disease 2019 infections were at their peak during the first wave in Japan; and May 9, 2020, to observe any changes in incidence over the preceding month. SETTING: The primary outcome was set as the number of coronavirus disease 2019 infections per 100,000 population. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: By conducting simple linear regression modeling, the incidence of cases on April 9 was associated significantly with four variables: population age greater than 65 years (%), university rate, hospital, and income. Using these four variables, multivariate linear regression analyses demonstrated that only income remained significant (p = 0.006 at April 9 and p = 0.03 at May 9). This indicates that the highest case numbers were dominant in high-income areas, and affected fewer patients in districts in the low-income areas. CONCLUSIONS: The result of the current study is exactly opposite to the data from New York. This may be considered one of the main reasons why the rate of death and new patients of coronavirus disease 2019 has been so low in Tokyo. That is, appropriate hygienic status, free access to hospital by ambulance, and universal health insurance system may contribute to the outcome in such low-income areas.

Pneumonia and Extracorporeal Cardiopulmonary Resuscitation Followed by Targeted Temperature Management in Patients With Out-of-Hospital Cardiac Arrest　- Retrospective Cohort Study.

Background: We examined the association between initiation of extracorporeal cardiopulmonary resuscitation (ECPR) and the incidence of infectious complications, such as pneumonia, sepsis, and bacteremia, after out-of-hospital cardiac arrest (OHCA) in patients who received targeted temperature management (TTM). Methods and Results: This retrospective study used data from hospital medical records of patients with OHCA treated with TTM who had been admitted to St. Luke's International Hospital between April 2006 and December 2018. The primary endpoint was the association between the type of CPR and the incidence of early onset pneumonia in the intensive care unit (ICU; between 48 h and 7 days of hospitalization). Univariate and multivariate logistic regression analyses were performed for the primary endpoints. After applying the inclusion/exclusion criteria, 254 patients were included in the analyses; of these, 52 were enrolled in the ECPR group, and 202 were enrolled in the CCPR group. Median age was 58 years, 88.5% were male, prophylactic antibiotics were used in 80.3%, and favorable neurological outcomes were observed in 51.9%. On multivariate analysis, ECPR (odds ratio [OR], 2.78; 95% CI: 1.16-6.66; P=0.037) was significantly associated with the development of early onset pneumonia. Conclusions: ECPR was an independent predictor of pneumonia after OHCA in patients who received TTM.

Prenatal vitamin A supplementation associated with adverse child behavior at 3 years in a prospective birth cohort in Japan.

BACKGROUND: Many pregnant women take vitamin supplements during pregnancy. The aim of this paper was to clarify the effects of dietary supplementation prior to and/or during pregnancy on child behavior. METHODS: A prospective birth cohort study from pregnancy to 3 years of age involving 1271 pairs of Japanese pregnant women and their newborns, was carried out. The women completed a self-administered questionnaire during the third trimester of pregnancy. To evaluate deviations in child behavior as an endpoint, each mother completed the Japanese Child Behavior Checklist for ages 2-3 years after 3 years of birth. Participant characteristics were compared between supplement takers and non-takers. RESULTS: Among many kinds of supplements, intake of supplemental vitamin A/ß-carotene prior to and/or during pregnancy was associated with hazardous effects on child behavior at 3 years of age (total t-score, P = 0.003; internal t-score, P = 0.027; external t-score, P = 0.013). This association held true even after adjusting for age, number of deliveries, infertility treatment, consumption of fast food, smoking status, maternal and paternal education, maternal and paternal income, gestational age at birth, anthropometry at birth (weight, height, head circumference and body circumference), and the State-Trait Anxiety Inventory at 3 years of age by means of multiple imputation. CONCLUSIONS: Intake of supplemental vitamin A prior to and/or during pregnancy may worsen child behavior at 3 years of age.

Effect of vitamin C depletion on UVR-B induced cataract in SMP30/GNL knockout mice.

