A Randomized Controlled Trial for the Intervention Effect of Early Exercise Therapy on Axial Pain after Cervical Laminoplasty.

Introduction: Cervical isometric muscle strengthening and cervical range of motion (ROM) training are recommended after laminoplasty (LP). However, their preventive effects on axial pain are unclear. We examined whether neck extension muscle strengthening and cervical ROM training from the early postoperative period effectively suppress postoperative axial pain. Methods: Sixty-one patients undergoing a muscle-preserving LP attached to C2 and C7 for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament were randomly allocated to the cervical exercise (33 patients) or nonexercize (28 patients) groups. Postoperative cervical collars were not worn in any cases. The cervical exercise group underwent neck extension isometric muscle strengthening and cervical ROM exercises for 3 months starting on postoperative day 2. Changes in axial pain (visual analog scale [VAS]) from baseline at 2 weeks and 3 months after surgery were evaluated as the primary outcome. Cervical muscle strength, cervical ROM, and Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores were evaluated as secondary outcomes. Results: Axial pain was significantly exacerbated at 2 weeks after LP compared with before surgery, and then, a significant improvement was observed at 3 months after surgery. No significant interaction was observed between the intervention and nonintervention groups. There was no difference in secondary outcomes between groups. The change in the VAS of axial pain from before surgery to 3 months after surgery showed a greater decreased neck extension muscle strength resulting in severer axial pain. Conclusions: Cervical muscle strengthening and cervical ROM exercise from the early postoperative period did not relieve axial pain at 2 weeks and 3 months after a muscle-preserving LP attached to C2 and C7. No significant difference in neck extension muscle and cervical movement was observed between the intervention and nonintervention groups. Therefore, a muscle-preserving LP attached to C2 and C7 is a good strategy to prevent axial pain in the early postoperative period.Clinical Trials Registration Number: UMIN000040692.

Can Hip-Knee Line Angle Distinguish the Size of Pelvic Incidence?-Development of Quick Noninvasive Assessment Tool for Pelvic Incidence Classification.

This study aimed to explore effective measurement angles for pelvic incidence (PI) classification and to develop a quick, noninvasive assessment tool for PI classification. We defined five variation types of hip-knee line (HKL) angles and tested the discrimination ability of the receiver operating characteristic (ROC) analysis using 125 photographs of upright standing posture from the right lateral side. ROC analysis revealed an applicable HKL angle defined by the line connecting the most raised part of the buttock and the central point of the knee and the midthigh line. The acceptable cut-off points for discriminating small or large PIs in terms of HKL angle were 18.5° for small PI (sensitivity, 0.91; specificity, 0.79) and 21.5° for large PI discrimination (sensitivity, 0.74; specificity, 0.72). In addition, we devised a quick noninvasive assessment tool for PI classification using the cut-offs of the HKL angle with a view to practical application. The results of intra- and inter-rater reliability ensured a substantial/moderate level of the tool (Cohen's kappa coefficient, 0.79; Fleiss's kappa coefficient, 0.50-0.54). These results revealed that the HKL angle can distinguish the size of the PI with a high/moderate discrimination ability. Furthermore, the tool indicated acceptable inter-/intra-rater reliability for practical applications.

[Behavioral assessments in infancy/toddlerhood and autism spectrum disorder: Effectiveness of a semi-structured behavioral observation incorporated into a legal health examination].

