Introduction: The Group Psychoeducation Program focuses on improving the attitudes towards medication of parents and their children/adolescents (G-PAM) with attention deficit hyperactivity disorder (ADHD). Aim:We evaluated the program’s effectiveness at improving children’s attitudes and identified what aspects required improvement. Method: This non-randomized, pragmatic evaluation had a comparative before-after design. The G-PAM comprised five 90-minute sessions. We assessed knowledge of psychopharmacology and employed several instruments including the Southampton ADHD Medication Behavior and Attitude Scale (SAMBA), Child Adherence Questionnaire (CAQ), and a Client Satisfaction Questionnaire, among others. Results: The intervention group consisted of 15 families (17 children) who participated in the program in 3 groups. The control group consisted of 24 families (24 children). Children in the intervention group showed improved treatment knowledge, a decreased SAMBA score for ‘resistance to medication’, and an increased CAQ score for ‘attitude toward medication’. Parents showed an increased SAMBA score for ‘perceived psychosocial benefits of medication’. Both children and parents reported high satisfaction levels. Discussion: The current psychoeducation program provides a new approach to improve the attitudes and behaviors towards medication of children/adolescents with ADHD and their parents in clinical settings.
Serum alkaline phosphatase (ALP) could be an indicator of osteoblastic activity, which initiates hematopoietic stem cell (CD34positive cell) production in bone marrow. Since chronic inflammation, which is a known risk factor for hypertension and endothelium dysfunction, stimulates bone marrow activity, ALP could be positively associated with hypertension. To clarify those associations, we conducted a cross-sectional study of 479 elderly Japanese men aged 60-69. Circulating CD34-positive cell levels could influence associations between serum ALP and hypertension because CD34-positive cell production is also a factor known to contribute to endothelial repair. Therefore, participants were stratified by the median value of circulating CD34-positive cell levels (1.00 cells/μL). A low level of circulating CD34-positive cells was identified in 240 members of the study population. A significantly positive association of ALP with hypertension was detected among participants with low circulating CD34-positive cell levels (multivariable-OR (odds ratio) for hypertension resulting from a 1 standard deviation (SD) increment in serum ALP (58.3 IU/L) = 1.44 (1.06, 1.95)) but not among those with high CD34-positive cell levels (multivariable-OR=0.91 (0.67, 1.23)). We also observed a significant effect of the interaction of circulating CD34-positive cell levels on the association between serum ALP and hypertension (multivariable p=0.011). Serum ALP was found to be positively associated with hypertension among elderly participants with low but not with high circulating CD34-positive cell levels. Since CD34-positive cells are a factor known to contribute to endothelial repair, capability for endothelial repair can be expected to have an effect on the association between serum ALP and hypertension.
Background: Bentall procedure is standard procedure for aortic root aneurysm or dissection in patients with Marfan syndrome. The purpose of this study was to evaluate whether valve-sparing root replacement (VSR) can be an alternative to Bentall procedure in patients with Marfan syndrome. Methods: Thirteen patients with Marfan syndrome underwent aortic root replacement between 1999 and 2017. Bentall procedure with a mechanical valve was performed in 9 patients and VSR was performed in 4. The mean durations of follow-up were 103.1 ± 61.6 months in Bentall and 35.0 ± 26.4 months in VSR. Results: There was no in-hospital death in both procedures. Reoperation for bleeding was performed in one patient after Bentall procedure. One patient died because of unknown cause in the Bentall group. No death occurred in the VSR group during a follow-up period. There was no difference in mortality between two groups. In the Bentall group, subarachnoid hemorrhage was developed in one patient and cerebral hemorrhage in one, while there was no hemorrhage or thromboembolism in the VSR group. Echocardiography showed improvement of aortic valve regurgitation grade (pre-operation 2.9 ± 1.4 vs postoperation 0.5 ± 0.4, P = 0.03) in all patients of the VSR group, and there was no reoperation for aortic valve after VSR. Conclusion: The significant inferiority of both early and late result in VSR could not be observed. VSR avoids the risk of complications associated with anticoagulation, which can be a preferable alternative to Bentall procedure in patients with Marfan syndrome.
Purpose: To identify predictive factors for postoperative uncorrected visual acuity (UCVA) following diffractive multifocal intraocular lens implantation. Subject and Method: Forty five eyes of 28 patients who underwent cataract surgery with diffractive multifocal intraocular lens TECNIS® ZMB00 (AMO) implantation from January 2015 to March 2018 were included. We formed two groups randomly with 18 eyes of 11 patients defined as the training set for preoperative factors and 27 eyes of 17 patients defined as the validation set for postoperative effects. All eyes had undergone superior corneal incisions of 2.4 mm. The predictive factors included age, mean corneal refractive power, corneal astigmatism, spherical equivalent, coma and spherical aberration of cornea, depth of angle recess, mesopic and photopic pupil diameters, PDist and MDist (distances from the alignment light to the photopic and the mesopic pupil centers, respectively). The good-UCVA group was defined as patients who had logMAR ≦ 0 one month after the surgery. Independent-related factors were identified by stepwise logistic regression analyses. Results: Only PDist was adopted (P = 0.0108) in the training set. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.91. In the validation set, it had a sensitivity of 66%, a specificity of 100% and a cut-off value of 0.23. Conclusions: It is supposed that distances from the alignment light to the PDist influence the postoperative UCVA following multifocal diffractive intraocular lens implantation.