VIABAHN® Stent Graft Implantation for Iatrogenic Arteriovenous Fistula and Pseudoaneurysm of the Deep Femoral Artery.

Femoral arteriovenous access is most commonly used in endovascular diagnosis and treatment. Complications arising during femoral arteriovenous access include hematoma, retroperitoneal hemorrhage, pseudoaneurysm, and arteriovenous fistula. A 66-year-old woman diagnosed with paroxysmal atrial fibrillation was treated with catheter ablation. This patient had a high femoral artery bifurcation, and we punctured the femoral vein by the conventional Merkmal method, which led to a femoral vein puncture through the deep femoral artery. The next day, echography revealed a pseudoaneurysm communicating with the deep femoral artery. We performed a thrombin injection without complication, and the pseudoaneurysm was occluded. However, echography three days after thrombin embolization showed a recurrence of the pseudoaneurysm and an arteriovenous fistula connecting to the common femoral vein. The first choice for the treatment of pseudoaneurysms and arteriovenous fistula is surgical treatment, but in addition to the lack of vascular surgery in our hospital, the patient did not want an invasive treatment and strongly preferred to be treated with a catheter. We performed endovascular treatment by VIABAHN® stent graft insertion. VIABAHN® stent graft was implanted at the deep femoral artery, and the patient was discharged without complications. VIABAHN® stent graft placement in the deep femoral artery sealed the entrance of the pseudoaneurysm and the arteriovenous fistula at once, which simultaneously treated both the pseudoaneurysm and AV fistula, and helped avoid the use of an invasive surgical procedure.

Allosteric regulation accompanied by oligomeric state changes of Trypanosoma brucei GMP reductase through cystathionine-ß-synthase domain.

Guanosine 5'-monophosphate reductase (GMPR) is involved in the purine salvage pathway and is conserved throughout evolution. Nonetheless, the GMPR of Trypanosoma brucei (TbGMPR) includes a unique structure known as the cystathionine-ß-synthase (CBS) domain, though the role of this domain is not fully understood. Here, we show that guanine and adenine nucleotides exert positive and negative effects, respectively, on TbGMPR activity by binding allosterically to the CBS domain. The present structural analyses revealed that TbGMPR forms an octamer that shows a transition between relaxed and twisted conformations in the absence and presence of guanine nucleotides, respectively, whereas the TbGMPR octamer dissociates into two tetramers when ATP is available instead of guanine nucleotides. These findings demonstrate that the CBS domain plays a key role in the allosteric regulation of TbGMPR by facilitating the transition of its oligomeric state depending on ligand nucleotide availability.

Development and Evaluation of a Parenting Resilience Elements Questionnaire (PREQ) Measuring Resiliency in Rearing Children with Developmental Disorders.

We developed a parenting resilience elements questionnaire (PREQ) measuring the degree to which mothers possess elements that aid in adapting to challenges and difficulties related to children with developmental disorders (DD). A total of 424 parents of children with DD were recruited from five medical institutes. Psychometric properties of PREQ were evaluated using data of 363 mothers of children with DD. Furthermore, multiple regression analysis was performed, predicting depressive symptoms and parenting behavior with PREQ subscales, a general health questionnaire, and the total difficulties score of a strength and difficulties questionnaire. Factor analysis revealed three reliable factors: "knowledge of the child's characteristics," "perceived social supports," and "positive perceptions of parenting." Moreover, multiple regression analysis showed that "knowledge of the child's characteristics" was associated with parenting behavior, whereas "perceived social supports" predicted depressive symptoms; "positive perceptions of parenting" influenced both parenting behavior and depressive symptoms. These findings indicated that the PREQ may be used as a scale measuring resiliency in mothers of children with DD and is useful for evaluating their parenting ability in clinical interventions.

[Parenting resilience for rearing a child with autism spectrum disorder: a qualitative study].

OBJECTIVE: Resilience is defined as the dynamic process of positive adaptation despite the experience of adversity. The aims of this study were to apply the concept of resilience to the mothers of children with autism spectrum disorder (ASD), which we call "parenting resilience" for rearing a child with ASD, and to explain the construct of parenting resilience. METHODS: Interviews were conducted with 23 mothers of adults with ASD to collect data on rearing these children from infancy to adulthood. Data were analyzed using a modified grounded-theory approach. RESULTS: The analytic theme was the thought process from the problems associated with raising developmentally challenged children to the implementation of the appropriate coping method. We proposed a model comprising twelve concepts and five categories, i. e., "a sense of motherhood", "self-efficacy", "knowledge of the child's characteristics", "perceived social support", and "foresight". The model assumes that a sense of motherhood and self-efficacy motivate these mothers to cope with the problems associated with developmentally challenged children, and they derive the way of dealing with it from knowledge of the child's characteristics, perceived social support, and foresight. DISCUSSION: We suggest that the construct of parenting resilience for rearing a child with ASD is composed of the proposed categories and concepts.

