Resolution of dopamine agonist-resistant hyperprolactinemia by hysterectomy: a case report.

Prolactin-producing uterine leiomyomas are very rare. Although hyperprolactinemia rapidly improves after removal of such leiomyomas, no preoperative diagnostic test has been established for prolactin-producing uterine leiomyomas. A 45-year-old Japanese woman, gravida 3 para 3, was referred to our hospital for further examination of hyperprolactinemia resistant to a dopamine agonist. A pituitary prolactinoma was undetectable by brain magnetic resonance imaging. A bromocriptine loading test revealed an increased serum prolactin concentration after loading. Examination for the detection of an ectopic prolactinoma revealed a 9.0 cm diameter uterine leiomyoma that had measured 6.6 cm in diameter about six months before the first visit to our hospital. The hyperprolactinemia rapidly improved after hysterectomy. A prolactin-producing uterine leiomyoma should be considered as a possible cause of hyperprolactinemia resistant to dopamine agonists. Responsiveness to dopamine agonists; deterioration of hyperprolactinemia may be diagnostic for prolactin-producing uterine leiomyomas, although further research is required.

Study of local intracellular signals regulating axonal morphogenesis using a microfluidic device.

The establishment and maintenance of axonal patterning is crucial for neuronal function. To identify the molecular systems that operate locally to control axonal structure, it is important to manipulate molecular functions in restricted subcellular areas for a long period of time. Microfluidic devices can be powerful tools for such purposes. In this study, we demonstrate the application of a microfluidic device to clarify the function of local Ca2+ signals in axons. Membrane depolarization significantly induced axonal branch-extension in cultured cerebellar granule neurons (CGNs). Local application of nifedipine using a polydimethylsiloxane (PDMS)-based microfluidic device demonstrated that Ca2+ entry from the axonal region via L-type voltage-dependent calcium channels (L-VDCC) is required for branch extension. Furthermore, we developed a method for locally controlling protein levels by combining genetic techniques and use of a microfluidic culture system. A vector for enhanced green fluorescent protein (EGFP) fused to a destabilizing domain derived from E. coli dihydrofolate reductase (ecDHFR) is introduced in neurons by electroporation. By local application of the DHFR ligand, trimethoprim (TMP) using a microfluidic device, we were able to manipulate differentially the level of fusion protein between axons and somatodendrites. The present study revealed the effectiveness of microfluidic devices to address fundamental biological issues at subcellular levels, and the possibility of their development in combination with molecular techniques.

Correlation between pediatrician supply and public health in Japan as evidenced by vaccination coverage in 2010: secondary data analysis.

BACKGROUND: In industrialized countries, assessment of the causal effect of physician supply on population health has yielded mixed results. Since the scope of child vaccination is an indicator of preventive health service utilization, this study investigates the correlation between vaccination coverage and pediatrician supply as a reflection of overall pediatric health during a time of increasing pediatrician numbers in Japan. METHODS: Cross-sectional data were collected from publicly available sources for 2010. Dependent variables were vaccination coverage for measles and diphtheria, pertussis, and tetanus (DPT) by region. The primary predictor of interest was number of pediatricians per 10,000-child population (pediatrician density) at the municipality level. Multivariate logistic regression models were used to estimate associations of interest, conditional on a large range of demographic and infrastructure-related factors as covariates, including non-pediatric physician density, total population, per capita income, occupation, unemployment rate, prevalence of single motherhood, number of hospital beds per capita, length of roads, crime rate, accident rate, and metropolitan area code as urban/rural status. The percentage of the population who completed college-level education or higher in 2010 was included in the model as a proxy for education level. RESULTS: Pediatrician density was positively and significantly associated with vaccination coverage for both vaccine series. On average, each unit of pediatrician density increased odds by 1.012 for measles (95% confidence interval, 1.010-1.015) and 1.019 for DPT (95% confidence interval, 1.016-1.022). CONCLUSIONS: Policies increasing pediatrician supply contribute to improved preventive healthcare services utilization, such as immunizations, and presumably improved child health status in Japan.