Objectives　We investigated the relationship between the diagnosis of autism spectrum disorder (ASD) based on legal health examinations and semi-structured behavioral observations conducted by the Social Attention and Communication Surveillance-Japan (SACS-J), wherein public health nurses evaluated sociality, verbal communication development, and tool employment in infants and toddlers through interactive play.Methods　Public health nurses evaluated the behavioral features of 372 babies. These babies were born in 2011 or 2012 in a town, received a routine of legal health examinations at one and a half year (20 months) and at three years (38 months), and remained traceable until December 2016. The nurses used SACS-J items and the babies underwent routines of the examinations at 15, 20, 27, and 38 months. We statistically compared the relationships of the behavioral features at each of the above-mentioned months between two groups: Children with ASD and children with typical development.Results　Eight children were medically diagnosed with ASD, while five children received a diagnosis other than ASD. We compared gender, conditions at birth, physical development, and SACS-J behavioral observation items between the ASD group and the typical-development group. The ratio of the mean of the results from the ASD group was high (P<0.05), which indicates that the ASD group was significantly slower than the typical-development group in acquisition timing of "the sitting" and "the walk" (P<0.05). Significant differences in SACS-J items were "eye contact" at 15 months (P<0.05), at 20, 27, and 38 months (P<0.001) and "joint attention" at 15 months (P<.001). Further significant differences were "joint attention - adults do" at 20 months (P<0.05), "joint attention - children do" at 20 months (P<0.01), "pointing" at 20 months (P<0.05), "showing" at 27 months (P<0.001), "verbal development" at 15 months (P<0.01), "Use of language" at 20 months (P<0.01), "2-word sentence" at 27 months, and "3-word sentence" at 38 months (P<0.001). The ASD group scored significantly higher than the typical-development group in "fine motor skill" at 15 months (P<0.001) and at 27 months (P<0.01).Conclusion　Introducing an evaluation of standardized behavioral observations by public nurses in the early stages of development, prior to the legal health examination of babies at one and a half year, revealed the possibility of the early identification of children suspected of ASD at the public health activity level by a local government. Related health guidance and upbringing-and-development support are necessary in the community.

Early childhood behavioral features that discriminate autism from other developmental problems in Japan.

PROBLEM: The criteria for early detection of autism spectrum disorder (ASD) and its discrimination from other developmental problems (ODP) are not clear. The Social Attention and Communication Study, which identified methods for early identification of ASD in community settings, was modified to the Japanese situation, and we examined its discriminant validity. METHODS: This study followed a cohort of newborns in one town for 4 years. Structured behavioral assessments were added to the standardized health examination and performed five times during toddlerhood. Of the 264 children included in the statistical analysis, four were diagnosed with ASD, and four were diagnosed with ODP. FINDINGS: A canonical discrimination analysis indicated two significant functions. Canonical 1, which involved disturbances of "eye contact" at 27 months and "concept comprehension" at 38 months, characterized both ASD and ODP. Canonical 2, which involved disturbances of "response name call" at 15 months, "showing" at 27 months, and negative loading of vocabulary development at 20 months, discriminated between ASD and ODP. The canonical plot showed good separation, but a few cases were misclassified. CONCLUSIONS: Evaluations of early behavioral signs by public health nurses during general toddler examinations could be useful and convenient.

Magnetoencephalography study of the effect of attention modulation on somatosensory processing in patients with major depressive disorder.

AIMS: Although affective and/or attention modulation of somatosensory processing has been well studied, the biological bases of somatic symptoms in patients with major depressive disorder (MDD) have rarely been examined. To elucidate changes in somatosensory processing underlying somatic symptoms in patients with MDD, we conducted a magnetoencephalography study of patients with MDD and healthy controls. METHODS: After median nerve stimulation, somatosensory evoked fields (SEF) were recorded in 10 patients with MDD and 10 sex-, age-, and height-matched healthy volunteers under somatosensory attending, visually attending, and non-attending conditions. The latencies and magnitudes of N20m and P60m SEF were examined. RESULTS: In the MDD group, P60m latency was significantly prolonged, irrespective of attention modulation, whereas N20m latency and root mean squares N20m and P60m amplitudes remained unchanged. Prolonged P60m latency negatively correlated with the somatosensory threshold, which was relatively high in the MDD group. Prolonged P60m latency also negatively correlated with a state of anxiety during the examination, but not with depressive symptoms or psychotropic medication. CONCLUSIONS: These results suggested that patients with MDD experience dysfunction in somatosensory information processing, approximately 60 ms after stimuli, irrespective of attentional conditions.

