Gamma Knife Radiosurgery With Mask Fixation Under General Anesthesia for Pediatric Patients.

Gamma knife radiosurgery (GKS) is performed on children by frame fixation of the skull under general anesthesia. With the introduction of the Gamma Knife Icon, treatment by fixing with a thermoplastic mask has become possible. In this study, we performed GKS by mask fixation under general anesthesia, measured the accuracy, and examined whether an accuracy equivalent to that of frame fixation could be guaranteed. We included three children who underwent mask fixation under general anesthesia between September and November 2020. After the induction of general anesthesia, a patient marker was attached to the nose, and the movement of the marker before mask fixation was measured using a real-time high-definition motion management (HDMM) system. The movement of the patient marker from the start to the end of treatment after mask fixation was monitored and measured. After the induction of general anesthesia, the movement of the patient marker was ≤0.3 mm in two cases and ≥1.0 mm in one case without mask fixation. When the mask was fixed, it was ≤0.2 mm in all three cases. It was confirmed that the marker could move even under general anesthesia without mask fixation, and it could be suppressed to a minimum after mask fixation. With the mask fixation method devised in this study, GKS under general anesthesia for children seems to be a safe and highly accurate method.

Effects of Donepezil on Extrapyramidal Symptoms in Patients with Dementia with Lewy Bodies: A Secondary Pooled Analysis of Two Randomized-Controlled and Two Open-Label Long-Term Extension Studies.

BACKGROUND/AIMS: The aim of this study was to clarify the effects of donepezil on extrapyramidal symptoms in patients with dementia with Lewy bodies (DLB). METHODS: Using pooled datasets from phase 2 and 3, 12-week randomized, placebo-controlled trials (RCT, n = 281) and 52-week open-label long-term extension trials (OLE, n = 241) of donepezil in DLB, the effects of donepezil on the incidence of extrapyramidal adverse events (AEs) and on the Unified Parkinson's Disease Rating Scale (UPDRS) part III were assessed, and potential baseline factors affecting the AEs were explored. RESULTS: The RCT analysis did not show significant differences between the placebo and active (3, 5, and 10 mg donepezil) groups in extrapyramidal AE incidence (3.8 and 6.5%, p = 0.569) and change in the UPDRS (mean ± SD: -0.2 ± 4.3 and -0.6 ± 6.5, p = 0.562). In the OLE analysis (5 and 10 mg donepezil), the incidence did not increase chronologically; all AEs leading to a dose reduction or discontinuation except one were relieved. The UPDRS was unchanged for 52 weeks. An exploratory multivariate logistic regression analysis of the RCTs revealed that donepezil treatment was not a significant factor affecting the AEs. Baseline severity of parkinsonism was a predisposing factor for worsening of parkinsonism without significant interactions between donepezil and baseline severity. CONCLUSION: DLB can safely be treated with donepezil without relevant worsening of extrapyramidal symptoms, but treatment requires careful attention to symptom progression when administered to patients with relatively severe parkinsonism.

The effectiveness of trivalent inactivated influenza vaccine in children over six consecutive influenza seasons.

OBJECTIVE: To estimate the effectiveness of two doses of trivalent inactivated influenza vaccine (TIV) over six consecutive influenza seasons in a small community in Japan. PATIENTS AND METHODS: A prospective, non-randomized, observational study of TIV effectiveness was performed involving children aged 6 months to 6 years accessing pediatric services in Soma and Shinchi, Japan. The total number of children under observation was 14,788. Each fall from 2002 to 2007 TIV was offered to all children with an average uptake of 52.9%. Influenza rapid diagnostic tests were performed to all children with respiratory symptoms and a temperature >38°C during each surveillance period. The efficacy of two doses of TIV was estimated by the relative risk of influenza illness and influenza associated hospitalizations and effectiveness by reduction in all respiratory illness in vaccinated and unvaccinated children. RESULTS: Influenza A occurred each year resulting in approximately one in five children in the unvaccinated group having an influenza A related clinic visit. For influenza A, two doses of TIV showed yearly efficacies that ranged from 42% to 69% with the highest efficacy during the 2002/2003 influenza season when the vaccine strains were well matched with the circulating viruses. The overall efficacy of two doses of TIV against influenza A and B associated illness was 52% and 59%, respectively. TIV also reduced the rate of the influenza associated hospitalizations attributable to both influenza A and B. CONCLUSIONS: Vaccination with two doses of TIV was consistently effective in preventing influenza-associated clinic visits and hospitalizations.

A new genotype of Arthroderma benhamiae.

Nucleotide sequence analysis of chitin synthase 1 (CHS1) indicated 90% sequence similarities among human and animal isolates of Arthroderma benhamiae. In particular, greater than 99% similarity was noted in the nucleotide sequence among Americano-European race isolates, African race isolates, and five isolates from four-toed hedgehogs (Atelerix albiventris). The phylogenetic analysis indicated that the five isolates from hedgehogs were included in the same cluster and distinct from the Americano-European and the African race standard strains of A. benhamiae. These results were confirmed by ITS analysis. Therefore, it was proposed that genotypes could be established for the isolates of A. benhamiae in association with the mating behavior.

A unique isolate of Malassezia from a cat.

An isolate of Malassezia from a cat with otitis externa was examined mycologically as well as molecularly. The isolate was similar to M. sympodialis in morphological and biochemical characteristics. In molecular analysis, however, it differed from the 7 species of Malassezia previously reported. Therefore, this clinical isolate from a cat might be a new species of Malassezia.