Evaluating the effect of Japan's 2004 postgraduate training programme on the spatial distribution of physicians.

BACKGROUND: In 2004, the Japanese government permitted medical graduates for the first time to choose their training location directly through a national matching system. While the reform has had a major impact on physicians' placement, research on the impact of the new system on physician distribution in Japan has been limited. In this study, we sought to examine the determinants of physicians' practice location choice, as well as factors influencing their geographic distribution before and after the launch of Japan's 2004 postgraduate medical training programme. METHODS: We analyzed secondary data. The dependent variable was the change in physician supply at the secondary tier of medical care in Japan, a level which is roughly comparable to a Hospital Service Area in the US. Physicians were categorized into two groups according to the institutions where they practiced; specifically, hospitals and clinics. We considered the following predictors of physician supply: ratio of physicians per 1,000 population (physician density), age-adjusted mortality, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. RESULTS: Baseline physician density showed a positive association with the change in physician supply after the launch of the 2004 programme (P-value < .001), whereas no such effect was found before 2004. Urban locations were inversely associated with the change in physician supply before 2004 (P-value = .026), whereas a positive association was found after 2004 (P-value < .001). Urban location and area-level socioeconomic status were positively correlated with the change in hospital physician supply after 2004 (P-values < .001 for urban centre, and .025 for area-level socioeconomic status), even though in the period prior to the 2004 training scheme, urban location was inversely associated with the change in physician supply (P-value = .015) and area-level socioeconomic status was not correlated. CONCLUSION: Following the introduction of the 2004 postgraduate training programme, physicians in Japan were more likely to move to areas with already high physician density and urban locations. These changes worsened regional inequality in physician supply, particularly hospital doctors.

Validation of predictive equations for resting energy expenditure in Japanese pediatric Crohn's disease patients: preliminary study.

BACKGROUND: Predictive equations are often used to estimate resting energy expenditure (REE). Determining the appropriate equation for different patient types, however, remains inconclusive, as in the case of Japanese children with Crohn's disease (CD). The aim of this study was to identify an appropriate predictive equation for measuring REE in Japanese children with CD. METHODS: Twelve Japanese children with CD managed at the National Center for Child Health and Development in Tokyo, Japan, were studied. REE (kcal/day) was measured using indirect calorimetry. The predictive equations used were the Japanese Dietary Reference Intakes (2010), the Schofield equation, the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) equation and the Cunningham equation. Difference between predicted and measured REE was analyzed on Bland-Altman plot. RESULTS: Japanese Dietary Reference Intakes (2010) had the smallest difference between predicted and measured REE. Weight was the primary predictor of REE on multiple regression analysis. As well, Japanese Dietary Reference Intakes (2010) had the highest ratio of weight to predicted REE (98.5%). CONCLUSIONS: Of the four equations, Japanese Dietary Reference Intakes (2010) appeared to be the most practical and accurate predictive equation for REE in Japanese children with CD.

Pediatricians' practice location choice-Evaluating the effect of Japan's 2004 postgraduate training program on the spatial distribution of pediatricians.

OBJECTIVES: To explore determinants of change in pediatrician supply in Japan, and examine impacts of a 2004 reform of postgraduate medical education on pediatricians' practice location choice. METHODS: Data were compiled from secondary data sources. The dependent variable was the change in the number of pediatricians at the municipality ("secondary tier of medical care" [STM]) level. To analyze the determinants of pediatrician location choices, we considered the following predictors: initial ratio of pediatricians per 1000 children under five years of age (pediatrician density) and under-5 mortality as measures of local area need, as well as measures of residential quality. Ordinary least-squares regression models were used to estimate the associations. A coefficient equality test was performed to examine differences in predictors before and after 2004. Basic comparisons of pediatrician coverage in the top and bottom 10% of STMs were conducted to assess inequality in pediatrician supply. RESULTS: Increased supply was inversely associated with baseline pediatrician density both in the pre-period and post-period. Estimated impact of pediatrician density declined over time (P = 0.026), while opposite trends were observed for measures of residential quality. More specifically, urban centers and the SES composite index were positively associated with pediatrician supply for the post-period, but no such associations were found for the pre-period. Inequality in pediatrician distribution increased substantially after the reform, with the best-served 10% of communities benefitting from five times the pediatrician coverage compared to the least-served 10%. CONCLUSIONS: Residential quality increasingly became a function of location preference rather than public health needs after the reform. New placement schemes should be developed to achieve more equity in access to pediatric care.