Bipolar Mood Tendency and Frontal Activation Using a Multichannel Near Infrared Spectroscopy.

UNLABELLED: This study aims to examine the association of frontal functioning with subclinical bipolar spectrum by a newly developed convenient method. We investigated subclinical bipolar tendency and frontal lobe activation during word productions using multi-channel near infrared spectroscopy. PARTICIPANTS: 44 healthy university students (mean ages 20.5 years old, and 29 female) gave their written informed consent, and we strictly protected privacy and anonymity was carefully preserved. A 13-items self-report questionnaire (Mood Disorders Questionnaire; MDQ) and a 16-channel near-infrared spectroscopy were used to compare frontal activations between two samples divided by median (4 points) of the total MDQ scores and to analyze correlations between relative changes of cerebral blood volume and bipolarity levels. There was no case suspected as bipolar disorders by MDQ screening (mean 3.4, max 10). Significant differences in lower activations were noted in the right and left pre-frontal cortex (PFC) with higher bipolarity scores using the specific software to analyze the NIRS waveform (P<0.05). Total MDQ were correlated significantly with frontal activation negatively in many channels; therefore, we conducted multiple linear regression to select significant frontal activations using the MDQ as a dependent variable. Stepwise method revealed that activation in left lateral PFC was negatively associated to bipolar tendency, and this regression model was significant (R2=0.10, F=4.5, P=0.04). Differences in frontal functioning suggest that subclinical bipolar tendencies might be related to left lateral PFC activations. It should be confirmed whether the identical pattern can be identified for clinical subjects with bipolar disorders.

Differential relationships between personality and brain function in monetary and goal-oriented subjective motivation: multichannel near-infrared spectroscopy of healthy subjects.

AIM: To examine relationships between personality traits and cerebral cortex reactivity under different motivating conditions. METHODS: Relationships between personality traits assessed using the NEO Personality Inventory-Revised (NEO-PI-R) and cerebral cortex reactivity during a verbal fluency task monitored using multichannel near-infrared spectroscopy (NIRS) were examined under three different motivational conditions: control, monetary reward, and goal-oriented, in healthy young male volunteers. RESULTS: Significant correlations between cerebral cortex reactivity and personality traits were found in the frontopolar region: a positive correlation with agreeableness and a negative correlation with the neuroticism and conscientiousness scores of the NEO-PI-R under the three motivational conditions. Higher scores for agreeableness were more strongly associated with a greater increase in total hemoglobin concentration ([total-Hb]) under the goal-oriented and control conditions than under the monetary reward condition. In addition, higher scores for neuroticism were more strongly associated with a greater increase in deoxygenated hemoglobin concentration ([deoxy-Hb]) under the monetary reward condition than the goal-oriented condition, and higher scores for conscientiousness were more strongly associated with a greater increase in [deoxy-Hb] under control conditions than under the goal-oriented condition. CONCLUSION: Using multichannel NIRS, certain personality traits of the big-five model are related to frontopolar reactivity. These relationships vary depending on the motivational condition when brain functions are monitored: agreeableness, neuroticism, and conscientiousness are all related to frontopolar reactivity depending on the motivational condition.

Micropolygyria in an infant born to a patient with severe anorexia nervosa: a case report.

We report the case of an anorexia nervosa (AN) patient with extremely low body weight who became pregnant following ovulation induction and subsequently delivered an infant with micropolygyria. To the best of our knowledge, no previous report has described live birth for a patient with such low body weight. The patient underwent hMG-hCG therapy for ovulation induction. Despite becoming pregnant, weight loss continued with extreme anemia occurring during the pregnancy. However, blood transfusion therapy was used for successful treatment. Despite the therapeutic and protective measures instituted, the child was born with micropolygyria. Pregnancy in an AN patient with extremely low body weight needs therapeutic intervention during early pregnancy with aggressive precautionary measures, particularly against anemia. On the basis of our experience, we consider that ovulation induction therapy should not be administered without sufficient caution for an AN patient with low body weight.