[Relationship between magnocellular function and reading skills in children: a study using visual evoked potentials].

OBJECTIVE: Developmental dyslexia (DD) is a neurodevelopmental disorder that is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. The magnocellular deficit theory is one of several hypotheses that have been proposed to explain the pathophysiology of DD. In this study, we investigated magnocellular system dysfunction in Japanese dyslexic children. METHODS: Subjects were 19 dyslexic children (DD group) and 19 aged-matched healthy children (TD group). They were aged between 7 and 16 years. Reversed patterns of black and white sinusoidal gratings generated at a low spatial frequency, high reversal frequency of 7.5 Hz, and low contrasts were used specifically to stimulate the magnocellular system. We recorded visual evoked potentials (VEP) from the occipital area and examined their relationship with reading and naming tasks, such as the time to read hiragana characters, rapid automatized naming of pictured objects, and phonological manipulation. RESULTS: Compared to the TD group, the DD group showed a significantly lower peak amplitude of VEPs through the complex demodulation method. Structural equation modeling showed that VEP peak amplitudes were related to the rapid automatized naming of pictured objects, and better rapid automatized naming resulted in higher reading skills. There was no correlation between VEP findings and the capacity for phonological manipulation. CONCLUSIONS: VEPs in response to the magnocellular system are useful for understanding the pathophysiology of DD. Single phonological deficit may not be sufficient to cause DD.

Developmental change of visuo-spatial working memory in children: quantitative evaluation through an Advanced Trail Making Test.

AIM: The present study aimed to investigate the developmental change in Visuo-Spatial Working Memory (VSWM) in typically developed children using a specially designed Advanced Trail Making Test for children (ATMT-C). METHODS: We developed a new method for evaluating VSWM efficiency in children using a modified version ATMT to suit their shorter sustained attention. The ATMT-C consists of two parts; a number-based ATMT and a hiragana (Japanese phonogram)-based ATMT, both employing symbols familiar to young children. A total of 94 healthy participants (6-28 years of age) were enrolled in this study. RESULTS: A non-linear developmental change of VSWM efficiency was observed in the results from the ATMT-C. In the number-based ATMT, children under 8 years of age showed a relatively rapid increase in VSWM efficiency while older children (9-12 years) had a more gradual increase in VSWM efficiency. Results from the hiragana-based ATMT-C showed a slightly delayed increase pattern in VSWM efficiency compared to the pattern from the number-based ATMT. There were no significant differences in VSWM efficiency for gender, handedness and test order. INTERPRETATION: VSWM in children gradually matures in a non steady-state manner and there is an important stage for VSWM maturation before reaching 12 years of age. VSWM efficiency may also vary depending on developmental condition of its cognitive subsystems.

Professional Caregiver's View on Mental Health in Parents of Children with Developmental Disabilities: A Nationwide Study of Institutions and Consultation Centers in Japan.

Parents of children with intellectual disabilities and/or physical disabilities are supposed to have an increased risk for parenting stress and psychological distress. We as professional caregivers sometimes experience difficulties in keeping good relations or communicating with the parents. Professional workers in 460 institutions and consultation centers throughout Japan answered a questionnaire on their clinical experiences. About 90% of the facilities experienced "distressed parents," and the parents' condition such as mental health seemed to influence this. Signs of a depressive state were the most common psychiatric disturbances detected, and it was notable in the pervasive developmental disorder group. More welfare support, presence of support groups, support from other family members, and medical treatment of the parents' problems were considered to be helpful and thus requested to be improved. Training more professionals who can properly deal with the parents' mental health needs is an urgent matter that must be tackled.

[Developmental changes of rapid automatized naming and Hiragana reading of Japanese in elementary-school children].

Two hundred and seven Japanese elementary school children aged from 6 (Grade 1) to 12 (Grade 6) years old were tested for their abilities to name numbers and pictured objects along with reading Hiragana characters and words. These children all showed typical development and their classroom teachers judged that they were not having any problems with reading or writing. The children were randomly divided into two groups, the first group was assigned to two naming tasks;the rapid automatized naming (RAN) of "numbers" and "pictured objects," the second group was assigned to two rapid alternative stimulus (RAS) naming tasks using numbers and pictured objects. All children were asked to perform two reading tasks that were written in Hiragana script: single mora reading task and four syllable word reading task. The total articulation time for naming and reading and performance in terms of accuracy were measured for each task. Developmental changes in these variables were evaluated. The articulation time was significantly longer for the first graders, and it gradually shortened as they moved through to the upper grades in all tasks. The articulation time reached a plateau in the 5th grade for the number naming, while gradual change continued after drastic change in the lower grades for the pictured object naming. The articulation times for the single mora reading and RAN of numbers correlated strongly. The articulation time for the RAS naming was significantly longer compared to that for the RAN, though there were very few errors. The RAS naming showed the highest correlation with the four syllable word reading. This study demonstrated that the performance in rapid automatized naming of numbers and pictures were closely related with performance on reading tasks. Thus Japanese children with reading disorders such as developmental dyslexia should also be evaluated for rapid automatized naming.