Does fever phobia cross borders? The case of Japan.

BACKGROUND: Undue parental fear of fever in children was termed "fever phobia" by Schmitt following a survey in the USA in 1980. In 2000, Crocetti et al. conducted the same survey and concluded that fever phobia existed even 20 years later. In this study, we explore differences in fever phobia between these two US populations and a Japanese sample, and determine whether parents of a single child or those whose child was previously hospitalized or had a febrile seizure report greater anxiety about fever. METHODS: A questionnaire was distributed to parents of children who visited a pediatric outpatient clinic in Juntendo University Nerima Hospital between 19 and 30 November 2007. RESULTS: Data was obtained from 211 parents who agreed to participate in the study. Compared with much smaller proportions reported in the two previous studies, 62% of caregivers considered a temperature below 37.8°C to be a fever, although less than half of parents reported that they were "very worried" about fever. Over 90% identified doctors and nurses as their primary information source. In contrast to 7% of parents in the US studies, almost no parents reported that temperatures could rise to or above 43.3°C if fever was left untreated; however, 63% of parents stated that they would visit a hospital. CONCLUSIONS: Fever phobia exists on both sides of the border, and while caregivers in Japan appear to have a more accurate understanding of fever, they are more likely to rely on health-care professionals to manage the condition.

The role of epidermal growth factor-like domain-related abnormalities, protein S Tokushima, and anti-protein S autoantibodies in pregnancy loss.

BACKGROUND: Protein S (PS) deficiency and autoantibodies that bind to PS (anti-PS) have been described in patients with adverse pregnancy outcomes, including pregnancy loss. PS Tokushima is a congenital abnormality of the second epidermal growth factor (EGF)-like domain, and anti-PS has been reported to recognize EGF-like domains. OBJECTIVES: We evaluated the role of PS Tokushima and anti-PS in patients with pregnancy loss. METHODS: Patients with recurrent early pregnancy loss (n = 324; group A), those with one or more mid-to-late pregnancy loss (n = 196; group B), and infertile women having no pregnancy loss (n = 650; group C) were screened for PS type II deficiency and anti-PS. Patients who were diagnosed with PS type II deficiency underwent genetic analysis for the detection of PS Tokushima. RESULTS: The incidence of patients with PS Tokushima was 1.85 %, 5.10 %, and 1.23 % in groups A, B, and C, respectively. The incidence of patients with PS Tokushima was significantly higher in group B (p = 0.0027) than in group C. The incidence of patients with anti-PS was 20.1 %, 23.0 %, and 19.2 % in groups A, B, and C, respectively. The incidence of patients with anti-PS was significantly higher in groups A (p = 0.0229), B (p = 0.0071), and C (p = 0.0288) than in previously reported healthy nonpregnant women (7.1 %, 4/56). CONCLUSIONS: Our data suggest that PS Tokushima is associated with mid-to-late pregnancy loss, while anti-PS are associated with recurrent early pregnancy loss, mid-to-late pregnancy loss, and infertility.

Effects of Both Japanese-Style Dietary Patterns and Nutrition on Falling Incidents among Community-Dwelling Elderly Individuals: A Cross-Sectional Study.