Associations among parenting experiences during childhood and adolescence, hypothalamus-pituitary-adrenal axis hypoactivity, and hippocampal gray matter volume reduction in young adults.

Recent human studies have indicated that adverse parenting experiences during childhood and adolescence are associated with adulthood hypothalamus-pituitary-adrenal (HPA) axis hypoactivity. Chronic HPA axis hypoactivity inhibits hippocampal gray matter (GM) development, as shown by animal studies. However, associations among adverse parenting experiences during childhood and adolescence, HPA axis activity, and brain development, particularly hippocampal development, are insufficiently investigated in humans. In this voxel-based structural magnetic resonance imaging study, using a cross-sectional design, we examined the associations among the scores of parental bonding instrument (PBI; a self-report scale to rate the attitudes of parents during the first 16 years), cortisol response determined by the dexamethasone/corticotropin-releasing hormone test, and regional or total hippocampal GM volume in forty healthy young adults with the following features: aged between 18 and 35 years, no cortisol hypersecretion in response to the dexamethasone test, no history of traumatic events, or no past or current conditions of significant medical illness or neuropsychiatric disorders. As a result, parental overprotection scores significantly negatively correlated with cortisol response. Additionally, a significant positive association was found between cortisol response and total or regional hippocampal GM volume. No significant association was observed between PBI scores and total or regional hippocampal GM volume. In conclusion, statistical associations were found between parental overprotection during childhood and adolescence and adulthood HPA axis hypoactivity, and between HPA axis hypoactivity and hippocampal GM volume reduction in healthy young adults, but no significant relationship was observed between any PBI scores and adulthood hippocampal GM volume.

Relationship of parental bonding styles with gray matter volume of dorsolateral prefrontal cortex in young adults.

Previous epidemiologic studies using the parental bonding instrument (PBI), a self-report scale to rate attitudes of parents during the first 16 years, have suggested that a lower parental care score or higher parental overprotection score could lead to an increased risk of several psychiatric disorders, including schizophrenia and mood disorder. However, neuroimaging studies of an association between PBI scores and brain developmental abnormalities are still limited. In this region-of-interest analysis study using a cross-sectional design, we examined 50 normal young adults, in terms of relationships of parental bonding styles during the first 16 years measured by PBI with regional gray matter (GM) volume in the dorsolateral prefrontal cortex (DLPFC). Our study showed that paternal care score positively correlated with the GM volume in the left DLPFC, and paternal and maternal overprotection score negatively correlated with the GM volume in the left DLPFC. In conclusion, our results suggest that in normal young adults, lower paternal care and higher parental overprotection scores correlated with the GM volume reduction in the DLPFC.

Dieting tendency and eating behavior problems in eating disorder correlate with right frontotemporal and left orbitofrontal cortex: a near-infrared spectroscopy study.

Frontal lobe dysfunctions have been implicated as one of the pathophysiological bases in eating disorder (ED). Neural substrates of ED have been examined in neuroimaging studies employing symptom-related stimuli, such as food and body-image distortion, but with inconsistent results because of differences in study design, task, and stimulus used. In order to elucidate frontal lobe dysfunction correlates of clinical symptoms in ED, we examined the frontal lobe function during a cognitive task, not a symptom-related task, using near-infrared spectroscopy (NIRS), which is suitable for the functional neuroimaging study of ED because of its complete noninvasiveness and natural measurement setting. Regional hemodynamic changes were monitored during a verbal fluency task (letter version) using a 52-channel NIRS apparatus in 27 female ED patients and 27 matched healthy controls, and their correlations with clinical symptoms assessed using the Eating Attitude Scale (EAT-26) were examined. Regional hemodynamic changes were significantly smaller in the ED group than in the control group in the bilateral orbitofrontal and right frontotemporal regions, and negatively correlated with dieting tendency scores in EAT-26 in the right frontotemporal regions and with the eating restriction and binge eating scores in the left orbitofrontal regions. The clinical symptoms of ED are considered to consist of two components: dieting tendency that correlates with the right frontotemporal cortex and eating behavior problems that correlate with left the orbitofrontal cortex.