We investigated whether decreased vitamin C (VC) in a mouse model increases lens opacity (cataract) induced by in vivo exposure to ultraviolet radiation type B (UVR-B). Senescence marker protein-30 (SMP30) knockout (KO) mice, which cannot synthesize VC due to genetic disruption of the gluconolactonase (GNL) gene, were divided into 2 groups: VC sufficient (VC (+)) and VC deficient (VC (-)). Starting at 1 month of age, these groups had free access to water containing 0.0375 and 1.5 g/L of VC, respectively. SMP30 KO VC (-), SMP30 KO VC (+), and wild-type (WT) mice, all 14 weeks of age, were unilaterally exposed in vivo to UVR-B (200 mW/cm(2)) for 100 s twice a week for 3 weeks (total: 1200 mJ/cm(2)). At 48 h after the last UVR-B exposure, cataract morphology was documented, and the ratio of cataract induction was quantified as the cataract area ratio (opacity area/anterior capsule). UVR-B exposure induced cataract mainly at anterior sub-capsular in SMP30 KO VC (-), SMP30 KO VC (+), and WT mice. In SMP30 KO VC (-) lenses the opacities were more extensive than in SMP30 KO VC (+) or WT lenses (cataract area ratios: 59.3% ± 10% vs. 32.2% ± 11.7% or 29.0% ± 9.0%; P < 0.01). In conclusion, VC depletion may increase the susceptibility to develop UVR-B induced cataracts in mice unable to endogenously produce VC.

Mutton fat-like subretinal precipitates associated with Vogt-Koyanagi-Harada disease.

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease presenting mutton fat like subretinal precipitates. DESIGN: Observational case report. METHODS: A 52-year-old Japanese woman developed bilateral uvetis with serous retinal detachment and mutton fat like subretinal precipitates. RESULTS: According to Opthalmologic, auditory, and systemic examination, we diagnosed the patient with VKH disease. Inflamation was controlled by three time steroid therapy and subretinal fluid and precipitates decreased and disappeared. CONCLUSIONS: Subretinal granulomatous lesion may present a manifestation of VKH and mean long standing subretinal fluid and inflammation.

Cancer chemopreventive activity of 3beta-methoxyserrat-14-en-21beta-ol and several serratane analogs on two-stage mouse skin carcinogenesis.

3beta-Methoxyserrat-14-en-21beta-ol (1) and 3alpha-methoxyserrat-14-en-21beta-ol (2) are the most abundant triterpenoids from two Picea plants, Picea jezoensis (Sieb. et Zucc.) Carr. var. jezoensis and P. jezoensis (Sieb. et Zucc.) Carr. hondoensis (Mayr) Rehder, and the total yield of 1 and 2 reach over 1/3 of the chloroform extract of the above two plants. This study deals with the potential of anti-tumor promoting activity of 1 and results of the assay of 22 synthetic serratane-type triterpenoids (6)-(27) derived from 1, 2, 21-episerratenediol (3), diepiserratenediol (4) and 13alpha,14alpha-epoxy-3beta-methoxyserratan-21beta-ol (5) to discuss the structure-activity relationship. As a preliminary evaluation of their potential to inhibit tumor promotion, the inhibitory effects on Epstein-Barr virus early antigen (EBV-EA) activation induced by 12-O-tetradecanoylphorbol-13-acetate (TPA) were used. All compounds except for 12 and 19 showed potent inhibitory effects on EBV-EA induction (100% inhibition at 1000 mol ratio/TPA), their effects being stronger than that of a positive control oleanolic acid. Compounds 1, 13, 14, 18, 20 and 26 were selected to examine the effect on the in vivo two-stage mouse skin carcinogenesis test induced by 7,12-dimethylbenz[a]anthracene (DMBA) as an initiator and TPA as a promoter. The most abundant triterpenoid 1 and the synthetic compounds 13 and 14 were found to exhibit the excellent anti-tumor promoting activity in the in vivo carcinogenesis test, and compounds 18, 20 and 26 also showed strong inhibitory effects.