Approximately 20% of the community-dwelling Japanese elderly (≥65 years) experience falling annually, with injury frequency rising with age. Increased nursing home admission/hospitalization risk influences healthy aging and QOL. Nutrition for musculoskeletal health is necessary, though the relationship of falling with nutritional status in the elderly is largely unknown. We investigated falling incidents and nutritional status, including a Japanese-style diet in a community-dwelling cohort. Using a cross-sectional design, 186 subjects (median age 83.0 years, males/females 67/119) were analyzed. Oral and systemic health conditions were assessed. A brief-type self-administered diet history questionnaire (BDHQ) was given for nutritional status. Analysis of covariance (adjusted for gender, age, BMI, articular disease/osteoporosis history, present tooth number, educational level) and the Japanese-Mediterranean diet (jMD) score adapted for Japan were used. The jMD score and falling incidents were significantly associated, with point increases related to a significantly decreased falling risk of 28% (OR: 0.72; 95%CI: 0.57−0.91). Of the 13 jMD food components, fish, eggs, and potatoes had a significant relationship with reduced falling, while significant associations of intake of animal protein, potassium, magnesium, zinc, and cholesterol (p < 0.05) were also observed. The results suggest that the jMD dietary pattern is an important factor for the prevention of falling incidents in elderly individuals.

Does the pediatricians' work setting or years of experience influence febrile seizure education?

INTRODUCTION: A febrile seizure is a benign condition. However, for parents, witnessing their child's FS can cause excessive anxiety. It is therefore important for pediatricians to provide appropriate information in order to reduce anxiety. In this study, we analyze whether work setting and years of experience influence the explanations given to caregivers. METHODS: Questionnaires were mailed to members of the Japan Pediatric Society, Tokyo Chapter (n=1 870). The Mantel-Haenszel test was used for dichotomous variables. Differences for continuous variables were evaluated at 95% confidence intervals. RESULTS: A total of 482 pediatricians participated. There were no significant differences in responses to any questions according to work setting. Responders with less than 20 years of experience reported a higher prevalence of febrile seizures than those in the more experienced group. Compared to the experienced group, more responders with less than 20 years of experience stated that they would administer antiepileptic prophylaxis and advise parents not to use antipyretics, and indicated that they did not know the FS treatment guidelines. CONCLUSION: The findings suggest the importance of promoting a better understanding of FS among less-experienced pediatricians and encouraging adherence to the guidelines to maintain a consistent level of support for parents and caregivers.

Disease patterns of outpatient visits by Japanese expatriate children in Thailand.

AIM: To clarify the health-related conditions of Japanese expatriate children in Thailand. METHODS: Records of Japanese children who consulted outpatient clinics at Bangkok Hospital in 2005 and 2006 (n = 2141) were analysed, and then compared with data from the patient survey conducted by the Ministry of Health, Labour and Welfare of Japan in 2005 (n = 575 400). RESULTS: 'diseases of the respiratory system', categorized as chapter X under ICD-10 was the most frequent category in both Thailand and Japan. Although 'certain infectious and parasitic diseases' (chapter I) was the second most frequent category in Thailand, it was infrequent in Japan. In the subcategories of 'diseases of the respiratory system', 'acute upper respiratory infections' was frequent and asthma was infrequent in Thailand. Conversely, 'acute upper respiratory infections' showed a low percentage and asthma was the most frequently observed disease in Japan. CONCLUSION: This study examined Japanese children having the same genetic background but divided into two groups according to different living environments. Results demonstrate that children living in Japan contract asthma more frequently than infectious diseases, whereas those living in Thailand show the opposite trend, which supports the hygiene hypothesis that infections may protect against the development of allergic diseases, such as asthma.

Disease pattern and seasonal variation among Japanese expatriate children in Thailand.

