The Kumagai Method Utilizing the Pigeon Bottle Feeder with a Long Nipple: A Descriptive Study for the Development of Feeding Techniques for Children with Cleft Lip and/or Palate.

We aimed to identify the steps involved in the Kumagai method-an experimental nursing procedure to feed children with cleft lip and/or palate, using a feeder with a long nipple. We conducted a descriptive study, enrolling five specialist nurses who have mastered the Kumagai method. Their approaches were examined using structured interviews. Moreover, the participants were asked to perform the sequence of actions involved in this method while describing each step. Therefore, we were able to explore the Kumagai method in depth and step-by-step, including the following aspects: correct infant posture; correct feeding bottle holding position; nipple insertion into the child's mouth; and feeding process initiation, maintenance, and termination. Each step comprises several clinically relevant aspects aimed at encouraging the infant to suck with a closed mouth and stimulating chokubo-zui, i.e., simulation of the natural tongue movement during breastfeeding in children without a cleft palate. In conclusion, when performed correctly, the Kumagai method improves feeding efficiency in children with cleft lip and/or palate. Feeders with long nipples are rarely used in clinical practice; the Kumagai method might popularize their use, thereby improving the management of feeding practices for children with cleft lip and/or palate.

Bottle-feeding techniques for children with cleft lip and palate experiencing feeding difficulties.

Objective: This study aimed to identify clinical bottle-feeding techniques practiced by nurses for children with cleft lip and palate experiencing feeding difficulties. Methods: A qualitative descriptive design was used. Five anonymous questionnaires were distributed to each hospital, and 1,109 hospitals with obstetrics, neonatology, or pediatric dentistry wards in Japan were enrolled in the survey between December 2021 and January 2022. Participants were nurses working for over 5 years providing nursing care for children with cleft lip and palate. The questionnaire comprised open-ended questions about the feeding techniques across four dimensions: preparation before bottle-feeding, nipple insertion methods, sucking assistance, and criteria for stopping bottle-feeding. The qualitative data obtained were categorized according to meaning similarity and analyzed. Results: A total of 410 valid responses were obtained. The findings regarding the feeding techniques in each dimension were as follows: seven categories (e.g., improving child's mouth movement, keeping child's breath calm), 27 sub-categories in preparation before bottle-feeding; four categories (e.g., closing the cleft using the nipple to create negative pressure in oral cavity, inserting the nipple to not touch the cleft), 11 sub-categories in nipple insertion methods; five categories (e.g., facilitating awakening, creating negative pressure in oral cavity), 13 sub-categories in sucking assistance; and four categories (e.g., reduced awakening level, worsening vital signs), 16 sub-categories in criteria for stopping bottle-feeding. Most participants responded that they would like to learn bottle-feeding techniques for children with cleft lip and palate who have feeding difficulties. Conclusion: Many bottle-feeding techniques were identified to address disease-characterized conditions. However, the techniques were found to be conflicting: some inserted the nipple to close the cleft to create negative pressure in the child's oral cavity, while others inserted it without touching the cleft to prevent ulceration on the nasal septum. Although these techniques were used by nurses, the effectiveness of the methods has not been assessed. Future intervention studies are needed to determine each technique's benefit or potential harm.

A case of behavioral changes in a castrated male cat due to a functional adrenocortical adenoma producing testosterone and androstenedione.

CASE SUMMARY: This case report describes a 9-year-old neutered male cat with a functional adrenal tumor showing aggression toward other cats in the household, excessive meowing and urine spraying. The diagnosis was made based on the clinical signs, an enlarged right adrenal gland on ultrasound, penile spines and elevated sex hormones on an adrenocorticotropic hormone stimulation test. The cat was submitted to celiotomy and adrenalectomy. Histopathological examination confirmed the adrenocortical adenoma. Three months after surgery the penile spines disappeared and urine spraying, as well as excessive meowing, had greatly decreased; however, aggressive behavior took much longer to stop and required behavior therapy. RELEVANCE AND NOVEL INFORMATION: Functional adrenal tumors producing only sex hormones and behavioral changes are uncommon. The cat reported herein started showing behavioral changes before spines appeared on the penis, and structural alterations in the adrenal gland at the abdominal ultrasonography were detected. Considering all the possible implications resulting from severe behavior problems such as cat-cat aggression, from a permanent separation of the cats to relinquishment, a detailed investigation of underlying medical mechanisms in these animals is crucial from the start. Examinations may need to be repeated later in the course.

Salmon acyl-ghrelin increases food intake and reduces doxorubicin-induced myocardial apoptosis in rats, likely by anti-oxidative activity.