Follow-up study of female delinquent adolescents in a detention centre: effectiveness of psychiatric intervention as a mental health service.

RESULTS: of previous studies suggest that many female offenders have co-morbid psychiatric disorders, which require mental health services. However, few longitudinal studies examined subjects during incarceration or detention. This study compares depressive symptoms, abnormal eating behaviour and impulsivity before release from a detention centre and after incarceration, thereby indicating the effectiveness of psychiatric intervention in a Japanese detention centre. METHOD: Of 64 young women, 36 were followed up. Self-report measures were used to assess depression, eating behaviour and impulsivity after incarceration and one month before release. RESULT: s: Of the 36 participants, nine were diagnosed using the MINI-kids as needing mental health services. Those who received psychiatric intervention were diagnosed as having major depression and/or post-traumatic stress disorder. Significant main effects of intervention and effects of time were shown in the DSD. The EAT-26 score demonstrated the significance of the effects of time and interaction. In the BIS-11 scores, neither intervention nor time showed significant effects. CONCLUSIONS: Results of this study showed that the time course and psychiatric intervention contributed to recovery of depression and therapeutic intervention. The time course might reduce eating problems. Psychiatric intervention might be necessary for female juvenile detainees, which presents an important issue for future studies.

Preattentive dysfunction in major depression: a magnetoencephalography study using auditory mismatch negativity.

Information processing deficits in major depressive disorder have been infrequently examined electrophysiologically. Its preattentive and sensory information processing was examined using mismatch field (MMNm) and P1m components, respectively, by magnetoencephalography. Fourteen major depressive disorder patients and 19 healthy volunteers participated in the study. MMNm was elicited in response to duration and frequency changes of pure-tone stimuli and in response to a vowel across-category change. The magnetic global field power (mGFP) of MMNm was significantly smaller in the major depressive disorder patients than in the healthy volunteers, although that of P1m did not differ between the two groups. Information processing at the preattentive level is impaired functionally in major depressive disorder, and this dysfunction is not due to the dysfunction at the lower level of information processing.

Decreased cortical reactivity underlies subjective daytime light sleepiness in healthy subjects: a multichannel near-infrared spectroscopy study.

Daytime sleepiness is considered to be one of the main problems in modern society. Of the four aspects of sleepiness, namely, subjective sleepiness, performance decrease, sleep propensity, and arousal decrease, subjective sleepiness is the most difficult to assess. Brain mechanisms underlying subjective light sleepiness in daytime were investigated in healthy subjects using multichannel near-infrared spectroscopy (NIRS), which enables the noninvasive measurement of regional cerebral blood volume (rCBV) changes under natural conditions. Forty right-handed healthy volunteers participated in this study. Relationships were investigated between subjective sleepiness and anxiety, assessed using the Stanford Sleepiness Scale (SSS) and State-Trait Anxiety Inventory (STAI), respectively, and cerebral cortex reactivities assessed as oxygenated and deoxygenated hemoglobin concentration ([oxy-Hb] and [deoxy-Hb], respectively) changes during a verbal fluency task using a 24-channel NIRS machine. SSS score correlated negatively with an [oxy-Hb] increase in the bilateral frontal channels mainly in the middle and last third of the verbal fluency task period. Subjective light daytime sleepiness in healthy subjects is considered to be related to decreased prefrontal reactivities in the later part of cognitive activation.

Trauma exposure and posttraumatic stress disorder in delinquent female adolescents.