BACKGROUND: Due to recent globalization, the number of Japanese expatriates including children has increased. The aim of the present study was to clarify the disease patterns and seasonal variation among Japanese children living in Thailand. METHODS: Records of Japanese children seen at the outpatient clinic at Bangkok Hospital in 2005 (n = 1668) were analyzed and records of Thai children (n = 23 339) were also analyzed for comparison. RESULTS: 'Diseases of the respiratory system' was the most frequent category in both groups (Japanese, 42.1%; Thai, 45.0 %,) followed by 'factors influencing health status and contact with health services' (Japanese, 12.7%; Thai, 14.9%), and 'certain infectious and parasitic diseases' (Japanese, 10.3%; Thai, 8.5%). The number of hospital visits by Japanese patients decreased in January, April, August and December and those by Thai patients in April and September. Identical drops in the number of visits for diseases of the respiratory system were also seen. A large number of patients visited the hospital for viral infections characterized by skin and mucous membrane lesions during the rainy season. The number of hospital visits for intestinal infection fluctuated during the rainy season. CONCLUSION: There were no marked differences between disease patterns of Japanese patients and Thai patients. Temporary visits back to Japan could account for sharp drops in total hospital visits and hospital visits for diseases of the respiratory system in January, April, August and December because these times of the year corresponded to extended school vacations. Preventive measures for viral infections characterized by skin and mucous membrane lesions should be promoted during the rainy season.

Parental knowledge and perceptions of fever in children and fever management practices: differences between parents of children with and without a history of febrile seizures.

OBJECTIVES: The aim of this study was to compare maternal knowledge and perceptions of fever, fever management practices, and information sources of mothers of children with and without a history of febrile seizures. METHODS: A questionnaire was used to survey mothers of children who visited health departments for a routine 18-month-old well baby check-up. RESULTS: A total of 386 responses were analyzed. More mothers of children with a history of febrile seizures than mothers of children without it stated that high fever caused febrile seizures and antipyretics prevented it. Fewer mothers of children with a history of febrile seizures than mothers in the other group thought that high fever caused brain damage and antipyretics prevented the disease from worsening and warmed the child's body during fever episode. Many mothers in both groups stated that they considered physicians to be their primary information source. Spouse and own parents were named as information sources among mothers of children with a history of febrile seizures, whereas books and the Internet were named in the other group. CONCLUSIONS: Mothers of children with a history of febrile seizures demonstrated a higher rate of accuracy in their knowledge of fever than those in the other group. Mothers of children with a history of febrile seizures used personal communication, whereas those in the other group relied on mass communication for health information. Providing accurate information to family members is essential to provide mothers with both accurate information and emotional support.

Anti-Factor XII Autoantibodies in Patients with Recurrent Pregnancy Loss Recognize the Second Epidermal Growth Factor-Like Domain.

Background Factor XII (FXII) deficiency and autoantibodies that bind to FXII (anti-FXII) have been described in patients with adverse pregnancy outcomes, including recurrent pregnancy loss. It has been reported that FXII functions not only as a coagulation protein but also as a growth factor. Objectives We studied the association between anti-FXII and the epidermal growth factor (EGF) system in patients with recurrent pregnancy loss. Patients/Methods We used synthetic peptides that span the second EGF-like domain in the heavy chain of FXII (EGF2) in inhibition and direct binding studies to determine if anti-FXII antibodies recognize EGF2. Furthermore, we examined whether anti-FXII antibodies, which recognize EGF2, also recognize recombinant EGF and heparin-binding EGF-like growth factor (HB-EGF). Results Among 100 patients with recurrent pregnancy loss, the plasma of 23 patients (23.0%) recognized the synthetic peptide ASQ41, which covers EGF2. Among the 23 anti-ASQ41-positive patients, plasma samples from 13 patients (56.5%) recognized the 22-residue segment C-terminal half of ASQ41. Among the 23 anti-ASQ41-positive patients, the plasma of 17 patients (73.9%) recognized recombinant human EGF. Affinity-purified anti-FXII antibodies, which recognize ASQ41, also recognized recombinant EGF family proteins such as EGF and HB-EGF. Conclusions The autoantibodies in patients with recurrent pregnancy loss recognized the EGF2 domain in FXII and other proteins of the EGF family. Since proteins in the EGF family play an important role in normal pregnancy, autoantibody-associated disruption of the EGF system may cause pregnancy loss.

