Preliminary early intervention study using Nursing Child Assessment Teaching Scale in Japan

Background: Mother–infant interactions have been acknowledged as one of the most important elements in measuring outcomes of parent support and infant mental health interventions. The present study was conducted to measure early intervention outcomes using the Nursing Child Assessment Teaching Scale (NCATS), and to identify factors that affected Japanese mother–infant interactions. Methods: Healthy Japanese mother–infant dyads who had lower scores on the NCATS, indicating potential problems, were assigned to an intervention group, and compared with a control group who had higher scores on NCATS. Health‐care professionals visited the intervention group dyads in their homes, and gave them positive feedback on their interactions, consultations on parenting, and health advice. The control group dyads had home visitation once every 6 months for assessment only. Results: The home visitations started at 3 months of age and continued until 18 months. NCATS scores in both groups were significantly different at baseline but differences faded by the end, which suggests that the intervention promoted improved interactions in the intervention group. Two of five factors were identified as influencing mother–infant interactions: maternal age; and personal networks, and together they significantly explained 27–30% of NCATS variance. Conclusion: The results appear to support the validity of measuring Japanese mother–infant interactions with NCATS. This study is the first to measure the outcomes of early intervention on Japanese dyads’ interactions using NCATS. Additional replication studies should be conducted elsewhere in Japan, and clinical practices for promoting mother–infant interactions should begin to assess their effectiveness with NCATS as an outcome measure.     

Ten cases of sebaceous carcinoma arising in nevus sebaceus

Although nevus sebaceus is known to develop various types of secondary neoplasms, it rarely causes carcinoma and only 14 cases of secondary sebaceous carcinoma have been reported. In this study, 10 cases of sebaceous carcinoma arising in nevus sebaceus were collected. The clinicopathological features and results of immunohistochemical examinations with adipophilin, perilipin and p53 were summarized. Sebaceous carcinoma arising in nevus sebaceous predominantly occurred on the scalp (8/10) of elderly women (mean age, 67.7 years). No case was associated with Muir–Torre syndrome. We found several pathological features of sebaceous carcinoma; that is, made up mainly of germinative cells, moderate nuclear atypia without pleomorphism and many mitoses (4–28/10 high‐power field). Adipophilin and perilipin antibodies highlighted lipid drops in the cytoplasm of the malignant cells in all cases. Overexpression of p53 was seen in all cases. In two cases there were coexisting benign‐looking sebaceous lesions at the periphery of the main cancer nodule, and in these lesions p53 showed low positivity compared with the clearly malignant area. There was co‐occurrence of another neoplasm in three cases with trichoblastoma, sebaceoma and syringocystadenoma papilliferum, respectively. All cases were treated by excision of the malignant lesion, with or without inclusion of the nevus sebaceus. In a follow‐up period of 1–7 years, there was no case of recurrence, lymph node metastases or distant metastases. With these specific pathological and immunohistochemical findings using adipophilin, perilipin and p53, we have to consider the possibility that there is a tendency to underdiagnose secondary sebaceous carcinomas in nevus sebaceus. These clinicopathological features of sebaceous carcinomas developing in the nevus sebaceus seem to indicate different biological entities from de novo sebaceous carcinoma.     

Suppression of Storms of Ventricular Tachycardia by Epicardial Ablation of Isolated Delayed Potential in Noncompaction Cardiomyopathy

A 65‐year‐old recipient of an implantable cardioverter defibrillator suffering from ventricular noncompaction developed storms of ventricular tachycardia (VT). Epicardial voltage mapping revealed the presence of a large low‐voltage area in the left ventricular apical and inferoposterior wall, and isolated delayed potential was recorded over 1.5 cm in the posterior border between low and normal myocardial voltage. Pacemapping at the delayed potential recording site produced two different QRS depending on pacing output strength, and these two QRS morphologies were similar to clinically documented VTs. During one of the VTs, a mid‐diastolic potential was recorded from the site with the delayed potential, and rapid pacing produced concealed entrainment. After epicardial radiofrequency ablation of the isolated delayed potential, VTs were noninducible and the VT storm was suppressed.     

Ball Measure for Quantitative Analysis of Minute Morphological Changes in Mucosal and Submucosal Cancer

Abstract: We introduce the “ball measure” concept, which is utilized for quantitatively evaluating minute morphological changes in the mucosal surface of superficial cancer. The ball measure device is a completely spherical, white-colored, plastic ball with a 1-mm outer diameter. An applicator is also available, which can settle the ball accurately on any mucosal surface target. The ball measure device is attached around the lesion, allowing precise assessment of the height of a marginal elevation or depression. The actual sizes of granules in the ulcer bed can also be described with this method. We believe that the ball measure technique is an indispensable means of objectively assessing morphology, and thereby of providing an accurate diagnosis of the infiltrative depth of an early cancer.     