Cancer chemopreventive activity of serratane-type triterpenoids from Picea jezoensis.

To search for cancer chemopreventive agents from natural sources, 13alpha,14alpha-epoxy-21alpha-methoxyserratan-3-one, 21alpha-methoxyserrat-13-en-3-one, and 21alpha-hydroxy-3beta-methoxyserrat-14-en-30-al isolated from the cuticle of Picea jezoensis (Sieb. et Zucc.) Carr. var. jezoensis (Pinaceae) were investigated for inhibitory effects in a two-stage mouse skin carcinogenesis test on mouse skin with 7,12-dimethylbenz[a]anthracene (DMBA) as initiator and 12-O-tetradecanoylphorbol-13-acetate (TPA) as promoter. 21Alpha-hydroxy-3beta-methoxyserrat-14-en-30-al and 13alpha,14alpha-epoxy-21alpha-methoxyserratan-3-one were found to exhibit strong antitumor-promoting activities in the in vivo carcinogenesis test.

Cancer chemopreventive activity of serratane-type triterpenoids on two-stage mouse skin carcinogenesis.

Eleven serratane-type triterpenoids isolated from the stem bark of Picea jezoensis (Sieb. et Zucc.) Carr. var. jezoensis (Pinaceae) and the stem bark of Picea jezoensis (Sieb. et Zucc.) Carr. var. hondoensis (Mayer) Rehder (Pinaceae) and three synthetic analogs were studied for their possible inhibitory effects on Epstein-Barr virus early antigen (EBV-EA) activation induced by 12-O-tetradecanoylphorbol-13-acetate (TPA). 21-Episerratenediol, serratenediol, diepiserratenediol, 3 beta-hydroxyserrat-14-en-21-one, 3 alpha-methoxy-21 beta-hydroxyserrat-14-en-16-one, 3 beta-methoxyserrat-14-en-21 beta-yl acetate, 3 alpha-methoxyserrat-14-en-21 beta-yl acetate and 3 beta-methoxyserrat-14-en-21 alpha-yl acetate demonstrated strong inhibitory effects on the EBV-EA activation without showing any cytotoxicity, their effects being stronger than that of a representative control, oleanolic acid. Furthermore, 21-episerratenediol exhibited a remarkable inhibitory effect on skin tumor promotion in an in vivo two-stage mouse skin carcinogenesis test using 7,12-dimethylbenz[a]anthracene as an initiator and TPA as a promoter. The result of the present investigation indicated that 21-episerratenediol might be valuable as a potent cancer chemopreventive agent.

Two new anti-tumor promoting serratane-type triterpenoids from the stem bark of Picea jezoensis var. jezoensis.

Two new serratane-type triterpenoids, 1 and 2, were isolated from the stem bark of Picea jezoensis Carr. var. jezoensis (Pinaceae). Their structures were determined to be 3beta-methoxyserrat-13-en-21beta-ol (1) and 13beta, l4beta-epoxy-3beta-methoxyserratan-21beta-ol (2) on the basis of spectroscopic methods and partial syntheses. Compounds 1 and 2 and their acetates were screened as potential anti-tumor promoters by using the in vitro short-term 12-O-tetradecanoylphorbol 13-acetate (TPA)-induced Epstein-Barr virus early antigen (EBV-EA) activation assay. IC50 value evaluation showed that compound 1 was more effective than others. In addition, compounds 1 and 2 were examined for anti-tumor promoting activities in a two-stage carcinogenesis assay of mouse skin tumors induced by 7,12-dimethylbenz[a]anthracene (DMBA) as an initiator and TPA as a promoter. Compounds 1 and 2 exhibited significant anti-tumor promoting effects on mouse skin carcinogenesis.