Factors associated with ambulance requests for febrile seizures.

The objective of this study was to determine factors associated with ambulance requests for febrile seizures. This study retrospectively investigated medical records of patients who visited the Emergency Care Unit at Tokyo Metropolitan Toshima Hospital in the 5-year period after April 2001. Subjects' basic characteristics (e.g., age and sex), medical history of febrile seizures, sibling and parental medical history of febrile seizures, and distance from hospital were investigated. In total, 310 subjects used ambulances, and 106 came to the hospital without requesting ambulances. The results of binomial logistic analysis indicated that factors associated with ambulance requests included patient's and parents' medical history of febrile seizures. Increasing awareness of febrile seizures and provision of a general public educational campaign are possible strategies to help decrease unnecessary ambulance requests. However, a medical history of febrile seizures among siblings revealed no association, indicating the need to conduct repeated early-stage interventions.

Linear IgA dermatosis: report of an infantile case and analysis of 213 cases in Japan.

A 3-year-old boy presented with multiple vesicles, showing a rosette-like arrangement around the crusts. Histopathological and immunohistochemical examinations demonstrated subepidermal blistering with neutrophilic infiltration associated with deposition of IgA, but not IgG, linearly distributed along the basement membrane zone (BMZ) of the epidermis. Indirect immunofluorescence revealed circulating antibodies (IgA class, x160) against the BMZ of guinea pig lip skin. Based on the diagnosis of linear IgA dermatosis (LAD) of childhood, administration of dexamethasone (2 mg/day) was started, and the eruptions diminished immediately. Western blot analysis using extract of the HaCaT cell as a substrate, demonstrated the corresponding antigen at 120-kDa molecular weight. There have been 213 cases of LAD reported in Japan including conference abstracts and these were studied to determine whether infantile cases differed from adult ones, and whether cases associated with IgG as well as IgA (IgA/G type), differed from the cases associated with IgA only (IgA type). IgG contributed less frequently to the infantile type (age of onset, < or =15 years) than to the adult type (age of onset, > or =16 years). Clinical appearance did not show any obvious difference between the IgA/G type and IgA type. However, three-quarters of cases showing localization of antigen to the dermal side were the IgA/G type.

Antigenic binding sites of anti-protein S autoantibodies in patients with recurrent pregnancy loss.

BACKGROUND: Protein S (PS) deficiency is a risk factor for adverse pregnancy outcomes including recurrent pregnancy loss. Several studies have shown that the presence of anti-PS autoantibodies (anti-PS) leads to an acquired PS deficiency. Hence, an epitope mapping study was conducted to know the pathogenesis of anti-PS in patients with recurrent pregnancy loss. METHODS: PS was treated with thrombin to divide the protein into γ-carboxyglutamic acid (Gla) domain and Gla-domain free PS. For the preparation of fragments of epidermal growth factor (EGF)-like domains (EGF1-4), PS was subjected to proteolysis using lysyl endopeptidase. The epitopes were identified in immunoblot. Whether anti-PS recognized EGF family proteins in anti-PS-positive patients was also examined. RESULTS: Anti-PS recognized Gla-domain free PS, especially the three fragments of EGF-like domains, EGF1-2, EGF3-4, and EGF1-4. Anti-PS recognized recombinant human EGF. Anti-PS and polyclonal antibodies to recombinant human EGF recognized PS in the absence of Ca2+ but not in the presence of Ca2+. In competitive inhibition studies, polyclonal antibodies to recombinant mouse EGF blocked anti-PS binding to PS in a concentration-dependent manner. CONCLUSIONS: These results suggest that anti-PS in patients with recurrent pregnancy loss recognize EGF-like domains in PS. Interestingly, anti-PS also recognized EGF family proteins. Anti-PS in patients with recurrent pregnancy loss may be associated with not only thrombophilia but also the disruption of the EGF system.