We had reported that orally administered ghrelin-containing salmon stomach extract prevents doxorubicin (DOX)-induced cardiotoxicity. In this study, we investigated the binding affinity of salmon ghrelin to rat ghrelin receptor and the cardioprotective effects of subcutaneous (sc) injected synthetic salmon ghrelin in rats with DOX-induced acute heart failure in order to clarify the potential efficacy of salmon ghrelin. Intracellular calcium mobilization assay was performed on rat GHS-R1a-expressing CHO cells to reveal ghrelin activity. Rats were divided into five groups; the normal control (I), and toxic control (II) groups were given saline (sc, twice daily), and the salmon acyl-ghrelin (sAG) (III), salmon unacylated-ghrelin (sUAG) (IV), and rat acyl-ghrelin (rAG) (V) groups were given corresponding synthetic ghrelins (sc, twice daily), respectively. After seven days of treatment, DOX (20 mg/kg BW) or saline was administered to the corresponding groups by intraperitoneal injection. The toxic control group was the negative control group for the DOX-induced cardiotoxicity groups. While sAG displayed similar affinity to rAG upon application to GHS-R1a-expressing cells, and also decreased DOX-induced apoptosis and increased food intake, sUAG did not. Both sAG and rAG improved DOX-induced deterioration, showing anti-oxidative activity. The anti-oxidative activity of sAG might contribute to the protective effects on cardiomyocytes. The results also suggest that, similar to rAG, sAG is a potent protectant against DOX-induced cardiotoxicity and a potential functional component in orally administered ghrelin-containing salmon stomach extract, which prevented DOX-induced cardiotoxicity in our previous study.

Feline behaviour problems in Brazil: a review of 155 referral cases.

BACKGROUND: Geographical variations in feline behaviour problems exist. The occurrence of feline behaviour problems in different regions are therefore important to prepare professionals for the emerging needs of cat owners. METHODS: One-hundred and fifty-five feline behaviour cases that were referred to a veterinary behaviourist in São Paulo (Brazil) during the period 2008-2014 are described. RESULTS: Inter-cat aggression was the main behavioural complaint reported (31%), followed by housesoiling (26.4%). Unlike other international studies, inter-cat aggression was more frequently seen than inappropriate elimination. Oral repetitive behaviours, including problems such as psychogenic alopecia and pica, were also a prevalent problem (ie, 16.8% of the cases). Human-directed aggression accounted for 13.5% of the cases, taking fourth place in the list of the most common feline behavioural problems. Female and male cats were equally likely to be presented (51% and 49% of cases, respectively). CONCLUSIONS: This study highlights potentially geographical or temporal variation in the behavioural problems that need to be recognised by veterinary behaviourists in order to meet the emerging needs of owners.

Cholesterol lowering effects of mono-lactose-appended ß-cyclodextrin in Niemann-Pick type C disease-like HepG2 cells.

The Niemann-Pick type C disease (NPC) is one of inherited lysosomal storage disorders, emerges the accumulation of unesterified cholesterol in endolysosomes. Currently, 2-hydroxypropyl-ß-cyclodextrin (HP-ß-CyD) has been applied for the treatment of NPC. HP-ß-CyD improved hepatosplenomegaly in NPC patients, however, a high dose of HP-ß-CyD was necessary. Therefore, the decrease in dose by actively targeted-ß-CyD to hepatocytes is expected. In the present study, to deliver ß-CyD selectively to hepatocytes, we newly fabricated mono-lactose-appended ß-CyD (Lac-ß-CyD) and evaluated its cholesterol lowering effects in NPC-like HepG2 cells, cholesterol accumulated HepG2 cells induced by treatment with U18666A. Lac-ß-CyD (degree of substitution of lactose (DSL) 1) significantly decreased the intracellular cholesterol content in a concentration-dependent manner. TRITC-Lac-ß-CyD was associated with NPC-like HepG2 cells higher than TRITC-ß-CyD. In addition, TRITC-Lac-ß-CyD was partially localized with endolysosomes after endocytosis. Thus, Lac-ß-CyD entered NPC-like HepG2 cells via asialoglycoprotein receptor (ASGPR)-mediated endocytosis and decreased the accumulation of intracellular cholesterol in NPC-like HepG2 cells. These results suggest that Lac-ß-CyD may have the potential as a drug for the treatment of hepatosplenomegaly in NPC disease.

[Outcome of the 6-year curriculum for pharmacy education: "Contribution to medical care and society: how will I act as a pharmacist in the future?"--A report on the 3rd National Student Workshop].

In August 2013, the Pharmaceutical Society of Japan held the Third National Student Workshop in Tokyo. A total of 88 people-70 sixth-year undergraduate students from 70 universities, and 18 alumni who had participated in the First and the Second Workshops-attended this Workshop. The theme of this Workshop was "Contribution to medical care and society: How will I act as a pharmacist in the future?" The first day took the form of a World Café, with participants exchanging information on such topics as, "The purpose for choosing a pharmacy major, and my achievement status", "My favorite aspects of my college", and "My dreams and paths: Painting my future image". Later that day, participants discussed and gave presentations on the ways they would be contributing as pharmacists to society and medical care. On the second day, participants discussed and gave presentations on the efforts they would like to make as pharmacists to contribute to society and medical care. The final session was a general assembly for discussion on the ways they would be contributing as pharmacists to society and medical care. Throughout the two days, attendees participated in discussions with an awareness of their common ground, in that they all had national qualification in spite of different intended paths. In this article, 4 sixth-year students (their status at the time of the symposium) from the Workshop introduce outlines of the discussions and products from each group.