Development of an exercise program for fall prevention for elderly persons in a long-term care facility

Aim: The purpose of this study was to develop an exercise program for elderly individuals in a long‐term care facility. Developed through the synthesis of evidence‐based nursing with the use of available research related to falls and exercise, the program was designed to increase balance, mobility, and muscle strength in the lower extremities in order to prevent falls and improve the self‐efficacy of the patients. Methods: We developed an exercise program consisting of a warm‐up, static stretching, muscle strengthening in the lower extremities, toe exercises, proprioceptive neuromuscular facilitation, and cool‐down. The study design was a prospective clinical trial. The intervention period was 3 months, with the outcomes measured before and after intervention and 3 months after cessation of the intervention. The 30 participants were elderly residents of a long‐term care facility, 16 of whom were in the intervention group and 14 of whom were in the control group. The outcome values were mobility, muscle strength in the lower extremities, postural sway, fall efficacy, and the number of fallers and falls. The Friedman test was used to analyze the effectiveness of the outcomes. Results: The intervention group showed increased balance, maintained mobility, and showed a decreased number of fallers and falls, although the muscle strength and fall efficacy did not increase. No training‐related medical problems occurred. Conclusion: The exercise program was shown to be acceptable to use for the prevention of falls among elderly individuals in a long‐term care facility.     

Search for a Susceptibility Locus to Tardive Dyskinesia

In order to find a genetic marker for vulnerability to tardive dyskinesia (TD), we looked for an association between vulnerability to TD and polymorphic sites in the gene loci encoding the dopamine D2 receptor (Nco I site), the dopamine D3 receptor (Bal I site), and the dopamine transporter (40-bp, tandem repeat polymorphism). No significant difference was observed in the allele and genotype frequencies of any of the polymorphic sites examined, when comparing psychiatric patients who were specifically vulnerable to TD (n = 49) and those who were not (n = 56). These results suggest that the polymorphic gene loci examined in the present study are unlikely to be of major aetiologic importance in the development of TD. © 1997 John Wiley & Sons, Ltd.     

Streak Metal Artifact Reduction Technique in Cone Beam Computed Tomography Images after Endovascular Neurosurgery

Cone beam computed tomography (CBCT) images are degraded by artifacts due to endovascular implants. We evaluated the use of streak metal artifact reduction technique (SMART) in non-contrast CBCT images after endovascular neurosurgery obtained from 148 patients (125 with aneurysm and 23 with dural arteriovenous fistula [dAVF]). Three neurosurgeons evaluated the cistern and brain surface visibility in CBCT images with and without SMART correction based on a 4-point scale (1, excellent; 2, good; 3, limited; and 4, insufficient). Significant improvement in visibility was achieved when the median scores improved from 4 or 3 to 2 or 1 or from 2 to 1. Metal artifact reduction in adjacent slices without metal and new artifacts after SMART correction was also examined. A significant improvement was achieved regarding the visibility of the cistern in 90 (60.8%) images and of the brain surface in 108 (73.0%) images. Metal size (cistern: odds ratio [OR], 0.91 per 1 mm increase; 95% confidence interval [CI], 0.83–0.99), irregular metal shape (cistern: OR, 0.18; 95% CI, 0.05–0.60 and brain surface: OR, 0.15; 95% CI, 0.05–0.45), and infratentorial lesions (cistern: OR, 0.37; 95% CI, 0.14–0.96 and brain surface: OR, 0.30; 95% CI, 0.11–0.80) were negatively correlated with improved visibility. Metal artifact reduction in adjacent slices without metal was obtained in 25.6% and 34.8% of images with aneurysm and dAVF, respectively. New artifacts after SMART correction were found in 4.8% and 13.0% of images with aneurysm and dAVF, respectively. SMART is especially effective for supratentorial small aneurysms.     

Angioplasty and Stenting for Intracranial Stenosis

Of the patients enrolled in the Japanese Registry of Neuroendovascular Therapy (JR-NET), a surveillance study in Japanese, 1133 patients who underwent intracranial percutaneous transluminal angioplasty (PTA)/stenting for intracranial stenosis during the period from 2005 to 2009 were investigated. A technical success was achieved in 98.3% of the patients, and 70.5% and 7.5% had a residual stenosis of < 30% and ≥ 50%, respectively. The incidence of ischemic complications and hemorrhagic complications was as low as 7.7% and 2.5%, respectively, but tended to increase in patients who underwent stenting. While a significant correlation with ischemic complications was observed in previously untreated patients and patients who underwent stenting followed by post-dilatation, a significant correlation with hemorrhagic complications was observed in patients who received emergency treatment and those treated between 24 hours and 14 days of the onset. Flexible intracranial stents are expected to contribute to improvement in the treatment outcome.