[Relationship between clinical symptoms and Hiragana reading ability in children with difficulties in reading and writing:usefulness of a clinical-symptoms-checklist].

We investigated the clinical symptoms of children with developmental dyslexia (DD) and evaluated the relationship between these symptoms and their Hiragana reading abilities. In order to detect the clinical symptoms of DD, we newly developed a clinical-symptoms-checklist (CL), which consisted of a total of 30 yes/no questions regarding symptoms linked to reading (15 questions) and writing (15 questions). Subjects were 98 Japanese school grade (1 to 9) children, aged 6 to 15 years old, with normal intelligence confirmed by the Wechsler Intelligence Test for Children (WISC-Ill) and they were divided into 2 groups according to their diagnosis. Twenty four children diagnosed as developmental dyslexia consisted the DD group, and the remaining 74 children were grouped in the non-DD group. CL showed significant construct validity (p<0.05) and inner consistency (reading: a =0.82, writing: a =0.72) after deleting two questions from the originals. The number of questions checked in the CL reading subcategory significantly correlated with the Hiragana reading ability of articulation time in all Hiragana reading tasks (p<0.001). More severe clinical symptoms and lower reading ability were observed in the DD group compared to the non-DD group. Receiver Operating Characteristics (ROC) analysis indicated that these two groups could be discriminated by the CL and the results of the reading task, and both sensitivity and specificity rate were approximately 80%. It was suggested that 7 or more positive checks in the CL and 2 or more abnormal scores in the reading tasks might discriminate DD from other conditions which cause difficulties in reading and writing in Japanese children.

Correlation between unconjugated bilirubin and total cholesterol in the sera of 1-month-old infants.

AIM: To investigate why breastfed infants are more likely to have prolonged jaundice than formula-fed infants. METHODS: Serum unconjugated bilirubin (UCB), total cholesterol (TC) and triglyceride (TG) were measured for 102 infants of 1 month. Enrolled infants were 42 breastfed, 40 mixed-fed and 20 bottle-fed infants. Statistic analyses for relationship among UCB, TC, TG, perinatal factors and post-natal factors were performed for these infants. RESULTS: In correlation analyses UCB was correlated with peak transcutaneous bilirubin value in neonatal period (TcBn) (r = 0.612, P < 0.0001) and with TC (r = 0.383, P < 0.0001). When analyses of covariance (ANCOVA) for UCB were performed using TcBn as the covariate, the results indicated that there was neither significant main nor interaction effect of feeding method on UCB, and that main and interaction effects of TC on UCB were significant when TC was categorised into two groups (≤150 mg/dL and >150 mg/dL). CONCLUSIONS: It is suggested that both neonatal hyperbilirubinemia and subsequent higher plasma TC are associated factors for prolonged jaundice.

[Developmental changes in reading ability of Japanese elementary school children--analysis of 4 kana reading tasks].

Five hundred and twenty-eight Japanese elementary school children aged from 6 (Grade 1) to 12 (Grade 6) were tested for their abilities to read Hiragana characters, words, and short sentences. They were typically developing children whom the classroom teachers judged to have no problems with reading and writing in Japanese. Each child was asked to read four tasks which were written in Hiragana script: single mora reading task, four syllable non-word reading task, four syllable word reading task, and short sentence reading task. The total articulation time for reading and performance in terms of accuracy were measured for each task. Developmental changes in these variables were evaluated. The articulation time was significantly longer for the first graders, and it gradually shortened as they moved through to the upper grades in all tasks. The articulation time reached a plateau in the 4th grade for the four syllable word and short sentence reading tasks, while it did so for the single mora and four syllable non-word reading tasks in the 5th grade. The articulation times for the four syllable word and short sentence reading tasks correlated strongly. There were very few clear errors for all tasks, and the number of such errors significantly changed between the school grades only for the single mora and four syllable word reading tasks. It was noted that more than half of the children read the beginning portion of the word or phrase twice or more, in order to read it accurately, and developmental changes were also seen in this pattern of reading. This study revealed that the combination of these reading tasks may function as a screening test for reading disorders such as developmental dyslexia in children below the age of ten or eleven years old.