Late-onset self-healing reticulohistiocytosis: pediatric case of Hashimoto-Pritzker type Langerhans cell histiocytosis.

An 8-year-old otherwise healthy girl presented with a 3-month history of multiple asymptomatic, reddish-brown papules over the face and upper limbs. Histopathological and immunohistochemical examinations demonstrated an infiltrate of mononuclear cells containing abundant histiocytic cells in the dermis, and microabscess-like accumulation of the histiocytic cells in the epidermis. The histiocytic cells were positive for antibodies against S-100 protein and CD1a, but negative for anti-CD68. Lag and anti-langerin monoclonal antibodies reacted more weakly with these histiocytic cells than with Langerhans cells in the surrounding epidermis. The skin lesions spontaneously regressed within the following 3 months, and neither systemic involvement nor local recurrence was observed during the next 10 months. This case should be categorized as congenital self-healing reticulohistiocytosis (Hashimoto-Pritzker), although the onset was not early in life.

Relationships among sense of coherence, oral health status, nutritional status and care need level of older adults according to path analysis.

AIM: Sense of coherence (SOC) is a measurement of ability of an individual to cope with psychological stress and remain in good health. The aim of the present study was to examine the relationships among SOC score, oral health status, nutritional status and care need level of older adults using path analysis. METHODS: We enrolled 53 older adults (17 men and 36 women) who were attending a day care service (mean age 80.4 ± 6.5 years). SOC was assessed using a 13-item, seven-scale instrument. Oral health status (number of present teeth, denture use) and nutritional status (assessed with Mini-Nutritional Assessment Short-Form) were also evaluated. Path analysis was used to examine the relationship of SOC with other related factors, including care need level. RESULTS: The mean SOC score was 57.0 ± 13.9. Mini-Nutritional Assessment Short-Form results showed that one participant (1.8%) was malnourished, 26 (49.1%) were at risk of malnutrition and 26 (49.1%) had normal nutritional status. Participants with high SOC scores showed a strong positive attitude, had a relatively large number of teeth, were in good nutritional condition and showed low care need levels. CONCLUSIONS: The present results showed that maintaining a high SOC level and good oral health help to reduce care need levels in older adults, and also prevent a worsening of their nutritional condition. Geriatr Gerontol Int 2017; 17: 2083-2088.

Steroid Pulse Therapy for De Novo Minimal Change Disease During Pregnancy.

BACKGROUND Nephrotic syndrome occurs very rarely, in only about 0.01%-0.02% of all pregnancies, and de novo minimal change disease during pregnancy is especially rare. Nephrotic syndrome and, especially, minimal change disease are highly responsive to steroids, and preterm labor may be avoidable if the maternal condition is improved with steroid therapy. Therefore, prompt diagnosis and proper management are critical to maternal and fetal outcome when severe proteinuria occurs during pregnancy. CASE REPORT A 30-year-old pregnant Japanese woman presented with systemic edema, oliguria, and severe proteinuria and hypoalbuminemia at 25 weeks of gestation, although she was normotensive. The patient had high urinary protein selectivity. Her illness was diagnosed as de novo nephrotic syndrome with high steroid responsiveness rather than pre-eclampsia. She began steroid pulse therapy the day after admission. Complete remission was confirmed after 3 weeks. The patient did not relapse during pregnancy and delivered a healthy male baby at 37 weeks of gestation. A renal biopsy at a relapse after delivery confirmed minimal change disease. CONCLUSIONS In pregnant women with de novo minimal change disease, serious maternal and/or fetal complications may occur if severe proteinuria and hypoalbuminemia are unabated for an extended time. Evaluation of urinary protein selectivity is noninvasive and useful for prediction of steroid responsiveness. Results of urinary protein selectivity can be obtained earlier than results of renal biopsy. Renal biopsy during pregnancy is not always necessary for initiation of steroid therapy. Rapid initiation of steroid pulse therapy may enable quicker achievement of remission and prevent serious perinatal complications.