BACKGROUND: Although juveniles within the justice system have high psychiatric morbidity, few comprehensive investigations have shown posttraumatic stress disorder (PTSD) in female delinquents. Here, we aim to describe the nature and extent of PTSD and trauma exposure and to clarify the relationships among comorbidity and psychosocial factors in juvenile female offenders. METHOD: Sixty-four girls were randomly interviewed using structured tools. Self-report measures were used to assess depression, eating behaviour, impulsivity and parental attitude. RESULTS: The PTSD prevalence was 33%, and 77% of the female juvenile offenders had been exposed to trauma. The offenders with PTSD showed a significantly high psychiatric comorbidity. Depression and adverse parenting were associated with PTSD development, and abnormal eating was also correlated with PTSD symptoms. Marked differences in the frequency and intensity of PTSD evaluation depending on the type of comorbidity and trauma were observed. CONCLUSIONS: Incarcerated young females in Japan have serious trauma-related problems, and the degree of depression is a strong predictor of PTSD development and symptoms. This study highlights the importance of adequate diagnosis and treatment of PTSD in delinquent female adolescents.

Time courses of brain activation and their implications for function: a multichannel near-infrared spectroscopy study during finger tapping.

The time courses of brain activation were monitored during a finger tapping task using multichannel near-infrared spectroscopy with a time resolution of 0.1s in 30 healthy volunteers. Task-induced brain activations were demonstrated as significant increases in oxygenated hemoglobin concentration ([oxy-Hb]) in a broad area around the motor cortex and significant decreases in deoxygenated hemoglobin concentration ([deoxy-Hb]) in a more restricted area, with a large degree of activation in the contralateral hemisphere. The time courses of the [oxy-Hb] changes varied depending on channel location: sustained activation across the task period in the motor cortex, transient activation during the initial segments of the task period in the somatosensory cortex, and accumulating activation along the task period in the frontal lobe. These characteristics are assumed to reflect the functional roles of the brain structures during the task period, that is, the execution, sensory monitoring, and maintenance of finger tapping.

[Application and potential of day hospital treatment for patients with eating disorders--a questionnaire survey on the day hospital program in Japan].

Eating disorders (ED) is an important cause of physical and psychological morbidity in 21st century mental health. Recent advances of day treatment for eating disorders in North America, Germany, and Australia advocate us to investigate the utility and possibility of the Day Hospital Program (DHP) in Japan. We reviewed previous reports and summarized the advantages and disadvantages of this approach. Also, we conducted a preliminary survey to clarify the detailed application of the DHP by sending a questionnaire to University hospitals, registered institutes of the Japanese Association of Psychosomatic Medicine, and prefectural mental health and welfare centers. The results revealed the strong need for the DHP for ED (about 75%), strong expectations to link hospitalization and outpatient treatment, and the strong possibility of a multimodal approach. The survey showed the importance of CBT, psychoeducation, and other modalities including nutritional education, exercise, or the family approach. Various types of structures were proposed concerning the duration of a session or treatment (half day and 2 or 3 times a week) and numbers of members (about 6 to 10). Over 75% of the participants answered regardless of the inclusion of diagnostic criteria, which exceeded our expectations. Economic background is one of the problems left pending. Based on the data, we discussed the potential and problems of the DHP in Japan.

Frontal lobe function in bipolar disorder: a multichannel near-infrared spectroscopy study.

Frontal lobe dysfunction has been implicated as one of the pathophysiological bases of bipolar disorder. Detailed time courses of brain activation in the bipolar disorder group were investigated using multichannel near-infrared spectroscopy (NIRS), a recently developed functional neuroimaging technology with a high time resolution, and were compared with those in the major depression and healthy control groups. Seventeen patients with bipolar disorder, 11 equally depressed patients with major depression, and 17 healthy controls participated in the study. Changes in oxy hemoglobin concentration ([oxy-Hb]) during cognitive and motor tasks were monitored using frontal and temporal probes of two sets of 24-channel NIRS machines. [oxy-Hb] increases in the bipolar disorder group were smaller than those in the healthy control group during the early period of a verbal fluency task, larger than those in the major depression and healthy control groups during the late period of this task, and were smaller than those in the major depression group during a finger-tapping task. Depressive symptoms and antidepressant dosages did not correlate with [oxy-Hb] changes in the two patient groups. Bipolar disorder and major depression were characterized by preserved but delayed and reduced frontal lobe activations, respectively, in the present high-time-resolution study by multichannel NIRS.